Hernia: Everything You Need to Know
Hernias can affect any one of us at any point in our lives. Regardless, not many people know exactly what a hernia is, how they develop or the common symptoms associated with hernias.
Whether you’re suffering from a hernia at the moment, know somebody who is or you just want to educate yourself in case you need to know in the future, in this article we’ll be running through everything you need to know about hernias.
What Actually is a Hernia?
As Healthline puts it,
‘A hernia occurs when an organ pushes through an opening in the muscle or tissue that holds it in place. For example, the intestines may break through a weakened area in the abdominal wall.’
Hernias typically occur in the abdomen but can form in other parts of the body, too. The upper thigh, belly button and groin areas are all areas at risk of being afflicted by hernias.
Hernias generally aren’t life-threatening, although they don’t go away on their own. A hernia will often require surgery, especially if it’s causing dangerous complications for the patient’s health.
Common Types of Hernia
Hernias can come in many different shapes and sizes and affect varying areas of the body. Common types of hernia include:
The most common form of hernia, inguinal hernias comprise around 70% of all diagnosed hernias, as says the British Hernia Centre (BHC). An inguinal hernia can be identified when fatty tissues or parts of the bowel push through into the groin at the top of the thigh – usually through the inguinal canal.
The inguinal canal is an area found in the groin. In men, the inguinal canal resides where the spermatic cord (which upholds the testicles) passes from the abdomen into the scrotum. In women, the inguinal canal contains a band of connective tissues that hold the uterus in place.
Inguinal hernias are generally more common in men than in women. That’s because the testicles usually drop into the inguinal canal after birth before it closes, but sometimes the canal can fail to close fully and leave a weakened muscular area wherein hernias can form.
Unlike an inguinal hernia, hiatal hernias occur when a segment of the stomach pushes through the diaphragm and upwards into the chest cavity. The diaphragm is a muscular fibre that assists breathing by contracting, allowing air to be drawn into the lungs.
Typically, patients that are 50 years and older are more susceptible to Hiatal hernias. Sometimes hiatal hernias can affect children, although this is usually a result of a hereditary birth defect.
Almost always, gastroesophageal reflux is a symptom of a hiatal hernia, which is where stomach acid frequently flows through the tube connecting the mouth to the stomach, causing pain and irritation.
Most common in children and infants younger than 6 months old, an umbilical hernia occurs when the intestines push through the abdominal wall close to the belly button.
This type of hernia can arise if the opening in the stomach that allows the umbilical cord to pass through does not seal properly after birth. In an infant, an umbilical hernia may be evident when the baby cries and the belly button appears to protrude.
Umbilical hernias are generally quite common and usually harmless, typically closing on their own within the first two years of life. Sometimes, though, umbilical hernias can show up during adulthood. These are more likely to require surgical repair.
Incisional hernias typically arise after a patient undergoes a surgical procedure, leaving a weak spot through which the contents of the abdomen can push through.
Even after a surgeon closes up incisions with stitching, sometimes these can come undone, allowing an incisional hernia to form.
Also referred to as myofascial defects, muscular hernias are usually found in the lower extremities of the body. Muscle hernias can arise as a result of a localised defect in muscular tissue, allowing muscles to protrude through open cavities and into neighbouring parts of the body.
Muscle hernias can sometimes be found in regions of the upper body, too, and can arise as singular hernias or double hernias.
Although muscular hernias don’t usually give rise to many symptoms, they can cause cramping sensations and/or pain during or after physical activity.
A muscular hernia may present itself as a visible mass and may even be mistaken for neoplasia – the abnormal growth of tissue which is often indicative of a tumour. The mass may not be visible when the patient is relaxed but only during activity.
Other Types of Hernia
There are, as you now know, many different types of hernia. Below are some more to familiarise yourself with:
- Epigastric hernias: Where fatty tissue pushes through the stomach, between the belly button and lower breastbone.
- Spigelian hernias: Where a segment of the large intestine pokes through the stomach to the side of the abdominal muscles, just below the belly button.
- Diaphragmatic hernias: Where organs in the stomach move up into the chest through an opening in the diaphragm. Diaphragmatic hernias can also affect babies if their diaphragm develops improperly before birth.
Symptoms of a Hernia
When a hernia develops, most people can feel a palpable bulge at a localised spot on their body. That bulge may also be accompanied by a sharp pain, burning sensation or feelings of fullness as a result of inflammation in the affected area.
If a hernia occurs as a result of lifting a heavy weight, sharp, tearing pains may be felt, although many patients experience nothing other than a feeling of fullness in the area that’s being affected.
Other common symptoms of hernias include:
- Pain or discomfort in the affected area (typically the lower abdomen) that’s made worse when bending, coughing or lifting
- Weakness, pressure or feelings of heaviness in the abdomen
- A burning or aching sensation at the site of the bulge
- Acid reflux (usually exclusive to hiatal hernias)
- Chest pain
- Difficulty swallowing
Sometimes, hernias cause no symptoms at all. In these cases, you may not know that it’s present unless it shows up during a routine exam.
The Complications of Having a Hernia
Sometimes hernias can be left untreated for some time without causing any complications. Hernias do have a tendency to grow, however, and can become more painful and disruptive as time goes on.
Inguinal hernias can force portions of intestines to become trapped within weak points in the abdominal wall, obstructing the bowels and causing severe pain and symptoms such as constipation or nausea. Such conditions are termed medically as ‘incarcerated’ hernias.
Untreated hernias can also cause pressure to build up, affecting the health of nearby tissues and causing inflammation. In men, larger hernias can descend into the scrotum and give rise to intense pain and/or swelling.
In more severe circumstances, hernias can become strangulated. This is where blood flow is prevented from reaching the trapped area of the intestines, causing it to become infected or die off. Strangulated hernias can be life-threatening and require immediate medical attention.
What Causes a Hernia to Form?
Generally, hernias are caused by a combination of both muscle weakness and strain. Other common causes include:
- Chronic or severe episodes of coughing
- Failure of the abdominal wall to fully close in the womb (a typical cause of umbilical hernias)
Any activity that puts strain on the body can cause a hernia, too, especially if the patient’s muscles are already weak. Such activities include:
- Pregnancy, which places added pressure on the abdomen
- Constipation, which encourages straining when using the toilet
- Lifting heavy weights
- Excess fluid in the abdomen known as ascites
- Sudden or rapid gains in weight
- Recent surgery in the affected area
- Persistent coughing and/or sneezing
Am I at risk of Developing a Hernia?
Some hernia types, such as umbilical and hiatal hernias, can develop for no particular reason and affect anybody. There are, however, certain factors that increase your risk of developing other hernia types, such as inguinal hernias. These include:
- A family history of hernias
- A chronic cough
- Ongoing constipation
Assessing/Diagnosing a Hernia
Inguinal and incisional hernias are usually diagnosed by way of a physical examination. Doctors search for bulges located in or around the abdomen that increase in size when the patient coughs, stands or strains their muscles. A physical examination is usually confirmed by an ultrasound, or a CT scan.
Some types of hernia are trickier to diagnose, however. Hiatal hernias, for instance, usually require a barium X-ray and/or endoscopy to be accurately identified.
A barium X-ray is a radiographic examination of the gastrointestinal (GI) tract and is used to diagnose abnormalities of the intestines. Endoscopic procedures, on the other hand, involve threading a small camera attached to a tube down into the throat via the oesophagus, allowing doctors to take a closer look inside the patient’s body in search of a suspected hernia.
If a hernia cannot be discovered via physical examination alone, doctors will proceed to take use the above methods in order to accurately diagnose, and then treat, a hernia.
Treatment Options for Hernias
Hernias can sometimes be left untreated if the patient is experiencing minimal or no discomfort. Whether or not treatment is necessary will depend upon the size of a hernia, its location and the severity of its symptoms.
If a hernia requires treatment, there are generally three options available. These include lifestyle changes, medication and/or surgery.
For some hernias such as hiatal hernias, dietary changes can be used to help manage the symptoms of a hernia, although they won’t make it go away completely. Avoiding excessively large meals, refraining from lying down or bending after eating and maintaining a healthy body weight will lessen the symptoms of hiatal hernias.
As well as these practices, some exercises can work to strengthen the muscles around the site of a hernia and further reduce symptoms. Take caution, though, as exercises conducted improperly can cause pressure around the affected area and make things worse. Before using exercise to manage the symptoms of your hernia, consult your doctor first.
Lastly, avoiding foods that cause acid reflux like spicy, tomato-rich ingredients as well as losing any extra weight will help to keep the symptoms of a hernia at bay.
If the above changes don’t work to lessen the symptoms of a hernia, patients may require surgery to correct it.
In the case of hiatal hernias, medications such as antacids, H-2 receptor blockers and proton pump inhibitors can help to relieve discomfort by managing acid reflux.
Sometimes hernias can grow larger, causing excessive pain and discomfort. In cases like these, doctors may decide to operate on their patients in an attempt to heal the hernia by sewing closed the hole through which tissue is protruding. This is usually achieved by patching up any cavities with surgical mesh.
Generally, hernias are repaired either via open surgery or by a procedure known as laparoscopic (or keyhole) surgery, whereby a surgeon will use a small camera and minimally-invasive surgery to stitch back together any open internal wounds.
Although laparoscopic procedures involve small incisions and a relatively short recovery time, patients that undergo open surgery can take as long as six weeks to recover and regain full mobility.
Deciding When to Operate
Unfortunately, not all hernias can be treated via laparoscopic surgery. If the extent of the hernia is too large, like in cases where the intestines have descended into parts of the scrotum, open surgery must be used.
Determining whether or not a hernia should treated surgically depends upon a number of factors. These include:
- The type of hernia: Some hernias are more likely to become strangulated and/or affect bowel functions. Such hernias almost always require surgery in order to avoid further complications.
- The contents of the hernia: If a hernia contains sections of the bowel, muscles or other important tissue, surgery may be required to prevent strangulation or obstruction.
- The symptoms and impact of the hernia: The symptoms caused by hernias can vary from person-to-person, ranging from almost non-existent to highly discomforting and painful. If a hernia begins to impact a patient’s ability to function on a day-to-day basis, surgery may be required.
- Overall health: If a patient’s health is generally poor, surgery may be too high-risk to perform safely.
How to Prevent Yourself From Getting a Hernia
While the occurrence of a hernia can’t always be avoided, there are certain measures that can be taken to lessen your chances of ever developing one. Most of these involve reducing the amount of strain placed upon the body, either to prevent a hernia in the first place or to reduce the chances that an existing hernia will worsen.
Ways to prevent a hernia from developing/worsening include:
- Quitting smoking: Nicotine in cigarettes can prevent blood vessels from forming and healing the weakened tissues that facilitate the formation of hernias.
- Receiving treatment from your GP for persistent coughs: Coughing, as discussed earlier, can put a strain on the muscles in the abdomen and encourage hernia formation/growth. If a persistent cough develops, seek treatment from your doctor.
- Maintaining a healthy BMI: Overweightness increases the amount of strain placed upon muscles in the body, increasing the likelihood that a hernia will develop.
- Refraining from straining during bowel movements: By increasing dietary fibre and reducing straining during bowel movements, your abdominal muscles aren’t placed under any excess stress and hernia formation is discouraged.
- Lifting objects with your knees rather than your back: Your leg muscles are far stronger than those in your back and abdomen. Lifting heavy objects via a squatting motion rather than bending horizontally will reduce the chances of you sustaining an injury and a subsequent hernia.
- Avoiding lifting weights that are too heavy for your muscle strength.
When to Seek Medical Advice
If you suspect you may have a hernia, it’s always wise to seek advice from a medical professional. They may refer you to a surgeon or advise particular lifestyle changes if the presence of a hernia is confirmed.
If you have a hernia already, the following symptoms may suggest that your condition has worsened and that you should visit A&E immediately:
- Sudden, severe pain
- Difficulty defecating and/or passing wind
- Firmness or tenderness at the site of your hernia
- You are unable to push your hernia back in
A hernia will not go away by itself. Seeking medical attention is crucial to your health, enabling you to minimise the effects of your hernia and seek treatment if necessary.