Hernia: Types, Causes, Diagnosis, Prevention And Treatment
A Hernia 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 a hernia.
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 hernia.
What Is A Hernia?
As Oxford puts it,
‘a condition in which part of an organ is displaced and protrudes through the wall of the cavity containing it (often involving the intestine at a weak point in the abdominal wall).’
A Hernia typically occurs 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.
A Hernia is not generally life-threatening, although it won’t go away on it’s own. Some supplements have been known to help manage a hernia effectively. However, in extreme cases, a hernia will 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:
1. Inguinal Hernia :
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.
An Inguinal hernia may or may not drop into the scrotal sac.
Inguinal Hernias are usually accompanied by symptoms such as:
- Pain in the hernia region
- Discomfort with stress in the hernia region
- Burning or pinching pain
- Irregular Bowel Movements
2. Hiatal Hernia :
Unlike an inguinal hernia, a hiatal hernia occurs when a segment of the stomach swells up and pushes through the diaphragm, upwards into the chest cavity. The diaphragm is a muscular fibre that assists breathing by contracting, allowing air to be drawn into the lungs. This is why most Hiatal hernia patients experience pain and discomfort in the chest area - especially after a heavy meal.
Gastroesophageal reflux or acid reflux is a major symptom of a hiatal hernia, which is where stomach acid frequently flows through the tube connecting the mouth to the stomach, causing irritation. Sometimes food and stomach acid also re-enters the mouth.
Hiatal Hernias are also often accompanied by symptoms such as:
- Loss of appetite
- Aggressive weight loss
- Irregular Bowel Movements
- Occasional Difficulty Swallowing
3. Umbilical Hernia :
An umbilical hernia occurs when the intestines push through the abdominal wall close to the belly button.
In an infant, this type of hernia may arise if the opening in the stomach that allows the umbilical cord to pass through does not seal properly after birth. An umbilical hernia may be evident when the baby cries and the belly button appears to protrude.
In adulthood, umbilical hernias are quite common and usually harmless. They may cause pain & discomfort around the navel area and are generally accompanied with a feeling of heaviness.
4. Incisional Hernia :
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.
5. Muscle Hernia :
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 hernia: Where fatty tissue pushes through the stomach, between the belly button and lower breastbone.
- Spigelian hernia: Where a segment of the large intestine pokes through the stomach to the side of the abdominal muscles, just below the belly button.
- Diaphragmatic hernia: 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.
Note: A Hernia is not to be confused with a Herniated Disc, which usually occurs in the back. This occurs when a fragment of the disc nucleus is pushed out of the annulus, into the spinal canal through a tear or rupture.
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, a hernia may cause no symptoms at all. In these cases, you may not know that it’s present unless it shows up during a routine examination.
The Complications of Having a Hernia :
Sometimes hernias can be left untreated for some time without causing any complications. A Hernia does have a tendency to grow, and can become more painful and disruptive if not cared for.
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 and need to be followed up with an emergency procedure. Such cases are rare if the hernia is properly managed.
Untreated hernias can also cause pressure to build up eventually, 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. Less than 1% of all hernia cases end up in strangulation. Unethical practices are also common here. Often Medical practitioners unnecessarily scare gullible patients and get them operated for a hernia.
What Causes a Hernia To Form?
Generally, hernias are caused by a combination of internal inflammation, muscle weakness and strain. Other common causes include:
- Chronic or severe episodes of coughing
- Sedentary Lifestyle habits
Forms of hernia such as inguinal, umbilical & incisional are caused due to internal inflammation of the intestines. Eventually the pressure from within forces the abdominal wall to tear and the intestines to protrude.
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
Hiatal & epigastric hernias are a bit different. They are caused due to inflammation of the stomach lining and underlying pathogenic infections. Over 60% of all hiatal hernias are caused after gastritis. Today, most of these cases have successfully been linked to pathogenic bacteria such as Helicobacter Pylori in the gut. Antibiotic resistance of pathogenic bacteria is making such cases of Hiatal hernia harder to cure.
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
- Chronic constipation
- Recurring diarrhea
- Sensitive stomach
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/ sonography, or a CT scan.
Some types of hernia are trickier to diagnose, however. Hiatal hernias, for instance, usually require a barium X-ray or an 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.
Treatment Options For Hernias :
Hernias can sometimes be left untreated if the patient is experiencing minimal or no discomfort. This is termed as ‘Watchful Waiting’.
For a hernia treatment, there are generally few options available. These include lifestyle changes, medication, supplements or surgery.
1. Surgery :
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 repair 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 to eight weeks to recover and regain full mobility.
Unfortunately, hernia surgeries also come with a dark side.
- 31% people reported pain after a hernia surgery - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1602172/ . In such cases, usually another surgery is done to fix damages or pain killers are prescribed which aren’t really a solution.
- Here's an article on the US FDA site mentioning the following about hernia surgeries: "The most common adverse events following hernia repair with mesh are pain, infection, hernia recurrence, adhesion, and bowel obstruction. Some other potential adverse events that can occur following hernia repair with mesh are mesh migration and mesh shrinkage (contraction)." - https://www.fda.gov/medical-devices/implants-and-prosthetics/hernia-surgical-mesh-implants
- Here are some more documented cases who have reported issues after surgery - https://www.noinsurancesurgery.com/hernia/patients-with-mesh-pain.htm
- This study - https://www.sciencedirect.com/science/article/pii/S1743919113000873 states that "The incidence of recurrent hernia after primary repair of a groin hernia varies from 1% in specialized centers to 30% in general surveys".
- The results from this study conducted in 2006 observed men diagnosed with an inguinal hernia, found that only 3 in 1,000 men had issues with strangulation. Moreover, the rate of post surgical complications following hernia operation was also the same.
2. Lifestyle Changes :
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. Avoiding excessively large meals, refraining from lying down or bending after eating and maintaining a healthy body weight should help lessen the symptoms of hiatal hernias.
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 a healthcare professional first.
Lastly, avoiding foods that cause acid reflux like spicy, tomato-rich, or high protein ingredients as well as losing any extra weight will help to keep the symptoms of a hernia at bay.
In our experience, the best thing you can do here is make freshly cooked meals at home. Eat your meals at fixed timings and have an early dinner. This helps a lot with a hernia.
3. Medication & Supplements :
In the case of hiatal hernias, medications such as antacids, H-2 receptor blockers and proton pump inhibitors are usually prescribed as they claim they can help to relieve discomfort by managing acid reflux.
According to the US FDA, these medications including - omeprazole, pantocid, nexium, esomeprazole, rabeprazole are strictly not to be taken for a period longer than 14 days upto thrice a year as they cause severe side effects. They are acid blockers which reduce stomach acids preventing proper digestion and thus are not a treatment but designed for symptomatic relief. In the long run, they make such cases worse.
There are a few effective herbal supplements with a healing rate of upto 80% which can help reduce intestinal inflammation & help with a hernia. Such a combination of supplements are Hernica® & Acidim® by Grocare which can help with intestinal inflammation and reduce the effects and pain associated with a hernia.
Hernica® is a herbal formula that reduces inflammation of the intestines and relieves pressure on the abdominal wall, by regulating bowel movements and eradicating subclinical infections.
Acidim® is designed to remove free radicals from the intestines, regulate stomach acid levels, reduce bloating, regulate digestion and it also acts as a catalyst in the healing process by maintaining optimum pH levels in the body.
Because this treatment addresses the root cause of the issue, chances of Hernia recurrence are minimal. This natural Kit is also effective in aiding post-surgical Hernia pain.
You can read more about this Hernia Kit here - https://www.grocare.com/products/hernia-kit
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.
At Last :
Hernias can affect people at any stage in their lives. Whether you have a hernia already or suspect that one may have developed, it’s important to know exactly what you’re dealing with and which course of action to take if your symptoms change.
A hernia will not go away by itself. Taking care of it is crucial to your health, enabling you to minimise the effects of your hernia