HERNIA (ABDOMINAL HERNIA)

What is an abdominal hernia?

A hernia happens when part of an internal organ or tissue bulges through a weak area of muscle. Most hernias are in the abdomen.The most common hernias are in the groin (inguinal hernias) and in the diaphragm (hiatal hernias). Hernias may be present at birth (congenital), or they may develop at any time thereafter (acquired).Some people are born with weak abdominal muscles and may be more likely to get a hernia.

Which type of hernia you have depends on where it is:

• Hiatal hernia occurs in the upper part of the stomach. Part of the upper stomach pushes into the chest.
• Femoral hernia is a bulge in the upper thigh, just below the groin. This type is more common in women than men.
• Umbilical hernia is a bulge around the belly button. It occurs when the muscle around the belly button does not close completely after birth.
• Incisional hernia can occur through a scar if you have had abdominal surgery in the past.
• Inguinal hernia is a bulge in the groin. It is more common in men. It may go all the way down into the scrotum.
• Spigelian hernia: This rare hernia occurs along the edge of the rectus abdominus muscle through the spigelian fascia, which is several inches lateral to the middle of the abdomen.
• Epigastric hernia: Occurring between the navel and the lower part of the rib cage in the midline of the abdomen, epigastric hernias are composed usually of fatty tissue and rarely contain intestine. Formed in an area of relative weakness of the abdominal wall, these hernias are often painless and unable to be pushed back into the abdomen when first discovered. Continue Reading
• Obturator hernia: This extremely rare abdominal hernia develops mostly in women. This hernia protrudes from the pelvic cavity through an opening in the pelvic bone (obturator foramen). This will not show any bulge but can act like a bowel obstruction and cause nausea and vomiting. Because of the lack of visible bulging, this hernia is very difficult to diagnose.

Causes of Hernias?

A hernia may be congenital (Present from birth)and present at birth or it may develop over time in areas of weakness within the abdominal wall.Hernias are caused by a combination of muscle weakness and strain. Increasing the pressure within the abdominal cavity can cause stress at the weak points and allow parts of the abdominal cavity to protrude or herniate.

Any activity or medical problem that increases pressure on the tissue in the belly wall and muscles may lead to a hernia, including:

• Persistent coughing or sneezing
• Lifting heavy objects without stabilizing the abdominal muscles
• Diarrhea or constipation
• Straining while using the toilet
• In addition, obesity, poor nutrition, and smoking, can all weaken muscles and make hernias more likely.
• Cystic fibrosis
• Extra weight
• Enlarged prostate, straining to urinate
• Fluid in the abdomen (ascites)
• Poor nutrition
• Peritoneal dialysis
• Smoking
• Undescended testicles
• Overexertion

Babies and children can get hernias. It happens when there is weakness in the belly wall. Inguinal hernias are common in boys. Some children do not have symptoms until they are adults.Hernias may be present at birth, but the bulge may not be noticeable until later in life. Some people have a family history of hernias.

SYMPTOMS OF Hernia ?
The most common symptom of a hernia is a bulge or lump in the affected area
Some people have discomfort or pain. The discomfort may be worse when standing, straining, or lifting heavy objects. In time, the most common complaint is a bump that is sore and growing, swollen protrusion of tissue that you are unable to push back into the abdomen (an incarcerated strangulated hernia).

Reducible hernia

• It may ache but is not tender when touched.
• It may be reduced (pushed back into the abdomen) unless very large.

Irreducible hernia

• An irreducible hernia is also known as an incarcerated hernia.
• It may be an occasionally painful enlargement of a previously reducible hernia that cannot be returned into the abdominal cavity on its own or when you push it.
• It can lead to strangulation (blood supply being cut off to tissue in the hernia).

Strangulated hernia

• This is an irreducible hernia in which the entrapped intestine has its blood supply cut off.
• This condition is a surgical emergency

Diagnosis
History and physical examination remain the best means of diagnosing hernias. The review of systems should carefully seek out associated conditions, such as ascites, constipation, obstructive uropathy, chronic obstructive pulmonary disease, and cough.


Laboratory studies include the following:

• Complete blood count (CBC)
• Stain or culture of nodal tissue
• Urinalysis
• Electrolytes, blood urea nitrogen (BUN), and creatinine
• Lactate

Imaging studies are not required in the normal workup of a hernia. However, they may be useful in certain scenarios, as follows:

• Ultrasonography can be used in differentiating masses in the groin or abdominal wall or in differentiating testicular sources of swelling
• Computed tomography (CT) or ultrasonography may be necessary if a good examination cannot be obtained, because of the patient’s body habitus, or in order to diagnose a spigelian or obturator hernia.
• If an incarcerated or strangulated hernia is suspected, upright chest films or flat and upright abdominal films may be obtained.

Hernia Treatment

Lifestyle Changes

• Dietary changes can often treat the symptoms of a hiatal hernia. Avoid large or heavy meals, don’t lie down or bend over after a meal, and keep your body weight in a healthy range.

Medication

• If you have a hiatal hernia, over-the-counter and prescription medications that reduce stomach acid can relieve your discomfort and improve symptoms. These include antacids, H-2 receptor blockers, and proton pump inhibitors.

Surgery

• Surgery is the only treatment that can permanently fix a hernia. Surgery may be more risky for people with serious medical problems.
• An umbilical hernia that does not heal on its own by the time a child is 5 years old will likely be repaired.
• Surgery repairs the weakened abdominal wall tissue (fascia) and closes any holes. Most hernias are closed with stitches and sometimes with mesh patches to plug the hole.

Outlook (Prognosis) -Hernia
The outcome for most hernias is usually good with treatment. It is rare for a hernia to come back. Incisional hernias are more likely to return.


Possible Complications OF HERNIA

• In rare cases, inguinal hernia repair can damage structures involved in the function of a man's testicles.
• If a part of the bowel was trapped or strangulated before surgery, bowel perforation or dead bowel may result.
• Another risk of hernia surgery is nerve damage, which can lead to numbness in the groin area.

HERNIA Prevention

To prevent a hernia:

• Lose weight if you are overweight.
• Use proper lifting techniques.
• Men should see their health care provider if they strain with urination. This may be a symptom of an enlarged prostate.
• Relieve or avoid constipation by eating plenty of fiber, drinking lots of fluid, going to the bathroom as soon as you have the urge, and exercising regularly.

Alternative Names
Hernia - inguinal; Inguinal hernia; Direct and indirect hernia; Rupture; Strangulation; Incarceration