Muscles and connective tissues play a vital role in keeping organs and fat in their proper place within the body. Weakness in muscles or tissues can cause organs to shift out of position during activities like bending or straining, resulting in pain and discomfort. This condition is known as a hernia, and if the displaced organs or tissues are not returned to their original place, it can result in serious complications. However, a wide range of treatments are available to repair hernia and alleviate symptoms. This blog provides a comprehensive guide to hernias, covering their types, symptoms, causes, and available treatment options.
What is a Hernia?
A hernia occurs when an organ or tissue bulges through an opening or weak spot in the muscle or surrounding tissue, typically when bending or straining. Hernias most commonly occur in the abdominal and groin regions, typically between the chest and hips, affecting areas such as the diaphragm, midline of the abdomen, or the groin. However, apart from abdominal hernias, hernias can also develop in other areas of the body, such as the upper thighs. Most hernias are not medical emergencies, but may worsen over time if untreated. Severe hernia cases, such as when they become stuck or cannot retract, can lead to complications such as necrosis, a condition where the blood supply to the affected tissue is cut off, may require emergency surgery.
Types of Hernia
A hernia can manifest in any area of the body where muscles or tissues have a weak spot or an opening. Common types of hernia include:
Hiatal Hernia: A condition where part of the stomach pushes into the chest cavity through the diaphragm. It is often associated with gastro-oesophageal reflux disease (GERD).
Inguinal Hernia: Occurs when a part of the intestines or fat presses outwards through a weak spot in the lower abdominal wall (inguinal canal) in the groin region. This is the most common type of hernia in men, with right inguinal hernias more frequent than left inguinal hernias.
Femoral Hernia: Occurs when fatty tissues push through the femoral canal in the upper thigh or groin area. It is more common among women, particularly after pregnancy.
Umbilical Hernia: When part of the intestine bulges through the abdominal wall near the belly button. Most cases are congenital. An umbilical hernia is categorised as a ventral hernia, occurring in the front wall of the abdomen.
Epigastric Hernia: Occurs when a tissue pushes through the abdominal wall between the belly button and the chest due to a defect that weakens the area. It is also a subtype of ventral hernia.
Perineal Hernia: When organs or tissues push through a weak spot or opening in the pelvic floor into the abdominal cavity. It is a rare form of hernia.
Incisional Hernia: Occurs when a tissue bulges through a weak spot in the incision in the abdominal wall after surgery. It is another type of ventral hernia.
Congenital Diaphragmatic Hernia: Occurs when the abdominal organs push up into the chest cavity through a diaphragm that doesn’t close completely due to a birth defect.
Spigelian Hernia: A rare type of hernia where tissues bulge through the abdominal wall between the belly button and the interspinal plane.
There are many other types of hernia, along with misnomers such as sports hernia, which is not actually a hernia, but an injury in the muscles or tendons in the groin or lower abdomen due to repetitive motions, especially forceful twisting of the pelvis in sports.
Symptoms of Hernia
Symptoms vary significantly based on the location of the hernia and its severity. Sometimes, there may be no symptoms at all. However, here are some common hernia symptoms individuals can watch out for:
Visible Lump or Bulge: A lump that appears during activities like laughing, lifting, or straining and typically disappears when lying down.
Dull Ache or Pinching Feeling: Discomfort in the area where the lump or bulge is visible.
Pressure or Heaviness: A feeling of increased pressure or heaviness in the area where the bulge appears along with a general sense of weakness.
Swelling and Tenderness: Swelling of the bulge that becomes sensitive to touch.
Changes in Appearance: Flattening or disappearance of the bulge when lying down, commonly seen in early-stage hernias.
Constipation: Difficulty in passing stool or gas (common in hernias involving the intestines).
Digestive Symptoms: Chest pain, heartburn, and difficulty swallowing (common in hiatal hernia)
Nausea and Vomiting: Indicative of a complication due to strangulated hernias; requires prompt care.
Causes and Risk Factors for Hernia
A hernia is usually caused by either weakness in the muscles and tissues that impacts their functioning or an injury or strain that damages the muscle or tissue, creating an opening. Some factors directly linked to the development and risk of hernia for individuals include:
Age: Older people with weak muscles and tissues are at higher risk of hernia.
Premature Birth or Low Birth Weight: Premature or low birth weight babies have a higher likelihood of developing umbilical hernias due to underdeveloped abdominal muscles.
Hip Dysplasia: Commonly observed in babies and young children, this condition, in which the hip joint doesn’t align properly, increases the risk of hernia.
Pregnancy: Women, especially those with multiple pregnancies, are at higher risk of developing hernias. Doctors advise hernia repair surgery post-delivery. Women who have had cesarean surgery are also at a higher risk of developing incisional hernia later on in life.
Chronic Constipation: Increased straining during bowel movements puts excess pressure on the abdominal muscles, thereby increasing the risk of hernia.
Chronic Cough or Allergies: Untreated allergies or chronic respiratory conditions can exert repetitive stress on the diaphragm and the abdominal wall, increasing the likelihood of a hernia.
Smoking: Smoking damages connective tissues, weakening muscles and increasing hernia risk.
Family History of Hernias: A family history of hernia may indicate a genetic predisposition of weak connective tissues, which increases the likelihood of hernia development.
Obesity: Excess weight puts additional strain on the abdominal muscles, resulting in their weakening and increased risk of hernia.
Cystic Fibrosis: This condition causes chronic coughing, increasing abdominal pressure and hernia risk.
Occupation: Jobs requiring heavy lifting or repetitive straining increase the risk of inguinal hernias.
Injury: Physical injury or trauma directly to the abdominal wall can create weak spots, increasing the risk of hernia.
Surgery: Abdominal or pelvic surgeries can weaken tissues and increase hernia risk near the surgical site.
Ascites: This medical condition results in the accumulation of fluid in the abdominal cavity due to liver disease or other medical conditions, creating excess pressure on the abdominal walls and increasing the risk of hernia.
Hernia Diagnosis
Doctors use a combination of techniques to diagnose a hernia accurately. This involves:
Clinical examination: The hernia specialist will physically examine the bulge and its appearance when the patient stands, strains, or coughs.
Discussion of symptoms and medical history: The doctor will inquire about the patient’s symptoms, the duration for which the bulge has been present, whether the patient has a family history of hernia, and lifestyle habits. Examples include smoking or activities involving heavy lifting.
Imaging Tests: Imaging tests such as an abdominal ultrasound, CT scan, or MRI may be ordered to identify and locate the hernia.
X-ray: An X-ray with a barium swallow may be ordered for patients with suspected hiatal hernia. Barium, a contrast dye, helps highlight abnormalities in the digestive tract.
Endoscopy: In cases of hiatal hernia, use an endoscopy, inserting a camera-equipped tube through the mouth to examine the stomach.
Blood Tests: While there are no specific hernia tests, if there are suspicions of an infection or complications, doctors may also order a blood test.
Hernia Treatments
The most effective treatment for hernia is surgery. However, not all patients need urgent repair, and the type and severity of the hernia are crucial determinants of whether a doctor will advise a wait-and-watch approach or recommend surgical intervention. Some of the hernia treatment approaches include:
Watchful Waiting: In hernia cases, where no symptoms are reported, doctors advise patients to monitor the hernia and report if symptoms or complications arise.
Medications: Over-the-counter medications and prescription medications can be effective in resolving painful symptoms of some types of hernia, such as hiatal hernia. Some of the medications used for hernia treatment include:
Antacids: Provides relief from acid reflux
Proton Pump Inhibitors: Helpful for reducing acid production and thereby heartburn symptoms
H2 Receptor Blockers: Helpful in lowering acid production and relieving symptoms such as indigestion and heartburn
Surgery:
Surgery is a common and highly effective treatment for hernia. In most cases, it is an outpatient procedure.
Herniorrhaphy: In this hernia operation, surgeons access the hernia and push it back into its original place. Then, they use surgical mesh and stitches to reinforce the barrier so that the hernia does not recur. Inguinal herniorrhaphy and umbilical herniorrhaphy are some of the most common applications; however, herniorrhaphy may not always work for hiatal hernia, incisional hernia, or recurring hernia. Hernia repair surgeries may be done through different techniques, depending on the patient’s medical condition:
Open surgery: In open surgery, a single incision is made to access the hernia.
Laparoscopic surgery: Laparoscopic surgery involves small incisions and precision tools guided by a camera. It offers high precision, short operation time, quick recovery, and minimal scarring.
Robot-assisted surgery: Surgeons use robotic arms and instruments to repair the hernia. It offers high precision, quick recovery, and minimal scarring.
Nissen Fundoplication: A common surgical intervention for hiatal hernia, involving the wrapping and stitching together of a portion of the upper stomach around the lower part of the oesophagus. It is very effective in resolving symptoms such as chronic acid reflux. Primarily used for treating severe GERD associated with hiatal hernias.
Note: Advanced surgical options may not be suitable for all hernia patients. A patient's specific case, individual preference, and hernia operation cost, among many other factors, influence the choice of treatment.
Complications of Hernia
The nature of complications in a hernia depends on its location and cause. Some types of hernia, such as congenital diaphragmatic hernia, are always complicated, requiring intensive care. Other types of hernia, such as hiatal hernia, cause minor complications such as chronic heartburn, which can often be managed without emergency care. Common hernia complications include:
Incarceration: A situation in which a hernia gets stuck and cannot move back into its original place. It usually causes severe pain, constipation, or nausea and may lead to obstruction or strangulation.
Bowel Obstruction: If a hernia involves a bowel, and it gets stuck, It blocks the passage of food and gas, leading to symptoms like nausea and abdominal pain.
Strangulation: It is a critical emergency where a trapped hernia cuts off blood supply, causing tissue death (gangrene or necrosis) and requiring prompt medical care.
Infection: Abdominal infections can develop due to strangulation of hernia surgery, causing symptoms such as swelling at the hernia site, redness, and fever.
Bowel Perforation: Severe hernia cases involving the intestines can lead to peritonitis, a life-threatening abdominal infection.
Chronic Pain: Patients may experience chronic pain or discomfort in the affected region due to the pressure exerted by the hernia.
Persistent Symptoms: Pain, heartburn, or other symptoms may become chronic, severely reducing the quality of life and ability to perform daily activities.
Hernia Prevention
Some causes of hernia are preventable. Taking proactive measures can help individuals at risk to prevent the likelihood of hernia:
Quit Smoking: Tobacco contains toxins that cause inflammation in the body. Smoking weakens connective tissues, increasing hernia susceptibility. Quitting can help prevent damage to muscles and tissues.
Seek Medical Treatment for Cough: Treat respiratory issues to avoid chronic symptoms that strain the abdominal muscles.
Maintain a Healthy Body Weight: Excessive body weight puts pressure on the abdomen and may affect the resilience of muscles and tissues.
Engage in Physical Exercises: Incorporate core and abdomen strengthening exercises.
Eat Fibre-rich Foods: Adopt a healthy diet with fibre-rich foods, such as lentils, bananas, chickpeas, nuts, and oats, to prevent hernia risk factors such as constipation.
Avoid Straining on the Toilet: Always empty your bladder and pass stool when nature calls. Avoid straining during urination and bowel movements to prevent excess pressure on the groin muscles.
Exercise Caution When Lifting Weights or Heavy Objects: Avoid lifting weights that may be beyond your capacity. When lifting heavy objects, ensure bending at your knees rather than your waist or back. Exhale while lifting to avoid straining abdominal muscles.
Conclusion
A hernia is an uncomfortable medical condition that makes daily life difficult, but effective treatments are available and within reach. If you experience hernia symptoms, consult the experts at Artemis Hospitals for a thorough evaluation and personalised treatment options. Call our customer care at +91-124-451-1111 or WhatsApp us at +91 959-928-5476. You can also schedule an appointment through our online patient portal or download and register on the Artemis Personal Health Record mobile app, available for both iOS and Android devices.
Article By Dr. Kapil Kochhar
Head (Unit II) - General & Minimally Invasive Surgery
Artemis Hospitals
