What is hernia? symptom, types, causes, treatment
1. An overview
From blinking (an eye) to running (a marathon), every movement (in human body) is controlled by muscle functions. Moreover, the muscles help hold the organs in its right position. But sometimes, a weak spot in a muscle wall can squeeze and yield to allow displacement and protrusion (of various organs in the body). One of such conditions are Hernia.
A hernia looks like a lump. One may not feel it while in lying position. But it gets prominent and as such can be strongly felt when one moves the body with different postures (especially dragging and lifting heavy load). It occurs when an organ or fatty tissue squeezes through a weak spot in a surrounding muscle or connective tissue (known as fascia). Hernias are mostly found in the abdomen (known as abdominal wall hernia. They are generally visible and look like a lump or bulge beneath the skin. They do not cause any symptom except for mild pain during strain).
However, hernia can also occur on the upper thigh / belly/ buttock/ groin areas. Most hernias are not life threatening. But they persist and don’t go away of their own. Sometimes, they may require surgical treatment to avoid potentially dangerous complications.
2. Hernia Symptom
One may experience symptoms depending on the type of hernia. The common symptoms experienced are discussed below.
2.1) The most prominent symptom is the visible bulge. It lies in the affected area on either side of the pubic bone (It is also known as pubis bone. It is one of the 3 principal bones that make up the pelvis). The bulge becomes more prominent when the patient is in an upright position (especially, while coughing/ bending/ straining). A burning or aching sensation is felt in the bulge
2.2) Sometimes, in the groin area, pain/ discomfort and even heavy dragging sensations are felt. Weakness and pressure may also be felt in the groin area.
2.3) Occasional pain/ swelling (around the testicles) may arise when the protruding intestine descends into the scrotum (it is an anatomical male reproductive structure. It consists of a suspended dual chambered sac of skin and smooth muscle. It is present in most of the terrestrial male mammals and located under the penis).
2.4) Severe hernia symptoms are shooting pain / vomiting /constipation. Other symptoms are: the organ or the tissue becomes infected /blocked/ strangled.
2.5) Symptom among the children (particularly, among the new born) is inguinal hernia resulting from weakness in the abdominal wall (detected at birth). Sometimes, the hernia (among the children) becomes visible only when the infant is crying /coughing /straining during a bowel movement. Under the condition, the infant may feel irritated and less hungry (than usual).
2.6) In case of strangulated hernia, the following symptoms may be experienced.
- Nausea and/or vomiting
- Sudden pain (that quickly intensifies).
- Hernia bulge (that quickly turns red/ purple/ dark).
- Inability to move bowels (or pass gas)
3. Pain in hernia
Most hernias are not painful. However, sometimes the area around the hernia may feel tender (having sharp pulling sensation). The pain may be intermittent (or constant). Again, a hernia can also be painless and only appears as bulge (with swelling). And the swelling may decrease (or disappear) depending on the pressure in the abdomen. Constant intense pain (at the bulge site) may be a cautionary signal for medical emergency.
- Complications in Inguinal hernia: Heavy pressure is felt in the surrounding tissues. Most inguinal hernias get enlarged overtime (if not removed surgically). In men, large hernias can extend into the scrotum (causing pain and swelling).
- Complications in Incarnated (trapped) hernia: If the contents of hernia become trapped (in the weak part of the abdominal wall), it can obstruct the bowel leading to severe complications (such as, inability to move bowels and pass gas).
- Complications in Strangulated hernia :Under the condition, blood flow (to a part of the intestine) can be obstructed. Ultimately, strangulation can lead to death of the affected tissue. A strangulated hernia is life threatening and needs medical emergency.
5. Causes and risk factors
In fact, causes are the agents directly responsible for the occurrence of a disease. On the other hand, a risk factor is not necessarily a cause. A risk factor may be anything that increases the likelihood for a patient to develop the disease (for instance, age is a vital risk factor for most of the diseases including hernia. But it cannot be a cause). In most cases, it is not clear what is the specific agent that is causing the disease. For a particular disease to occur, the conglomerated effects of a host of factors (such as age, environment, body weight, life style including food habits, physical activity, type of job involving strain, seasonal characteristics, medication and surgery undertaken to cure other diseases) play a key role.
5.1) Causes of Hernia
Hernias are caused by combination of muscle weakness and strain. Depending on the causes, a hernia can develop quickly (or gradually over a longer period of time). Common causes of muscle weakness include failure of the abdominal wall to close properly in the womb. Ultimately, all hernias are caused by combination of pressure and weakness of muscle (the ressure pushes the organ or tissue through the opening or weak point). Sometimes, the weakened muscle starts at the very birth.
To sum up, anything that causes the increase in pressure in the abdomen, can cause hernia.
5.2) Risk factors: The risk factors contributing to increase in pressure include
- Age: Age is a great risk factor for hernia. Muscles weaken as one ages.
- Being Male: Males are 8 times more likely to develop hernia (than females).
- Family history: If anyone among the close relatives (such as, parents/ brothers/sisters) have the disease, then the person is more likely to develop hernia (as compared to those whose close relatives don’t have the disease).
- Chronic cough: Smokers suffering from chronic cough are more likely to develop hernia.
- Chronic constipation: Constipation causes straining during a bowel movement.
- pregnancy: Being pregnant can weaken the abdominal muscles causing increased pressure inside the abdomen.
- Lifting heavy load: Lifting heavy baggage without stabilizing the abdominal muscles make it easy to develop hernia.
- Other risk factors include: diarrhea /obesity/ poor nutrition/ premature birth/ low birth weight / previous hernia repair.
6. Type of Hernia
Type, to a large extent, determines the treatment procedure. Again, type of any malignant disease is itself determined by the causes / risk factors /signs / symptoms and feelings experienced by the patient. There are mainly 5 types of hernias...
6.1) Inguinal hernia (located in inner groin): In such hernia, the intestine protrudes through the abdominal wall (or through the inguinal canal of the groin) about 90% of groin hernias are inguinal. They mostly occur in males (because of natural weakness of the area)
6.2) Femoral hernia (located in outer groin): It occurs when the intestine enters the canal (running through the artery into the upper thigh). Femoral hernia is found common among the women (especially, those who are pregnant and obese).
6.3) Incisional hernia (resulting from incision): The hernia, in such case, pushes through the abdominal wall (at the site of incision in the wake of surgery previously conducted in the abdomen). This mostly occurs I among old obese people (who become inactive after abdominal surgery).
6.4) Umbilical hernia (located in belly buttock): In umbilical hernia, a part of the small intestine passes through the abdominal wall (near the navel). It is found common among the newborn as well as the obese women (having many children).
6.5) Hiatal hernia (located in upper stomach): It occurs when the upper stomach squeezes through the hiatus (an opening in the diaphragm through which the esophagus passes).
7. Diagnosis of Hernia
Diagnosis is identifying the root problem through applying various tests/ observing the symptoms / interrogating the patient about his feeling and observations /genetic history / personal history (including his lifestyle).
During the tests, the doctor will typically feel the presence of hernia (around the groin area including the testicles, while asking the patient to cough). This procedure is applied because, hernia gets prominent during coughing (in addition to standing/ straining). Among the various tests applied, the following tests are important
- Ultrasound test (using a sound wave through scanning the body) is conducted to detect hernia.
- Another test conducted is barium X- ray (taking images of digestive area including intestine).
- A CT scan (Computed Tomography scan using X- ray) can get picture to detect the presence of hernia
- An endoscopy examines the esophagus and the stomach (using a small camera at the end of a flexible tube).
8. Hernia Treatment and repair
Surgery is the only option to cure hernia. A surgical repair involves pushing the bulge back inside the body part (where it originally lies). The doctor will usually recommend surgery if anyone of the following conditions occurs.
- Tissues (such as in intestines) become trapped.
- The hernia becomes strangulated. This can cause a permanent damage which needs surgical emergency.
- The hernia is growing larger attended with increasing pain and discomfort. The following 2 surgical procedures are usually conducted to cure hernia.
8.1) Non tension (or mesh) repair:
In the procedure, a piece of mesh is placed to reinforce the area with sutures or staples (instead of pulling the tissue around the hernia together. A mesh is made of flexible material that stays in the abdomen and helps the tissue to grow).
Conclusively, mesh (or non-tension) repair has a lower recurrence of incidence (than tension repair).
8.2) Laparoscopic (or closed) repair
Many inguinal hernias can be repaired using a laparoscopic or closed procedure (especially, when the inguinal hernias are of smaller size). The procedure entails inserting special instruments through tiny incisions in the abdomen (with the help of which the surgeon is able to visualize to correctly perform the procedure. The instruments include a laparoscope, a fiber optic tube with tiny camera at the end). In the procedure, the surgeon makes 3- 4 incisions (size: ¼ inch-- ½ inch) in the abdomen (one is near the navel and the others lie downwards).
- Since Laparoscopic procedure uses mesh (for reinforcement) so it has a lower recurrence rate. Moreover, a smaller incision means less discomfort (and in addition, little or no scarring/ quicker return to normal activity within a few days).
- Laparoscopic procedure is always done under general anesthesia.
- Before surgery, the surgeon may recommend a pre-operation exam (Blood test / ECG i.e. Electrocardiogram /Chest X-ray) to be sure that the lungs and the heart are in good condition.
- The patient may be asked to stop taking over the counter (which needs no prescription) medications (7- 10 days before surgery lest it should aggravate bleeding).
- Before surgery, the patent should invariably disclose to the surgeon all medicines (regularly and occasionally taken)
- After surgery, the doctor may also prescribe some pain medications.
It is not possible to prevent hernia (especially caused by genetics). Further, a congenital diaphragmatic hernia is a birth defect (which is inevitable). One born with weak muscles, makes it easier to get hernia later in life.
However, one can reduce the chances of developing hernia (later in life) through following a healthy life style as described below.
- Eat smaller meals (One needs to avoid large meals and instead, should consume small meals at short intervals)
- Avoid spicy foods and consume high fiber foods (fruits/ vegetables/whole grain s contain fiber that can help prevent constipation as well as straining).
- Avoid smoking and alcohol (these 2 expensive bad habits have no social recognition. They invite early death as they act as major risk factor for most of the malignancies including hernia).
- Maintain an ideal and healthy weight for the obese people (it is essential for the obese people to talk to the doctor for advice to effectively reduce weight through suitable diets and exercises. An ideal weight is measured by BMI i.e. Body Mass Index) =20 – 25 having height 1.7 meters. And BMI= W/ H2. Where, W =weight in kg and H2= square of height in meter).
- Maintain a proper balance (while lifting heavy objects) so as to prevent strain. If one needs lifting at all. It is advised not to lift objects heavy enough beyond one’s ability.
10. Key global information
- Males are 8 times more likely (than women) to develop inguinal hernia
- Globally, at least 2% among males develop abdominal wall hernia (in USA, it is 1.5%).
- Every year around the world, more than 20 million hernias are repaired (0.3% of total world population).
- Abdominal wall hernias are most common (followed by inguinal;/ femoral /umbilical types).
11. Concluding remarks:
There is no medicine to cure hernia (which is a hole / tear/weakened part in the body tissue through which another body part may protrude causing a bulge). Surgery is the only option to cure hernia. However, taking certain medications might help prevent hernia from worsening further.
- H= HERNIA (occurs when an organ squeezes through a weak spot in a surrounding muscle)
- E = EMERGENCY (treatment is needed in case of strangulated hernia)
- R= Risk (of hernia is great for old obese people)
- N = NOT (life threatening is most of the hernias)
- I = Inguinal (hernia occurs mostly among the males)
- A = Abdominal (wall hernias are most common)