What is a hernia?
A hernia is the bulge (protrusion) of abdominal viscera through a defect or an area of weakness in the abdominal wall much in the same way that an inner tube pushes through a damaged area in a tire.
The defect allows intestine, part of the bladder, ovary or fat from inside of the abdomen to pop out into the hernia. Hernias occur in both men and women and can be present from birth.
Where do hernias occur?
There are several types of hernias depending on the location as follows:
- Groin hernias (inguinal and femoral types): these are the most common hernias
- Inguinal hernias occur in the path taken by the testicles to descend into the scortum
- femoral hernias occr at the top of the thigh in the space next to the femoral vein
- Umbilical or paraumbilical hernias: these occur at the umbilicus (belly button)
- Epigastric hernias: these occur in the area between the sternum and umbilicus
- Incisional hernias: these occur at sites of previous operations
- Spegelian hernias: these occur on the sides of the rectus abdomenis muscles
What are the causes of hernias?
Some hernias are present from birth but the majority are acquired later in life.
- Straining and heavy lifting
- Chronic coughing
- Previous abdominal or groin surgery
- Congenital weakness of the connective tissue
- Liver diseases
What are symptoms of hernias?
Sometimes a hernia does not cause any symptoms other than a bulge. However, more often a hernia causes pain and discomfort over the hernia site. The pain tends to be brought by heavy lifting, coughing or straining. Typically the bulge is more noticeable with these activities and with standing and tend to disappear when lying flat.
Most hernias are reducible meaning that the content can be squeezed back into the abdominal cavity. Neglected hernias can can become crowded making it difficult or impossible to push back (irreducible).
What is a strangulated hernia?
Strangulation of hernia is a surgical emergency. It is a serious complications of neglected hernia. The bowel entrapped inside the hernia loses its blood supply caused by pressure inside the hernia leading to gangrene of the entrapped bowel . Signs of strangulation are severe abdominal pain, vomiting, bloating, and redness and tenderness over the hernia site.
Do hernias ever resolve without surgery?
No. In adults hernias do not repair themselves.
Can hernias be left without repair?
Some small hernias that are not causing any symptoms can be observed and surgery is performed if they enlarge or start to cause symptoms. Hernias tend to get bigger with time and it easier and more successful to repair hernias before they get big.
Emergency surgery to repair entrapped painful hernias is more complicated often requiring bowel resection, longer stay in hospital, more complications and more chance for the hernia to come back. The year to year risk of strangulation is small, however if the patient has a reasonable life expectancy then this risk will become a significant risk over the patient's lifetime.
A simple rule of thumb is: "the sooner the better".
How hernias are fixed?
The only way to permanently fix a hernia is with surgery. This can be performed by the open technique or by laparoscopy (key-hole surgery).
Are there any alternatives to surgery?
Patients with inguinal hernias sometimes wear a truss. This is a special belt designed to be worn first thing in the morning after pushing in the inguinal hernia. The idea is to apply a pressure over the defect in the abdominal wall and thus preventing the hernia from popping out. This does not fix the hernia just hold it in place. Most patients do not use it properly and the truss end up pushing on the bowel instead of hold in the hernia. Therefore, it should be reserved for patients who are not fit for surgery.