What is a Hernia? What are the Symptoms of Hernia?

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Main Category: GastroIntestinal / Gastroenterology
Also Included In: Public Health;  Neurology / Neuroscience
Article Date: 16 Mar 2009 - 0:00 PDT

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In Latin the word Hernia means "a rupture". When tissue protrudes through a structure, or a part of an organ through the muscle tissue or the membrane, that is a hernia. There are three parts to a hernia - the orifice, the hernia sac, and the hernia's contents.

The most common place for hernias to occur in humans is the abdomen. A part of the abdominal wall is weak and allows a localized hole to develop - this hole is also known as a defect. Tissue, or abdominal organs may stick out through this hole. A hernia that involves the spinal discs commonly causes sciatica (pain in the lower back, the pain can radiate down one or both legs).

Not all hernias are painful. It is possible for somebody to have a hernia and feel nothing. In general, a patient with a hernia will feel pain, and often feel a lump in the affected area. Fatty tissue will usually jut through first, then an organ may protrude later.

In most cases a hernia will occur when the compartment which envelopes an organ receives increased pressure, this weakens the boundary. This may happen for several reasons, including:

• Genetic propensity - if either or both of your parents had a hernia you are more likely to develop one.


• Age - the older you are the higher is your risk of developing a hernia.


• Ehlers-Danlos syndrome - a group of uncommon genetic disorders that affect humans and domestic animals caused by a defect in collagen synthesis.


• Marfan syndrome - a is genetic disorder of the connective tissue.


• Pregnancy - the muscles of the mother stretch, making it easier for tissue to poke through.


• Drastic weight loss - when obese people lose weight they may be more prone to developing hernias.


• COPD, Whooping cough - the patient may cough a lot. Coughing raises pressure in the abdomen. Any illness that includes severe coughing can cause hernias to occur. A severe bout of flu may sometimes cause a hernia to develop.


• Ascites - the buildup of extra fluid in the abdomen (peritoneal cavity).


• Benign prostatic hypertrophy - the prostate gland enlarges, increasing pressure around it.


• Intracranial pressure - if intracranial pressure rises parts of the brain may develop hernias which protrude through the cranial cavity.


• Excessive lifting - raises pressure on the abdomen and others parts of the body.


• Prior surgery - some surgeries may result in the weakening of membranes.


• Obesity - if a person is obese his chances of developing a hernia are significantly higher, compared to people who are not obese.

What types of hernias are there?

There are many types of hernias. Below is a list of some of the most common hernias:

• Abdominal Hernia - an abdominal organ or fatty tissue juts through a weakened area of the abdominal wall, resulting in a protrusion


• Anal Hernia - tissue protrudes through the membrane around the anal region.


• Diaphragmatic Hernia - hernia resulting from the protrusion of part of the stomach through the diaphragm - a hole in the diaphragm which the bowel can pass through, also known as congenital diaphragmatic hernia.


• Hiatal Hernia - forms at the opening in the diaphragm where the esophagus (food pipe) joins the stomach. A part of the stomach pushes through this opening.


• Herniatied Disc - the cushion that lies between the spinal vertebra is squeezed outside its normal position. As the spinal disc loses its elasticity, it may rupture - rupturing may cause a portion of the spinal disc to push outside its normal boundary - resulting in a herniated disc


• Intracranial Hernia (in the brain) - caused by extreme intracranial pressure. This is a protrusion of brain from the cranial vault through the foramina (tentorial notch or foramen magnum) or ventral dural septae. The patient may need immediate medical attention as intracranial hernias might be life-threatening, especially if the hernia takes place in the brain stem region. Usually caused by brain edema or hemorrhage which results in increased intracranial pressure.


• Pelvic Hernia, Inguinal Hernia - an interstitial hernia (happens in the small opening between tissues or parts of an organ) projecting into the pelvis from the internal inguinal ring. The inguinal ring is at the entrance to the inguinal canal. The inguinal canal is an oblique canal through the lower abdominal wall; in males it is the passage through which the testicles move down into the scrotum, it contains the spermatic cord; in females it transmits around the ligament of the uterus.


• Femoral Hernias - more common among females. Occurs when part of the intestine protrudes through the femoral canal, it juts through at the top of the thigh. Blood vessels that supply the legs with blood go through the femoral canal.


• Umbilical Hernia - more common among children. The abdominal wall is weakened where the umbilical cord enters/leaves the body (the belly button, the naval). Umbilical hernias can also be found in puppies.


• Epigastric Hernia - occurs between the naval and the breastbone. Fat protrudes through the abdominal wall.


• Ventral Hernia - most commonly after a surgical operation or trauma (e.g. car accident or bad fall). When tissue is scarred it weakens the abdominal wall, leading to hernia.


• Obtuator Hernia - bits of intestine penetrates through the space between bones in the front part of the pelvis.

Treatment for hernia

Your GP may initially try to push the hernia back, if he/she thinks it is possible. In many cases surgery is required to repair a hernia. During the operation the surgeon will put the protrusion back. If the protrusion is through the abdominal wall, for example, a synthetic mesh may be fixed to the muscles to strengthen the area.

Surgery can be either open surgery, where a large incision is made, or keyhole (laparoscopic) surgery, where only a tiny incision is made, using a specially designed camera and instruments to carry out the operation.

Advantages and disadvantages of open surgery and laparoscopic surgery

Both open surgery and keyhole surgeries have their own advantages and disadvantages. Although open surgery involves a longer recovery time and more post-operative pain, it can be done with a local anesthetic. A patient who undergoes keyhole surgery will recover faster and experience less pain. However, keyhole surgery requires a general anesthetic. Elderly patients, or those with bad health may be too weak to undergo a general anesthetic.

Gastrointestinal experts say that despite faster recovery time and less pain after the operation, laparoscopic surgery carries a higher risk of damage to the bowel. A European study found that laparoscopic hernia surgery has a 5 in 1000 risk of serious complications, compared to 1 in 1000 with open hernia surgery (NHS Choices, UK) .

In the UK approximately 2% of hernia surgery patients will require further surgery later on. The 2% risk is the same for both types of surgery (NHS Choices, UK) .

If you have to wait a long time for your surgery your doctor may recommend you wear a truss till the day of your operation. Trusses keep many hernias in place.

Prevention of hernias

In many cases, hernias are due to age and your genetic propensity. There is not much you can do about that. However, there are some factors which can raise your risks of developing a hernia.

Heavy lifting - heavy lifting is known to cause hernias. Try to avoid heavy lifting. If you can't, learn how to position yourself for lifting. According to www.bodybuilding.com, if you are weight training you should use an appropriate amount of weight relative to your strength. You should make sure you are warmed up before lifting any weights. Make sure you bend at the knees when lifting a weight - do not bend at the waist as this will cause excessive pressure. If you are lifting a heavy object in the gym (or anywhere) take a squatting position, keep your back straight and as vertical as you can. Make sure your bodyweight is centered over your feet when you start your lift. Frequent abdominal training will strengthen those areas most susceptible to hernias.

Smoking and coughing - coughing, especially persistent coughing can cause a hernia to develop. Anything you can do to reduce or eliminate your cough will help enormously. If you smoke, try to give up, or at least cut down. Quitting smoking will prevent several other serious diseases. Studies indicate that your chances of succeeding in giving up smoking are significantly greater if you seek help from your GP (primary care physician) and join a support group.

Nutrition - a diet that is high in fiber will help your bowel movements. Constipation, especially if the person is often constipated, greatly increases hernia risk. Eat plenty of fruits, vegetables and wholegrains. Make sure you drink plenty of fluids.

Obesity - being overweight can increase your risk of developing a hernia considerably. The more overweight you are, the higher your risk. Try to lose weight. Make sure, if you are obese, that you lose weight gradually. It is always advisable to seek professional help before you embark on any exercise program. Ask your doctor for advice on diet and exercise.

How common are hernias?

England

According to the National Health Service, approximately 70,000 people undergo a surgical operation for inguinal hernias each year - 98% of these patients are men. 16 out of every 100,000 people develop femoral hernias. Incisional hernias, which develop as a complication of abdominal surgery, occur in 0.5% to 10% of patients, depending on the type of surgery involved. Children of black-African descent are ten times more likely to have an umbilical hernia compared to white children (in most cases umbilical hernias do not need treatment and get better as the child becomes older).

USA

Approximately 5 million Americans have a hernia (National Center for Health Statistics, USA). However, only about 750,000 of them seek treatment each year.

Most common male and female hernias

Inguinal hernias (hernias in the groin area) are most common among men - mainly because there is unsupported space in the groin area after the testes descend in the scrotum. Femoral hernia is most common among women.

Sources - NHS (UK), National Center for Health Statistics (USA), BodyBuilding.com, CDC, Wikipedia.

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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