Category

Hernia

Category

There are different types of Hernia. All of them have common symptoms like a bulge, pain, and pressure. It is important to know what type of pain and at which part of the body so that you can administer the right treatment. Hernias are best treated with surgery.

What is a hernia?

A hernia is an abnormal bulging of abdominal organs when an internal organ pushes through a weak spot in muscle/tissue in the abdominal wall. Typically, you will discover most hernias within the abdominal cavity between the chest and the hips. 

Types of Hernia

Hernias are divided into several types based on where the bulge is located. A hernia can be congenital, which is present at birth. Or it can be acquired, caused by trauma or other factors. An acquired hernia is a “wound hernia” when abdominal organs protrude through an unnatural opening in the abdominal wall.

The most common types are

a.      Inguinal Hernia (Inner Groin) – Mostly occurs in men due to a natural weakness in the groin, where the bladder or the intestine protrudes through the abdominal wall or into the inguinal canal in the groin.

b.     Femoral Hernia (Outer Groin) – Most common among women, especially obese or pregnant, where the intestine enters the canal carrying the femoral artery into the upper thigh. 

c.      Incisional Hernia (as a result of an incision) – Most common among elderly and overweight folks who are inactive after an abdominal surgery, where the intestine pushes through the abdominal wall at the site of abdominal surgery.

d.     Hiatal Hernia (Upper Stomach) – Where the upper stomach pushes through the hiatus, an opening in the diaphragm through which the oesophagus passes. 

e.     Umbilical Hernia (Belly Button) – Most common among newborns and obese women or those who have had many childbirths, where a part of the small intestine passes through the abdominal wall near the navel (aka belly button).

The less common types are 

a.      Giant Abdominal Wall Hernia – Most typical among those with incisional Hernia or another kind that keeps coming back, is hard to treat and may need surgery to fix it.

b.     Epigastric Hernia (Epigastric Region – above the belly button and below the rib cage) – Common among men than women and in some newborn babies, where fat tissues push through a gap between the two sides of the abdominal muscles, namely the belly button and the lower part of the breastbone. 

c.      Spigelian Hernia – Commonly affects the intestines and omentum, where a layer of fat tissues pushes through the muscle below your navel like split like opening in the fascia. 

Causes of Hernia

Increased pressure causes all types of hernias in the abdomen, fascia, and a combination of the following reasons.

a.      Bad diet – Poor nutrition and a diet high in sugar can lead to weak abdominal muscles. 

b.     Bad posture and Balance while lifting heavy objects/weights – Careless lifting of heavy weights and objects without stabilizing the abdominal muscles can lead to a hernia.

c.      Disc problems – When the disc in your spine is compressed, it can pressure the nerves that control your muscles. This can cause your abdominal muscles to weaken. 

d.     Diarrhea, constipation, persistent sneezing, or coughing – These occurrences can weaken the muscles and lead to a hernia.

e.     Pregnancy complications – While it’s rare, pregnancy-related weakening of abdominal muscles may lead to a hernia.

f.       Poor lifestyle habits – Obesity and smoking can weaken muscles, leading to hernias.

Risk Factors of Hernia

The risk factors for Hernia are,

a.      Obesity – If you have a high body mass index (BMI), you are at an increased risk of developing a hernia. 

b.     Sports injuries – If you’ve experienced frequent sports injuries to your abdomen, you are at an increased risk of developing a hernia.

c.      Previous surgery – If you’ve had a previous surgery involving abdominal incisions and the abdominal wall is weak, you are at an increased risk of developing a hernia.

Symptoms of Hernia

The symptoms are many,

– A noticeable swelling, bulge, or lump in the abdomen/groin

– Mild to increased pain, pressure, or swelling at the bulge site. 

– Nausea, heartburn, indigestion, constipation, difficulty in swallowing, chest pain, or frequent regurgitation

– Dull aching sensation and feel that something is lodged in your intestines.

– Pain while lifting, laughing, crying, sneezing, or coughing.

Foods and Activities that cause Hernia and relieve Hernia

Exercising too intensely can strain your abdominal muscles and lead to an underlying weakness. This increases your risk of developing a hernia. Binge drinking alcohol can lead to abdominal muscle weakening, which puts you at risk of a hernia.

Drinking warm fluids, such as water, herbal tea, or sugary drinks, can relax the abdominal muscles and relieve hernia pain. Stay hydrated to prevent dehydration and maintain normal urine pressure. Pushing hard during pregnancy or after giving birth can help work out the pressure in your abdominal muscles, relieving the pain of a hernia.

Prevention and Detection of Hernia

Hernias cannot be prevented since they occur due to an accidental combination of medical history and genetic makeup. However, in the interest of good health, we can do the following, 

– Make sure you visit your doctor regularly for regular check-ups so they can detect any hernias early. 

– Your doctor will likely check your abdomen to feel for a bulge. 

– You should inspect your belly button to look for any abnormal bulges. 

– Exercising regularly can help you maintain healthy, strong abdominal muscles and prevent them from weakening.

– Avoid any pressure on the abdominal wall like lifting weights

– Refrain from poor lifestyle habits like smoking, drinking, or straining during bowel movements.

– Eat a high-fibre diet and stay hydrated.

Treatment of Hernia

The best treatment for hernias is to prevent them from happening. You should avoid activities that strain your abdominal muscles if you have a hernia. This will help to avoid a hernia. For most hernias, doctors will wait and watch for the abdominal wall to repair and heal but most hernias do not get healed on their own. More significant types of hernias like intestinal hernias may require surgical correction to improve the Hernia and the abdominal wall or prevent an emergency in case of an incarcerated hernia or a strangulated hernia. 

Hernia surgery is minimally invasive in most cases for faster recovery and better outcome. In case of umbilical hernia in children, hernia surgery may be recommended if the hernia is large or has not healed by the age of 4-5 years. In case of adults, there are two kinds of surgery available for hernia which the doctor will take a call on the final recommendation –

  1. Open Surgery – where a cut is made at the site of the hernia, and the protruding tissue is reset and the weakened muscle walls are sutured. A type of mesh is implanted for extra support.
  2. Laparoscopic surgery – unlike an open surgery but with the same set of repairs, here tiny incisions are made for surgical tools to complete the procedure

Recovery from Hernia

You may be able to resume normal activities after hernia repair. One may need to rest and strengthen their abdominal muscles to prevent a recurrence. In some cases, it is likely to experience pain and discomfort for a few days and may experience constipation or nausea.

The following needs to be kept in mind,

a. It would help if you avoid heavy lifting or straining your abdominal muscles. 

b. You should also avoid coughing or straining to pass urine because these can further weaken your weak muscles. 

c. You should also drink lots of water to prevent dehydration and maintain normal urine pressure. 

d. Follow-up care is essential after hernia surgery. You should return to your doctor for check-ups to ensure no complications. 

e. You should also wear a compression garment after surgery to help to reduce swelling and pressure on your incision.

FAQs

1. What is the most common type of Hernia?

Answer – The most common types of Hernia are

– Inguinal Hernia (Inner Groin) 

– Femoral Hernia (Outer Groin) 

– Incisional Hernia (as a result of an incision)

– Hiatal Hernia (Upper Stomach)

– Umbilical Hernia (Belly Button) 

2. What is the most common type of Hernia in males?

Answer – The most common type of Hernia in males is Inguinal Hernia ( Inner Groin) which mainly occurs due to a natural weakness in the groin, where the bladder or the intestine protrudes through the abdominal wall or into the inguinal canal in the groin.

3. What is the most common type of Hernia in females?

Answer – The most common type of Hernia in females is Femoral Hernia (Outer Groin), especially in obese or pregnant women, where the intestine enters the canal carrying the femoral artery into the upper thigh. 

4. Are there rare hernias?

Answer – Yes, Spigelian Hernia is a rare hernia.

5. Is Hernia life-threatening?

Answer – An incarcerated hernia can become strangulated and life-threatening if not treated on time.

6. What are the signs of Hernia?

Answer – Hernia signs are pain and a bulge around the abdomen or affected site.

7. What happens if the Hernia is not treated?

Answer – If the Hernia is not treated, it can become life-threatening.

8. Does Hernia require major surgery?

Answer – Yes, an intestinal Hernia may require surgery.

9. How painful is hernia surgery?

Answer – Hernia surgery is not painful because, at the time of surgery, the patient would be administered general anaesthesia. It is the period before surgery and post-surgery during recovery that the patient might experience pain.

10. What is the best treatment for Hernia?

Answer – Timely diagnosis of symptoms, proper lifestyle habits, and medical surgery, where applicable, is the best treatment for Hernia.

11. What foods cause Hernia?

Answer: Fatty, fried food, citrus fruits, spicy food, garlic, onion, and chocolate can trigger hernia symptoms.

12. What foods to avoid in case of Hernia?

Answer – Hernia patients should avoid foods with high sodium, fats and spices, chocolate, garlic and onion, citrus fruits, and fried food in case of Hernia.

Hernias do not heal on their own. Though they can remain asymptomatic for a long time and cause no trouble, they also have high possibilities of getting worse with time. Usually surgical repair is recommended for treating hernias but your doctor may prescribe OTC (Over-the-Counter) antacid medicines at times to reduce the risk of your hernia or may ask you to wear a supporting truss. The hernia has a high rate of recurrence, and surgeons often use surgical mesh to strengthen the repair and reduce the rate of recurrence. The use of surgical mesh may also improve patient outcomes through decreased operative time and minimized recovery time. Now let’s understand more about Hernia mesh.

What is hernia mesh?

A hernia mesh is a surgical device used to provide added backing to damaged or impaired tissue due to hernia till it gets healed. It is placed through the area around the hernia, attaching it with stitches, staples or glue. Mesh’s pores let tissue to grow into the device.

How a hernia mesh works?

A hernia surgical mesh functions as an elastic scaffold for hernia repair. It reinforces walls of muscles and prevents organs from protruding through them.

Types of Hernia mesh

Most of contemporarily existing hernia mesh devices are composed of synthetic materials or tissues of animals. Surgical mesh manufactured from synthetic materials is available in knitted or non-knitted variants. The synthetic hernia meshes are made of absorbable, non-absorbable or a combination of these materials. Animal-derived meshes are made of processed and disinfected intestine or skin of pigs or cows, which are absorbable, suited for application as an implanted device.

Is Hernia mesh safe?

Hernia repair using mesh is currently one of the most regularly accomplished surgeries in general surgery. The use of mesh is recognized to reduce recurrence rates of hernia. As per evidence, non-mesh repair of hernias are associated with a higher recurrence rate at 1 year when compared to mesh repair.

Currently, chronic pain following hernia surgery is the most concerning post-operative complication with recurrence rates decreasing than ever before by using surgical hernia mesh.

Hence, the focus in hernia surgery is now shifted in defining, assessing and identifying risk factors relating to chronic pain. Chronic pain hernia surgery is a vital problem for a considerable number of patients. Some identified risk factors for post-operative pain include younger age, female gender, hernia recurrence, operative complications, and elevated pain levels in the immediate post-operative period. However, recent evidence confirms the safety and effectiveness of mesh utilization in hernia surgery. The recent evidence demonstrates that hernia repair with mesh is not linked to an intolerable level of severe chronic pain. Complication rates are low for hernia repair surgery and in majority of cases, not related to the mesh itself. It is shown that pain scores normally improve post 1 year of hernia repair.

How long does Hernia mesh last?

Non-absorbable mesh stay in the body forever and is termed as an everlasting implant. It is used to provide long-lasting support to the repaired hernia. On the contrary, absorbable mesh gets degraded eventually, losing its strength over time depending on its composition. It is not meant to provide lasting support to the repair site. As the absorbable mesh material degrades, new tissue growth is meant to give power to the repair.

If you are unsure about the specific which mesh to go with, mesh manufacturer and brand used in your surgery and have questions about your hernia repair, contact your surgeon or the facility where your surgery was performed to obtain the information from your medical record. 

If you get a minor cut or scrape at home while chopping food or while playing then it usually is self-treatable through the use of bandages or any home remedy. But, what if you get a nasty cut then how will you comprehend in case of a suture or a staple requirement? Usually, severe gash or wounds require the use of sutures, staples or surgical glues in order to close the wounds or surgical incisions. Doctors choose appropriate methods depending on the type of the wound or the surgery required.

Having said that, both sutures and staples have peculiar benefits and limitations that make them more or less appropriate for specific conditions. In many cases, sutures are essential for convenient healing. Severe wounds and deep cuts are prone to infection and other complications, and the longer a wound stays naked and vulnerable, the greater the risk of infection becomes. Sutures are one of the most common methods used for closing wounds of the skin. However, in cases of major wounds, the selection of an optimum method of wound closure is extremely vital. The type of material and technique depends on many factors such as depth, appearance, size, location, bleeding, age, material availability, and your doctor’s preference. 

Sutures

This is the most common method used for closing skin wounds. Sutures are basically thread-like medical devices that can either be permanent or temporary in nature, depending on their material of the composition.

Your doctor uses a surgical thread to sew or stitch two ends of the skin together. Temporary sutures get degraded in the body. However, the suture type to be used is decided by your surgeon based on your medical history. Your doctor may prefer to use permanent sutures in case you have:

  1. A major wound that might take a prolonged period to heal.
  2. To close your surgical wounds.
  3. Tying off blood vessels or bowel parts.
  4. If your wounds involve connective tissues or muscles.

Biodegradable sutures are preferred in cases of lower skin layer wounds, internal mouth surface wounds, internal soft tissue or smooth muscle wounds. Wounds with vasculature close to the skin surface are also preferred to be stitched by biodegradable sutures.

Sutures must be removed within 1-2 weeks of their placement, depending on the intensity and location of the wound. Immediate removal reduces the risk of marks, infection, and tissue reaction.

Staples:

Doctors prefer to use a surgical stapler in case of a long skin wound or an incision in a difficult-to-reach area. Alike sutures, staples can also be permanent or dissolvable in nature. Permanent staples need to be removed by your doctor. However, with dissolvable staples you have a lower risk of getting infected.

There are a plethora of benefits associated with the use of staples:

  1. They permit rapid wound closure causing the lowest damage.
  2. They are easier to apply and remove as compared to sutures, and anesthesia is given for a much lesser time.
  3. The most vital advantage of using staples is a decreased infection risk.
  4. Wounds also heal better with staples and lower are the chances of scar formation.

Surgical staples need to stay in for some days or up to 21 days in some cases before they can be removed.  How long the staples must stay in place depends mostly on factors such as:

  • Size and placement of the incision.
  • The type of surgical procedure. 
  • The complexity or severity of your incision or wound.

Numerous signs that your surgical staples may be ready to be extracted include:

  • The area has recovered completely and the wound won’t reopen.
  • There’s no pus, fluid, or blood drainage from the area.
  • There aren’t any symptoms of infection.

It is evenly important to take post-care of your injury or wound, once the stitches or staples are removed. Check with your doctor on how to take the necessary precautions which will help restore and heal your scars.

Despite the fact that they differ in many ways, sutures and staples are cosmetically equal when it comes to scarring. Conclusively, a doctor will decide the choice of technique and device based on his or her experiences and preferences according to the case.

A hernia repair surgery is usually very safe but several risk factors determine patient’s morbidity and mortality. Incarceration and strangulation are some of the common complications of hernias. The surgery complications include infections, fascial dehiscence, recurrence, visceral injury, and mesh erosion preset by many risk factors.

Strangulation and Incarceration:

A strangulated hernia occurs when the blood supply to the affected tissue has been cut off. This situation forces to release toxins and infection into the bloodstream, which could lead to sepsis or death in some cases. An incarcerated hernia occurs when herniated tissue becomes trapped and cannot easily be moved back into place. This state can lead to bowel obstruction.

Surgical complication:

As compared to laparoscopic surgery, an open approach has higher chances of complications. Most of the serious complications occur while accessing the abdominal cavity. Most common injuries occur to the small bowel and the iliac artery. Patients with past abdominal injuries or abdominal surgeries are more prone to severe complications.

As per the available evidence, surgical repair is the only current effective way to treat a hernia and it could be of two types – conventional and non-invasive. Hernia surgery can assist relieve pain, return the hernia abdominal organs to their exact place thus reinforcing the weak muscle area. A hernia operation usually takes around an hour as a day case procedure. It is a routine procedure, but as with all surgeries, there are risks of complications.

The conventional procedure being the open procedure whereas the non-invasive method includes laparoscopy. Though the hernia surgery is termed as “safe”, however, all surgical procedures come with certain risks. Probable risks involved in a hernia surgery could be:

  • Wound Infection at the cut- Despite the latest technologies and advancement in the surgical procedure, post-operative infection is still the leading cause of complications in hernia surgery. Infections can occur due to various reason including sutures, mesh that fails to suit the human body.
  • Recurrence of hernia- This state is occurred due to deep infection or when there’s extra pressure on repaired site or when a person resumes to physical activities much earlier than suggested by the doctor. However, it is preventable by mesh implantation.
  • Post-operative risk- This occurs as a direct result of fascial tissue failure to heal post laparotomy. Factors that can add to the misery is excessive smoking, obesity, age, malnutrition etc.
  • Blood clot formation due to prolonged bed rest.
  • In some cases, an open hernia procedure may lead to nerve damage and the patient can develop chronic pain in the affected area post-surgery.

The recovery process may depend on the surgical procedure itself. Majority of patients undergoing open hernia surgery can return home the same day and the estimated recovery time frame is proximately 3 weeks to 1 month. Depending upon your nature of work, total recovery may require one to six weeks. In the case of laparoscopic hernia surgery, the patient can return home the same day and estimated recovery period is about 1 to 2 weeks. One must wait for a month before starting any heavy exercises or activities that may cause strain.

Usually, the faster you return to your regular lifestyle, the better is the recovery rate. However, consult your surgeon before making any assumptions yourself because a prolonged approach can also lead to several complications. Your doctor may suggest that you wear a corset or a truss to lessen the pain. These supportive undergarments apply gentle pressure on the hernia and hold it in place. They may relieve any kind of discomfort or pain and are used only for temporary relief.

Among surgeries, a laparoscopic procedure is preferred because it shortens the duration of recovery post-surgery. However, a hernia recurrence post-surgery is not uncommon. A recurring hernia can be identified as a lump, sometimes painful, appearing at or near the site of the initial hernia. It can lead to major complications if the recurrence is progressive.

There could be various reasons adding to the factor such as infected hernia wound, resuming heavy physical activities soon after surgery, chronic cough, and obesity. Other common predisposing factors are smoking, old age, and muscle weakness. Hence, it’s always advisable to practice a certain healthy lifestyle which includes maintaining a healthy body weight, avoid lifting heavy objects without supervision and eating a fiber-rich diet to make bowel movements softer and easier to pass

Hernias are rather usual and can confound anyone. However, how can you know that you have developed one? There are various causes of hernia such as straining of muscles due to heavy weight lifting, multiple pregnancies, congenital reasons or you can get one even from a recent accident. Additionally, lifestyle variables such as obesity, smoking, and not having a nutritious diet can cause a hernia.

The abdomen is the most common area for developing a hernia, however, it can also be seen in the upper thigh or chest. A hernia can take time to show symptoms and sometimes those symptoms can lead to intense pain thus leading to surgery. The conventional symptom of a hernia is the appearance of a bulge in the groin area. You may observe a lump in the pubic region if you have an inguinal hernia whereas hiatal hernia has more characteristic symptoms such as heartburn, chest pain, breathing, and swallowing problems etc. In many cases, a person may not complain of any symptom at all and it may be accidentally detected during a routine examination. As your hernia grows, discomfort may grow as well.

Early signs of a hernia may include:

  • A bulge in the groin area or scrotum or swelling in the scrotum.
  • Pain or discomfort in the affected area which worsens during bending or heavy lifting.
  • Heaviness in the abdomen and burning or aching sensation in the bulge.
  • Pain or aching sensation while passing stools or urinating.
  • Pain in the abdomen, typically during evenings after you have remained standing for most of your day.
  • In case of a strangulated hernia, you may also have a fever, vomiting, nausea, and severe abdominal cramps.

While a hernia may begin as an innocuous lump, it can get bigger and begin to trouble with time. In some cases, it can even be perilous. So regardless of whether it doesn’t appear to be a serious deal, it’s ideal to see your primary care physician in case you have indications of a hernia, similar to a bump or lump you can’t clarify.

Seek medical attention immediately if you have a hernia and these symptoms:

  • The bulge appears to be dark, purple, or red.
  • You can’t pass stools.
  • You have a high fever.
  • The pain quickly worsens.
  • You’re throwing up or have an upset stomach.

The diagnosis of a hernia is generally a clinical one, which implies that your doctor will go through a history of your symptoms followed by a brief physical examination. In the great majority of cases, where there is a conspicuous swelling in the groin/abdominal area, which increases in size on standing, straining or coughing, a clinical diagnosis of hernia is made and no tests are needed. More challenging diagnoses are best performed by hernia specialists.

Usually, your doctor can determine if you have a hernia with just physical examination. They may ask you a variety of questions along with cross-checking your medical history. During this diagnosis of a hernia, your doctor may ask you to perform activities like standing and coughing to confirm the possibility of a hernia.

Furthermore, your doctor will confirm that you have a hernia by prescribing some tests such as ultrasound of your abdomen, A CT or MRI scan which is like X-rays. Your doctor may also ask you to undergo an endoscopy; a non-surgical procedure used to examine a person’s digestive tract. Using an endoscope, a flexible tube with a light and camera attached to it, your doctor can view pictures of your digestive tract on a colour TV monitor.

For adults, particularly if the medical procedure could be dangerous for you, your primary care physician may propose simply watching out for it as long as the hernia’s small and not creating any serious issues for you. However, in some cases, you can always lower your odds of getting a hernia by following simple steps such as following a well-balanced diet and staying at a healthy weight, quitting smoking, talking to your doctor if your cough won’t go away, and using the correct form while doing any physical activity (bend from your knees instead of the waist while weight lifting).