Hernia Symptoms, Risk Factors, Diagnosis and Treatment

1.

What is Hernia?

A Hernia occurs when there is a weakness or hole in the peritoneum (muscular wall). The function of peritoneum is to keep the organs in the abdominal region in place. In here if the organs or tissues are pushed out to form a bulge, then it is said to be herniated. They are commonly found in the abdomen, upper thigh and groin region. They are usually not life threatening but in some cases surgery is advised to avoid potentially dangerous complications.

2.

What are the common types of Hernia?

1. Inguinal Hernia (inner groin)

2. Incisional Hernia (resulting from an incision)

3. Femoral Hernia (outer groin)

4. Umbilical Hernia (belly button)

5. Hiatal Hernia (upper stomach)

What is an inguinal Hernia?

These Hernias make up seventy-five percent of all abdominal wall Hernias and occurs typically in men than women, these Hernias are divided into two different types, direct and indirect. Both occur within the groin area where the skin of the thigh joins the body part (the inguinal crease). Both of these Hernias will present themselves as a bulge within the inguinal area. Distinguishing between direct and indirect Hernia, however, is an important part of the clinical diagnosis.

Indirect inguinal Hernia: An indirect Hernia follows the pathway that the testicles created throughout fetal development, descending from the abdomen into the scrotum. This pathway unremarkably closes before birth however might become a site for a Hernia in later life. Sometimes the Hernia sac might protrude into the scrotum. An indirect inguinal hernia may occur at any age.
Direct inguinal Hernia: The direct inguinal hernia happens in a distinct area where the abdominal wall is slightly diluent. It seldom will protrude into the scrotum and might possibly cause pain that’s hard to tell apart from testicle pain. Unlike the indirect Hernia, which might occur at any age, the Direct Hernia tends to occur to the aged as a result of their abdominal walls weakening as they age.

What is an incisional Hernia?

These Hernias occur at the site of a previous abdominal surgery where the intestine pushes out against the abdominal wall. It is said to be common in overweight or elderly people who are inactive, especially after their abdominal surgery.

What is a Femoral Hernia?

The femoral canal is the path through which the femoral artery, vein, and nerve leave the cavity of the abdomen to enter the thigh. Although usually a stiff space, typically it becomes large enough to permit the abdominal contents (usually intestine) to protrude into the canal. A femoral hernia causes a bulge just below the inguinal crease roughly in the middle of the upper leg.

Femoral Hernias in women are common and are particularly at risk of becoming irreducible (not able to be pushed back into place) and strangulated (cutting off blood supply). Not all Hernias that are irreducible are strangulated (have their blood supply cut off), however all Hernias that are irreducible have to be evaluated by a skilled physician.

What is an umbilical Hernia?

These common Hernias (10%-30%) are often noted in children at birth, they are observed as a protrusion at the belly button (the umbilicus). An Umbilical hernia is caused when an opening in the child's abdominal wall, which normally closes before birth, doesn't close completely. If tiny (less than half an inch), this type of Hernia usually closes gradually by age 2. Larger hernias and those that do not close by naturally require surgery when a child is 2 to 4 years of age. Even if the region is closed at birth, umbilical hernias can appear later in life because this spot may remain a weaker place in the abdominal wall. Umbilical Hernias can appear later in life or in women who are pregnant or who have given birth which is caused due to the additional stress on the area. They usually do not cause abdominal pain.

What is Hiatal Hernia?

This type of hernia happens if part of the abdomen pushes through the diaphragm. The diaphragm commonly includes a little gap for the esophagus. This gap will become herniated when part of the abdomen pushes through. Small Hiatal Hernias may cause no major symptoms, however, larger ones can cause pain and heartburn.

What are other rare types of Hernias?

Diaphragmatic Hernia : This is usually a birth defect causing an opening in the diaphragm, which allows abdominal contents to push through into the chest cavity.
Spigelian Hernia : This rare hernia happens on the sting of the rectus abdominal muscle through the Spigelian connective tissue, which is several inches lateral to the middle of the abdomen.
Obturator Hernia : This very rare abdominal hernia develops principally in women. This hernia protrudes from the cavum through a gap within the girdle bone. This will not show any bulge but can act like a bowel obstruction which causes nausea and vomiting. Because of the shortage of visible bulging, this Hernia is very difficult to diagnose.
Epigastric Hernia : Occurring between the navel and therefore the lower part of the skeletal structure within the sheet of the abdomen, epigastric hernias are composed usually of fatty tissue and rarely contain intestine. Formed in a locality of the relative weakness of the wall of the abdomen wall, these hernias are often painless and unable to be pushed back into the abdomen when first discovered.

3.

What are the main causes of Hernia?

In most cases, there is no reason for a Hernia to occur except for a complication of abdominal surgery causing an incisional Hernia. As age increases, the risk of Hernia also increases. Hernias are a more common occurrence in men than women.

A Hernia may be present from birth i.e. congenital such as a congenital diaphragmatic Hernia or it may develop in children with a weak abdominal wall.

The following activities or medical problems which put pressure on the abdominal wall lead to Hernia:

Straining on the toilet
Persistent cough
Enlarged prostate
Cystic fibrosis
Straining to urinate
Obesity
Abdominal fluid
Lifting heavy items
Peritoneal dialysis
Poor nutrition
Smoking
Physical exertion
Undescended testicles

What are the symptoms of the Hernia?

In many cases, it is simply a painless swelling causing no problems which need no immediate medical attention. However, it may cause discomfort and pain while doing certain activities such as lifting or bending over.

In a few cases, for instance, when the gut part becomes strangulated due to the inguinal Hernia it may require immediate medical attention or even a Hernia surgery.

Other symptoms which may require Hernia treatment are as follows:

1. Reducible Hernia

It may appear as a new lump in the groin or abdominal region
It may ache but not tender when touched
The pain precedes in the lump region
The lump may increase in size while standing or when abdominal pressure is increased due to coughing or sneezing continuously
It may be pushed back unless very large

2. Irreducible Hernia

Occasionally painful
Enlargement of the previously reducible Hernia will not be able to return to its original shape when you push it
It may be chronic without pain
It is also known as incarcerated Hernia
Leads to strangulation Hernia
Bowel obstruction symptoms may occur such as nausea and vomiting

3. Strangulated Hernia

The blood supply of the entrapped intestine is cut off
Pain followed by tenderness
Nausea and vomiting
The person may appear ill with or without fever

4.

Which are the risk factors regarding Hernia?

Incisional Hernia

This Hernia is caused after the surgery mostly around 3-6 months after the procedure. This happens usually when the person involved is:

Involved in strenuous activity
Gains extra weight
Becomes pregnant.

These activities put extra stress on the healing tissue which mostly causes a Hernia in women.

Inguinal Hernia

These Hernias are usually common in:

Older adults
Hereditary
Males
Smokers
Chronic constipation
Premature birth
Pregnancy
Low birth weight

Umbilical Hernia

These Hernias occur in cases of:

Babies

With a low birth weight
Who are born prematurely

Adults

Who are overweight
Women who bear multiple pregnancies

Hiatal Hernia

These Hernias occur in:

Individuals aged over 50 years
Individuals who are overweight

5.

Diagnosis and Treatment of Hernia

How are Hernias diagnosed?

Direct inguinal Hernia or incisional Hernias are diagnosed usually through a physical examination. The bulge may appear in the abdomen or groin which gets larger when the person stands, cough or strain.

Hiatal Hernia is diagnosed through a Barium X-ray or endoscopy. The barium X-ray is a series of X-ray images of a digestive tract. An endoscopy examination involves threading a tiny camera hooked up to a tube down the throat and into the gullet and abdomen. These tests are to exactly locate your Hernia in the stomach.

CT Scans

The doctor may also order a CT scan for the diagnosis of Hernia to check for conditions that can cause abdominal pain and swelling, such as appendicitis, which is an inflammation of the appendix.

This procedure uses X-rays to form pictures of the abdomen and its organs. Sometimes, you’re given a distinctive dye intravenously, through a vein in your arm, before the test. This helps give the hernia more visibility in the pictures. The dye leaves the body hours later within the excreta.

MRI Scans

The Hernia doctor or specialist may recommend an MRI scan, particularly if your pain gets worse when you exercise. In some people, participation in sports can cause a Hernia that has no visible bulge initially. An MRI scan will help observe any tears within the abdominal muscles.

In MRI, radio waves and a magnetic field are used to create images of abdominal organs and other structures. Sometimes, a contrast dye is injected into a vein in the arm to make the Hernia more easy to distinguish from the organs.

Ultrasound

Your doctor could advocate an ultrasound if you’re a woman of childbearing age. This test allows doctors to check for other pelvic conditions, such as ovarian cysts or fibroids, which can cause abdominal pain.

This test uses sound waves to create images of the abdomen and pelvic organs. A hand-held device known as a transducer is placed on the abdomen, sending pictures to a monitor to be viewed.

Treatments for Hernia

The need for Hernia treatment depends upon the size and the severity of the symptoms. Hernia treatment includes three options:

Lifestyle changes
Medication
Surgery

Lifestyle changes

Dietary changes can often treat the symptoms of a Hiatal Hernia but it won’t make the hernia go away. The affected person is asked to avoid large or heavy meals and not to bend over after the meal or to lie down. The person must keep the body weight in a healthy range.

Certain exercises for Hernia may help strengthen the muscles around the Hernia site which helps reduce the symptoms. But if the exercise is done improperly, it increases the pressure in that area and causes the Hernia to bulge. And so it is essential to follow the Hernia doctor or physical therapist's order properly.

The symptoms of a Hernia can be treated by avoiding foods such as spicy foods which may cause acid reflux or heartburn. Additionally, you can avoid acid reflux by weight loss and quitting cigarettes.

Hernia Medication

Hernia medicines such as antacids, H-2 receptor blockers and proton pump inhibitors. can reduce stomach acid which can relieve the discomfort and improves symptoms.

Hernia Surgery

Hernias are often repaired with either open or laparoscopic surgery. Laparoscopic surgery for Hernia uses a tint camera and miniaturized surgical equipment to repair the Hernia using few incisions. They are said to be less damaging to the surrounding tissues.

An open hernia operation is typically performed when someone has a single Hernia and has never had one before. In this procedure, the doctor makes an incision within the groin or abdomen, returns the muscle, organ, or other tissue to its original position, and removes the sac that held the Hernia. The doctor could either put together healthy muscle or insert a mesh to bolster the weakened space. Open surgery has a longer recovery process. The patient is unable to move around normally for up to six weeks.

The Hernia doctor may perform laparoscopic surgery for inguinal Hernia, particularly if you have bilateral Hernias one on each side or if a previous open repair didn’t correct the Hernia or prevent it from returning.

In laparoscopic hernia surgery, the surgeon makes a small incision in the peritoneum, to fix the Hernia and does not open up the operated area. Laparoscopic surgery creates smaller incisions, and hence leaves smaller scars, there is also less chance of pain after surgery and a faster recovery.

However, not all hernias are suitable for laparoscopic repair. This is especially the case in Hernias where a small portion of your intestine has descended into the scrotum.

6.

Complications arising if a Hernia is left untreated

If the Hernia is left untreated, it may grow and become more painful. A portion of the intestine could become trapped in the abdominal wall. This can obstruct the bowel and cause severe pain, nausea, or constipation. An untreated hernia also can place an excessive amount of pressure on nearby close tissues. This can cause swelling and pain within the surrounding space.

If the trapped section of the intestines doesn’t get enough blood flow, strangulation Hernia occurs. This can cause the tissue of intestine to become infected or die. A strangulated hernia is critical and needs immediate medical aid.

Untreated Hernia complications

It is important to recognize the early signs of a Hernia. An untreated Hernia may not disappear on its own. However, with proper medical care or lifestyle changes, the effects of Hernia can be minimized which can avoid life-threatening complications like strangulation Hernia.

7.

How to prevent a Hernia

The muscle weakness which causes the Hernia cannot be prevented. However, the amount of strain one puts on their body can be reduced. This helps in avoiding Hernia or keeping an existing Hernia from getting worse.

Few tips that may help in preventing Hernia are as follows:

No smoking
Seeing the doctor when you are sick to avoid developing a persistent cough
Maintaining a healthy body weight
Avoiding straining during bowel movements or urination
Lifting objects together with your knees and not your back
Avoid lifting weights that are too heavy

8.

Road to recovery and aftercare

1. Diet

There are no absolute diet restrictions after a Hernia surgery. Some patients could notice that their appetence is poor for a few weeks after the surgery. This is a normal result of the stress of surgery, the patient’s appetite should return in time. If you find you are persistently nauseated or unable to take in liquids, contact your Hernia doctor immediately.

2. Wound Care

● It is fine to shower starting around 36 hours after a hernia operation. If you have gauze on the incisions, take it off before showering.
You might see little item of tape (called steri-strips) directly connected to your skin. It is fine to get these little tapes wet in the shower. The tapes will begin to peel up on the ends 7 – 10 days after the Hernia operation; at this point, they have done their job and it is fine for you to peel them the rest of the way off if you wish. You do not have to have them on when you come for your post-operative visit.
No baths, pools or hot tubs for two weeks post surgery.
Do not apply any ointment or different medication on your incisions; it’ll not build them heal sooner.

3. Activity

There are not any medical or physical restrictions on activity once the surgery. That means it is fine to walk, climb stairs, lift, have sexual intercourse, mow the lawn, or exercise as long as it doesn't hurt. Returning to normal activity is not really a problem for recovery. However, if it doesn't feel good, don't do it. Take it easy and let pain be your guide.

It’s also normal to feel tired and washed out for a week or two following the surgery. These factors can place some limitations on your activity, but you will not cause any long term harm even if some soreness is experienced.

4. Work

Everyone returns to work at different times. If you want, you may return to work right away; however, as a rough guide, most people take at least 1-2 weeks off before returning to work as hernia operation recovery time.

5. Driving

You will usually be able to drive once you are off the prescribed narcotic (prescription) or pain medications for two days.

6. Bowel Movements

The first bowel movement occurs anyplace from one-five days once surgery; as long because the patients don’t seem to be ill or having abdominal pain this variation is suitable. Remember that it’s quite common to pass a great deal a lot of gas from your body than you are accustomed to. This is because you will not be able to belch.

It is also common to have symptoms of diarrhea or "loose bowels" after hernia surgery, the bowel function normalizes with time. Constipation might also be common because of the pain medication. To avoid constipation it is recommended to take Milk of Magnesia (2 tablespoons; twice a day) for a few days post the operation.

7. Seroma

Some patients notice that their hernia returns right once the surgery. This occurs when the hernia contents fills up with postoperative fluid. This fluid is typically absorbed by the body in a few weeks.

8. Pain (Usually witnessed in male Hernia patients)

It is expected that your scrotum may be slightly swollen or tender. Along with the usage of oral pain medications you can also make use of ice packs to make the swelling subside.

9. Urgent medical attention needed

Call your Hernia doctor immediately if any of the following serious complications occur:

Fever of 100.4 or greater
Shaking chills
Pain that increases progressively over time
Redness, warmth, or pus draining from incision sites
Persistent nausea or inability to take in liquids

9.

Hernia FAQs: All your concerns addressed

1. What are the leading causes of Hernia?

Other than incisional hernia (a complication of abdominal surgery), mostly there’s no particular reason for the hernia to get triggered. However, in some cases, the hernia can be congenital or can also trigger due to medical issues that increase the pressure on the abdominal walls. These include:

Persistent cough
Cystic fibrosis
Issues in urinating
Enlarged prostate
Poor nutritional habits
Smoking
Physical exertion

2. What are the different types of Hernia?

Some common forms of hernia include:

Epigastric hernia: It occurs in the epigastric region of your abdomen (above the belly button and below the ribcage). In this case, you experience an undue pressure on your abdominal wall whenever you laugh, cough, or are performing a bowel movement. You might also experience pain around the area where the hernia is

Femoral hernia: It occurs when tissues push through a weak point in the groins or inner thigh. In this case, the hernia might block your blood flow to and from the leg, and thus doctors prefer removing this through a surgery
Inguinal hernia: It occurs when your intestines or fat bulges through the lower stomach wall and passes the inguinal canal (present in the groin area)
Umbilical hernia: It occurs when tissues in the body bulge through the umbilicus and gets worse whenever you cough or strain during a bowel movement. It’s common in newborn and is easily curable through a surgery

3. I am hesitant about the Hernia surgery. Is it necessary for me to operate?

You need to realize that having fear regarding surgery is normal. If your health condition doesn't require it than the doctor wouldn't have suggested it. But still, if you have any queries regarding your surgery you can note them down and ask your doctors. This will help alleviate undue stress.

4. How long will it take for me to resume my normal activities after the surgery?

For every person the recovery time is different. If you want, you may resume your normal activities right away; however, as a rough guide, most people take at least 1-2 weeks off before doing any strenuous work. But there are no medical or physical restrictions on activity after surgery. That means it is fine to walk, climb stairs, lift, have sexual intercourse, mow the lawn, or exercise as long as it doesn't hurt. Returning to day-to-day activity as shortly as attainable can possibly enhance your recovery.

5. Which is a safer alternative; Open surgery or Laparoscopy?

Open repair of a Hernia operation is typically performed when someone has a single Hernia and has never had one before. The surgeon makes an incision in the groin or abdomen, they then return the Herniated muscle, organ, or other tissue to its original position, the sac that held the Hernia is removed. The surgeon may insert a mesh to reinforce and reduce the stress on the weakened area. Open surgery requires a longer recovery process. The patient is unable to move around normally for up to six weeks.

In laparoscopy, the doctor or specialist will make an incision in the peritoneum, a layer of tissue that lines the groin, and uses required surgical tools to fix the Hernia. Because laparoscopic surgery requires smaller incisions, it usually results in smaller scars and less pain after surgery.

Besides, not all Hernias are suitable for laparoscopic repair. This includes Hernias wherever some of your intestines have moved down into the scrotum.

6. Can Hernia become a medical emergency? How to recognize if it needs medical supervision?

The hernia can often get severe in two cases: when it becomes strangulated or incarcerated. In the latter scenario, the protruding tissues fail to be pushed back into place which puts undue pressure on your body leading to discomfort.

However, in the case of strangulated hernia, the situation worsens and it’s indeed a medical emergency because the area bulging through starts losing blood frivolously. So, as soon as doctors notice signs of hernia, they recommend treating it immediately to keep it from getting worse.

You must consult a doctor in case you are suffering from hernia and experience the following symptoms:

Constipation
Fever
Nausea
Problems passing gas
Sudden and severe pain at the hernia site
Vomiting

7. What is the Hernia surgery cost in India?

The cost of the Hernia depends on many factors such as the type of Hernia and the location where you are getting operated. After the appropriate tests are done, your doctors shall suggest the estimate of the Hernia surgery cost. The cost of Hernia surgery is less in India than if you get it done from other countries. The Hernia surgery cost in India may vary from hospital to hospital, hence it’s essential to do your research online and compare prices at various hospitals. However, make sure to choose the best hospital for Hernia operation and not compromise on quality of care.

8. What tests help doctors diagnose a hernia?

First and foremost, you will undergo a physical examination. If there are visible signs of hernia, the doctor will not perform any other tests to diagnose. However, if you have a dull ache in the groin area or are feeling pain in any other body part while lifting heavy items, the doctor might ask you to stand or cough to check probable signs of hernia.

If you’re showing signs of indirect inguinal hernia, your doctor might look for a hernia by inverting the skin of the scrotum with his/her finger.

Also, the doctor may recommend you undergo an X-ray, a CT-Scan, or get an Ultrasound test done. Depending on the severity of the situation, your doctor may also recommend surgery and refer you to a surgeon for the procedure.

9. How long should I stay at the hospital after the Hernia surgery is completed?

This depends entirely on what you are being treated for and the location of the Hernia surgery. Sometimes, people don’t need to stay in the hospital overnight after the procedure but others do. Your doctor will inform you about the length of your stay so that you can make arrangements accordingly.

10. What are the risks associated with Hernia?

As is the case with all surgeries, infection and/or bleeding are two common risks associated with hernia surgery. Also, if you’re an avid smoker and consumes alcohol in excess, and are quite aged, the complications could be worse. Other side effects include injury of the intestines, bladder, blood vessels, etc. along with extended scarring. To understand more about complications, you must consult with your doctor well-in-advance before the surgical process takes place.

11. Can a hernia be misdiagnosed?

Hernias can be misdiagnosed in women, they are usually thought to be ovarian cysts, endometriosis, fibroids, or other abdominal problems. This is usually because hernias, in women, can be small and internal. The bulge may not be felt during an exam or be visible outside the body. Male or female, if you experience consistent pain in the abdominal or groin regions, visit your doctor immediately. If left untreated the hernia can block a portion of the intestine and cause gangrene, which will lead to further complications. When a hernia is properly diagnosed, the operations will take an hour and you won’t require hospitalization. The patient will be back on their feet and can return to normal activities within four weeks.

12. How to check for a hernia?

If it’s an inguinal hernia, then a physical exam is needed for effective diagnosis. During the test, the doctor will check for a bulge in the groin area and you will be asked to stand or cough because it will make the hernia bulge more prominent. If it’s an internal hernia then it won’t be evident, and your doctor will ask you to go for an imaging test like an ultrasound or CT scan. This will help then diagnose you better. Many people think they can repair the hernia themselves, especially if the hernia is small and not painful, but it’s always best to seek medical help so that the condition doesn’t get worse.

13. What are the three types of hernia?

Groin Hernias: Most hernias occur around the groin region. Mostly all the groin hernias are of the Inguinal type, and they occur when a section if the intestine pushes through a weak spot in the lower belly area and it affects the inguinal canal; which is located in the groin area. The inguinal hernia is further divided into two types: • Indirect: This is the common type and it enters the inguinal canal • Direct: Doesn’t enter the canal People experience inguinal hernia when they lift heavy objects and it's more common in men than women. Umbilical hernias: This is more common in newborns, and it occurs when a section of the intestine or fat pushes through the muscles that are located near the belly button. You can have surgery to get rid of it, but it’s mostly harmless. Epigastric Hernia: This takes place when the fat pushes through the area between the navel and lower part of the breastbone.

14. How to check for a hernia in the initial stages?

If you think you have a hernia and feel a bulge in your abdominal region, then visit a doctor as soon as possible. Most people tend to wait until they start feeling pain or severe discomfort, or if the hernia has grown larger than before. Hernias don’t repair themselves and if left untreated, they will get worse with time. If you get medical help in the initial stages, the hernia will be repaired with minimally invasive surgery, and it’s easier than open surgery with fewer complications as well.

15. Can a hernia cause bloating?

Bloating and constipation can be significant symptoms for hernias. This is because hernias usually obstruct the intestines and this leads to blockage; which results in bloating, cramps, and constipation. A hernia blockage will keep liquids and foods in your small/large intestine or colon. If there is no treatment the blocked section of the intestine can die, and this will lead to serious complications like an infection that will build to a surgical emergency.

16. Can weight loss help prevent a hernia?

Yes, weight loss is imperative if you want to prevent a hernia. This is because it relieves the abdomen area from any excess pressure. Weight loss can prevent a hernia from developing, improve its symptoms, and avoid any complications. If you are overweight, the doctor will recommend that you lose weight, if the hernia needs to be treated with surgery. Weight loss will also decrease the risk of any complications that come with a hernia, including, slow wound healing, blood clots, and infections.

17. Can you feel a hernia while lying down?

Not really, hernias are usually under-pronounced when you’re lying down. This is because there is less pressure on the abdominal wall from the internal organs. If you think you have a hernia, then you will experience shooting pain and discomfort when the body is under strain. So, acts like coughing, sneezing and lifting will help you identify the hernia.

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NH cares All you need to know about Hernia

1.