All you need to know about Hernia
(Symptoms, Diagnosis, Treatment, Risks)

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.

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.

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