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Hernia
Definition
A hernia is a sac formed by the lining of the abdominal cavity (peritoneum). The sac comes through a hole or weak area in the fascia, the strong layer of the abdominal wall that surrounds the muscle.
The types of hernias are based on where they occur:
- Femoral hernia appears as a bulge in the upper thigh, just below the groin. This type is more common in women than men.
- Hiatal hernia occurs in the upper part of the stomach. In this hernia, part of the upper stomach pushes into the chest.
- Incisional hernia can occur through a scar if you have had abdominal surgery in the past.
- Inguinal hernia appears as a bulge in the groin. This type is more common in men than women. The bulge may go all the way down into the scrotum.
- Umbilical hernia appears as a bulge around the belly button. It occurs when the muscle around the navel doesn't close completely.
Alternative Names
Hernia - inguinal; Inguinal hernia; Direct and indirect hernia; Rupture; Strangulation; Incarceration
Causes
Usually, there is no obvious cause of a hernia. Sometimes hernias occur with heavy lifting, straining while using the toilet, or any activity that raises the pressure inside the abdomen. Hernias may be present at birth, but the bulge may not be noticeable until later in life. Some patients may have a family history of hernias.
Hernias can be seen in infants and children. This can happen when there is weakness in the abdominal wall. About 5 out of 100 children have inguinal hernias (more boys than girls). Some children may not have symptoms until they are adults.
Any activity or medical problem that increases pressure on the abdominal wall tissue and muscles may lead to a hernia, including:
- Chronic constipation, straining to have bowel movements
- Chronic cough
- Cystic fibrosis
- Enlarged prostate, straining to urinate
- Extra weight
- Fluid in the abdomen (ascites)
- Heavy lifting
- Peritoneal dialysis
- Poor nutrition
- Smoking
- Overexertion
- Undescended testicles
Symptoms
Most often there are no symptoms. However, sometimes there may be discomfort or pain. The discomfort may be worse when you stand, strain, or lift heavy objects. In time, most people will complain about a growth that feels tender and is growing.
Although a hernia may only cause mild discomfort, it may get bigger and strangulate. This means that the tissue is stuck inside the hole and its blood supply has been cut off. If this occurs, you will need urgent surgery.
Exams and Tests
A health care provider can confirm that you have a hernia during a physical exam. The growth may increase in size when you cough, bend, lift, or strain.
The hernia (bulge) may not be obvious in infants and children, except when the child is crying or coughing. In some cases, an ultrasound may be needed to look for a hernia.
If you may have a blockage in your bowel, you will need an x-ray of the abdomen. CT scans are also very useful for finding some hernias.
Treatment
Surgery is the only treatment that can permanently fix a hernia. Surgery may be more risky for patients with serious medical problems. If the hernia is small and not causing symptoms, your surgeon may just need to watch it to make sure it is not growing or causing problems.
Surgery will usually be used for hernias that:
- Are getting larger
- Are painful
- Cannot be reduced without surgery
- May involve a trapped piece of bowel
Surgery secures the weakened abdominal wall tissue (fascia) and closes any holes. Today, most hernias are closed with cloth patches to plug up the holes.
An umbilical hernia that does not heal on its own by the time your child is 5 years old may be repaired.
Emergency surgery is sometimes needed. The sac containing the intestine or other tissue may become stuck in the hole in the abdominal wall. If it cannot be pushed back through, this can lead to a strangulated loop of intestine. If left untreated, this portion of the intestine dies because it loses its blood supply.
Today, hernias can be fixed by open surgery or with the use of a laparoscope (camera). The advantages of using a camera include smaller surgical cuts, faster recovery, and less pain after the procedure.
For information on hernia surgery, see also:
Outlook (Prognosis)
The outcome for most hernias is usually good with treatment. It is rare for a hernia to come back (1 - 3%). Incisional hernias are more likely to return.
Possible Complications
In rare cases, inguinal hernia repair can damage structures involved in the function of a man's testicles.
Another risk of hernia surgery is nerve damage, which can lead to numbness in the groin area.
If a part of your bowel was trapped or strangulated before surgery, it may lead to a bowel perforation or dead bowel.
When to Contact a Medical Professional
Call your doctor right away if:
- You have a painful hernia and the contents cannot be pushed back into the abdomen using gentle pressure
- You develop nausea, vomiting, or a fever along with a painful hernia
- You have a hernia that becomes red, purple, dark, or discolored
Call your doctor if:
- You have groin pain, swelling, or a bulge
- You have a bulge or swelling in the groin or belly button, or that is associated with a previous surgical cut.
Prevention
- Use proper lifting techniques.
- Lose weight if you are overweight.
- Relieve or avoid constipation by eating plenty of fiber, drinking lots of fluid, going to the bathroom as soon as you have the urge, and exercising regularly.
- Men should see their health care provider if they strain with urination. This may be a symptom of an enlarged prostate.
References
Turnage RH, Richardson KA, Li BD, McDonald JC. Abdominal wall, umbilicus, peritoneum, mesenteries, omentum, and retroperitoneum. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier;2008:chap 43.
Reviewed By: Shabir Bhimji MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
