What is a hernia?
What is a hernia?
A hernia is a gap in the muscles and fascia of the abdominal wall through which the inner contents, small and/or large intestines, stomach, bladder etc, may protrude out beneath the skin.
What are the types of hernia?
There are several types of hernias. They are broadly divided into internal and external hernias. Internal hernias are not apparent on the outside and can be dangerous. They may occur from birth defects or after some bariatric procedures. As such, they will not be discussed any further here.
External hernias are far more common and vary in size and location. They may present at birth, in old age or any time in between. Both sexes are affected by this condition.
External hernias are the more common ones and are of several types:
Inguinal Hernia
Seen very commonly, a swelling in the groin may which appears on standing and reduces on lying down may be an Inguinal hernia. Both females and males may suffer from Inguinal hernia.
Femoral Hernia
This is also seen in the groin. It occurs more commonly in women, and often presents as an emergency with bowel obstruction (abdominal pain, severe vomiting, distension of the belly and inability to pass wind).
Incisional Hernia
A hernia that appears after an abdominal surgery is known as incisional hernia. The location of the hernia depends upon the type of incision chosen for the primary surgery. The hernia occurs when the scar of the surgery becomes weak due to any reason and gives way.
Umbilical Hernia
This term refers to a hernia of the navel. This is quite commonly seen in females, especially post pregnancy. Umbilical hernia is the most common cause of disfigurement of navel region.
Epigastric Hernia
This type of hernia is seen in the mid upper portion of the abdomen. Although usually small in size, they may be painful or large in a few individuals.
Lumbar Hernia
A lumbar hernia occurs in the flank (towards the back). Though hernias at this site typically result from kidney surgeries, they may occur as primary hernias.
Spigelian hernia
A Spigelian hernia occurs through a gap in the side of the six pack muscles (rectus abdominis). They are typically located in a zone somewhere below the level of the navel.
Hiatus hernia
When the stomach slides to the chest cavity through the diaphragm, it is called a sliding hiatus hernia. Reflux and heartburn are the most common symptoms. A paraesophageal hernia, the less common type, typically presents with vomiting, often resulting from gastric volvulus.
Parastomal hernias
When the bowel escapes by the side of a segment of colon or ileum that is sometimes done as part of abdominal surgery, it is called a parastomal hernia. These hernias are notoriously difficult to treat, with very high recurrence rates.
Diastasis of recti
When the gap between two six pack muscles of the abdomen is more than 2 cm, the shape of the belly may be lost. This is called diastasis recti. In severe cases, the patient may have functional problems with urination, defecation and may also have low back pain.
What are the symptoms of hernia?
1. Swelling in the groin or abdominal wall which increases on prolonged standing, coughing, sneezing or even a good laugh!
2. Pinching or dull aching pain in the swelling.
3. Constant pulling sensation inside the abdomen.
4. Constipation or difficulty in passing urin.
5. Gross abnormality the the shape of the belly or private parts lead to embarrassment.
Why do hernias need treatment?
Although majority of the hernias remains symptom free there is always a chance that the gut may get trapped in the defect, leading to a life-threatening condition called strangulation.
How are hernias treated?
There are no magic pills for hernias! Surgery is the only way out to treat a hernia.
In groin hernias, a space underneath the muscles is created so as to allow the placement of a large piece of synthetic mesh that stays permanently in place and prevents the hernia from recurring.
In ventral and incisional hernias, the defect is closed with stitches after the contents are safely placed back into the abdominal cavity. An appropriately large mesh is placed under or over the abdominal muscles. This protects the repair.
At present, laparo-endoscopic (keyhole) approaches have made recovery very quick, safe and pain free, with minimal hospital stay. To a large extent, laparoscopic surgery has helped reduce the fear involved with open surgery, e.g. long cuts, prolonged and severe pain, delayed recovery, loss of work and wages. Using a mesh is the standard of care in most cases.
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