Hernea

Hernias are common and may affect people of all ages.

A hernia is when an internal part of the body e.g. organ, pushes through a weakness in the muscle or surrounding tissue wall. Usually, your muscles are strong and tight enough to keep your intestines and organs in place; but sometimes they aren't, causing a hernia.

A hernia feels like a soft bulge or swelling under the skin.

There are different types of hernia:

Inguinal

The most common type of hernia is found in the groin and is called an inguinal hernia. This type of hernia is caused by a loop of bowel pushing through a weakness in the inguinal canal. The inguinal canal is a triangle-shaped opening between layers of abdominal muscle near the groin.

They are most common in men and male babies, and occur when a loop of bowel slides down the narrow canal down towards the scrotum. The hernia usually appears as a swelling in the groin or enlargement of the scrotum, which may or may not be painful and often disappears when lying down.

98 out of 100 people who develop a hernia in their groin are male.

Femoral

A femoral hernia occurs most commonly in over- weight women. Part of the intestine passes down the natural canal through which the large blood vessels for the leg pass and make a swelling on the upper and inner part of the thigh.

Umbilical

Umbilical hernias can sometimes occur in infants, particularly those who are born prematurely. However, they are usually painless and close on their own before the age of two.

An umbilical hernia occurs when part of the intestine protrudes through a weakness in the abdominal wall, creating a soft swelling near the navel. Umbilical hernias can also occasionally occur in adults if the hernia does not appear until later life, in which case, they can cause abdominal pain.

Epigastric

An epigastric hernia is caused by a weakness in the upper abdomen and the intestine bulges between the breastbone and the navel. These are more common in men.

Incisional

An incisional hernia is the result of weakness following a surgical wound or scar in the wall of the abdomen.

Causes

Hernias in adults may arise as a result of the strain caused by:

  • persistent heavy coughing
  • being overweight or pregnant
  • injury or surgery
  • lifting, carrying or pushing heavy loads
  • straining to produce a bowel movement, or
  • straining to urinate e.g. men who have an enlarged prostate

Those over 50 have a higher risk of hernia, possibly due to the muscles in the stomach wall becoming weaker with age.

In babies, hernias are usually due to congenital (present at birth) weakness. A common type of hernia in babies is an umbilical hernia. This appears near the navel and results from a weakness in the wall of the abdominal wall at birth.

An inguinal hernia occurs in the groin and is common in baby boys, especially in boys born early and underweight. About 1 in 50 boys get a hernia.

Complications

In some cases, a loop of the intestine can push through the weakness and become trapped, or strangulated, causing severe pain. The blood supply is cut off and gangrene can set in. A strangulated hernia can be life-threatening and youll need to have an operation right away.

After inguinal hernia surgery, men may occasionally get a painful swelling of the scrotum or testicles.

In an inguinal hernia, gangrene can lead to perforation of the bowel and peritonitis.

There is an increased risk of complications with your hernia if:

  • you are over 50
  • you've had your hernia for less than a year, pr
  • you have another illness, such as heart disease or breathing problems

Hernia surgery is one of the most commonly performed and generally safe operations. As with all surgery, there are some risks involved, which may include serious problems just after the operation e.g. infection, pain or numbness in the area of the operation, and the hernia coming back.

Risk factors depend on the exact type of operation and the state of your general health.

Symptoms

The sign of hernia is a soft, bulge or swelling under the skin and can be painless, cause slight discomfort or can be painful.

Hernias tend to get larger with time and can make it difficult for you to do normal activities, like shopping or having sex.

Treatment

The main treatment of hernias is surgery.

There are two main types of laparoscopic hernia repair:

Transabdominal preperitoneal (TAPP) - the repair is performed by inserting instruments through your abdominal wall and membrane that lines it (called the peritoneum) that encloses the abdominal organs. A flap of the peritoneum is peeled back over the hernia, and a sterile mesh is used to cover the problem area in the abdominal wall.

Totally extraperitoneal (TEP) - this approach is the newest keyhole technique. In this method, the hernia is repaired without entering the peritoneal cavity. This approach is more difficult to do, but there may be less risk of damaging organs in the abdomen.

The operations are usually carried out under general anesthetic.

You may ask for local anesthetic, if preferred, but this will need to be discussed with your doctor.

A truss is a type of corset designed to hold in a hernia and relieve discomfort. It is rarely used nowadays- only when surgery is not possible or needs to be delayed. It should not be used to support a femoral hernia as it can lead to a strangulated hernia.

Most umbilical hernias in babies correct themselves by two to three years old but occasionally surgery is needed after this age to strengthen the area of the hernia.

Inguinal hernias in babies and children do need surgery to prevent the possibility of it becoming strangulated.