A hernia occurs when an internal organ protrudes out of a weak area in a tissue or muscle. There are various types of hernias, and some require immediate surgical treatment.

Hernia

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Iqra Mazhar

Overview

A hernia is described as a rupture in tissue against which an organ pushes or protrudes. It might be visible depending on where it is and how big it is.&nbsp;

It occurs most frequently in the upper thigh, groin, belly, and abdominal. Abdominal hernia is relatively common and believed to affect at least 2% of males (15 cases per 1000)<a href="#accordion">[2]</a>.&nbsp;

Daily operations, including bending over or carrying heavy items, are said to worsen the condition.&nbsp;

&nbsp;

When an internal organ or other body component bulges through the muscles or tissues that surround it, the condition is known as a hernia. Approximately 20 million hernias are treated via surgery per year in the entire world<a href="#accordion">[1]</a>.&nbsp;

Usually, hernias develop in the abdomen, between the chest and the hips. Inguinal hernias, in particular, account for 73% of all hernia cases, making them the most common type of hernia<a href="#accordion">[6]</a>.&nbsp;

&nbsp;

This section explores the different types of hernia in detail and the parts of the body they develop in.

&nbsp;

<h5>Inguinal Hernia</h5>

The most typical kind of hernia is inguinal hernia. The intestines push out a weaker point or rupture in the lower abdominal wall, generally in the inguinal canal.

The inguinal canal is situated in the groin. In men, it is the region where the spermatic cord reaches the scrotum via the abdomen. This cord is linked to the testicles. In women, there is a round ligament in the inguinal canal that aids in stabilizing the uterus.

Men are more prone than women to get inguinal hernias because a baby boy&#39;s testicles drop through the inguinal canal right after birth. The canal is initially intended to close beneath them completely. But, sometimes, the canal does not shut entirely and leaves a weak point, which becomes a cause of hernia. 
&nbsp;

<h5>Femoral Hernia</h5>

A tissue pushing via a weak spot in the inner thigh or groin causes a femoral hernia. The hernia might appear like a tiny to medium-sized bump in the groin.

Femoral hernias make up between 2 and 4% of all groin hernias<a href="#accordion">[7]</a>. Children rarely have them and even in men, the frequency of occurrence is lower than that for women.&nbsp;The frequency of femoral hernia has a&nbsp; male-to-female ratio of 1:4 and the higher frequency in women can be attributable to a wider pelvis.

Femoral hernias can sometimes be felt while squeezing to go to the bathroom or lifting a lot of weight. The fact that the femoral artery and vein are close to the hernia makes a femoral hernia potentially dangerous. The hernia might impact these blood veins, preventing blood circulation to and from the leg. Owing to the fatal nature of this hernia, surgeons always attempt to treat a femoral hernia as soon as possible. 
&nbsp;

<h5>Hiatal Hernia</h5>

When a portion of the stomach pushes through the diaphragm and into the chest cavity, it is known as a hiatal hernia.&nbsp;

The diaphragm is a muscular layer that contracts to bring air into the lungs, helping a person breathe. It divides the organs in the thorax from those in the abdomen.

The majority of cases of this kind of hernia occur in adults over 50. If a child has the syndrome, it&rsquo;s often a congenital birth defect.

Hiatal hernias might trigger<a href="https://www.merisehat.pk/disease/gerd-56" target="_blank"> gastroesophageal reflux (GERD)</a>. The stomach&#39;s fluid flows backward into the esophagus in <a href="https://www.merisehat.pk/disease/gerd-56" target="_blank">GERD</a>, giving the patient a burning feeling. 
&nbsp;

<h5>Umbilical Hernia</h5>

If the intestines protrude through the abdominal wall close to the belly button, children and infants might experience umbilical hernias. In children, you might see a bulge in or close to their belly button.

Only an umbilical hernia tends to resolve by itself when the muscular region of the abdominal wall becomes stronger. This often occurs when the kid is 1 or 2 years old. If the hernia has not disappeared by the time the child is 5 years old, surgery could be an option to treat it.

Sometimes, umbilical hernias also occur in grownups. They develop due to the abdomen being repeatedly strained by conditions, like ascites, obesity, or pregnancy. 
&nbsp;

<h5>Ventral Hernia</h5>

When tissue protrudes through a tear in the muscles of the abdomen, it is known as a ventral hernia. Whenever you&#39;re lying down, a ventral hernia seems to get smaller.

A ventral hernia could occur from birth, but it&#39;s more likely to develop throughout a person&rsquo;s lifetime. Pregnancy, obesity, and intense activity are all common causes of ventral hernias.

A clinical incision area could also subject you to ventral hernias. An incisional hernia develops when abdominal muscles weaken near the surgery site or surgical damage.&nbsp; 
&nbsp;

Other Types Of Hernias&nbsp;

These include:

&nbsp;

<ul>
	<li>Incisional Hernia: Tissue protrudes from a previous abdominal or pelvic operation scar on the abdomen. According to research, recurrence was a major aftereffect following large abdominal incisional hernias surgery; recurrence rates were around 31% after the initial surgery and 44% after the second repair<a href="#accordion">[4]</a>.</li>
	<li>Epigastric Hernia: Fatty tissue protrudes in the region of the abdomen between the navel and lower section of the sternum.</li>
	<li>Spigelian Hernia: Just below the navel, the intestine protrudes from the abdomen on the sides of the abdominal muscle.</li>
	<li>Diaphragmatic Hernia: Abdominal organs pass into the chest through a hole in the diaphragm.</li>
</ul>

&nbsp;

Signs And Symptoms

A bulge or lump in the affected region is hernia&#39;s most prevalent symptom. For instance, if you have an inguinal hernia, you could feel a bump where your groin and thigh connect on either side of the pubic bone.

The lump seems to &quot;disappear whenever you&#39;re lying down.&quot; You have a greater chance of feeling your hernia by touch whilst standing up, turning over, or coughing.&nbsp;There might also be irritation or soreness in the vicinity of the bump.

&nbsp;

Hiatal hernias cause more specific symptoms, including:

<ul>
	<li>Chest pain</li>
	<li>Difficulty swallowing</li>
	<li>Heartburn</li>
</ul>

&nbsp;

Hernias frequently have no symptoms. Unless it manifests during a standard physical examination or a medical examination for an unrelated issue, you might not even be aware that you have a hernia.

&nbsp;

Causes

Muscle strain and weakened tissues cause hernias. Hernias might develop suddenly or gradually, depending on the cause of the disease.&nbsp; 
&nbsp;

The following are some typical causes of muscle weakening or straining that result in hernias:

<ul>
	<li>A congenital disorder that is present from birth&nbsp;</li>
	<li>Ageing&nbsp;</li>
	<li>Injury from an accident or surgery</li>
	<li>Heavy lifting or strenuous activity</li>
	<li>Chronic obstructive pulmonary disease or persistent cough&nbsp;</li>
	<li>Several pregnancies&nbsp;</li>
	<li><a href="https://www.merisehat.pk/disease/constipation" target="_blank">Constipation</a>, which makes you struggle to go to the bathroom</li>
	<li><a href="https://www.merisehat.pk/disease/obesity" target="_blank">Obesity </a>or being overweight that causes ascites</li>
</ul>

&nbsp;

Diagnosis

Your doctor would perform a physical examination before diagnosing your disease. A bulge in your abdomen or groin that gets bigger when you cough, stand, or strain could be felt by the doctor throughout this examination.

Your doctor would then take your medical history. They will ask questions, like:

&nbsp;

<ul>
	<li>When did the bulge become apparent to you?</li>
	<li>Have you felt any further symptoms?</li>
	<li>Do you believe a specific factor might have contributed to it?</li>
	<li>Tell me a bit about your way of life.&nbsp;</li>
	<li>Does your job require a lot of lifting?&nbsp;</li>
	<li>Do you work out frequently?&nbsp;</li>
	<li>Do you exercise weights for fun or a living?&nbsp;</li>
	<li>Have you ever smoked before?</li>
	<li>Do you or anyone in your family have a history of hernias?</li>
	<li>Have you undergone any groin or abdominal surgeries? 
	&nbsp;</li>
</ul>

<h5>Imaging Investigations</h5>

Your doctor would probably also use this to arrive at a diagnosis.&nbsp;These consist of:

&nbsp;

<ul>
	<li>Abdominal Ultrasound: In abdominal ultrasound, high-frequency sound waves produce images of the inner body structures.</li>
	<li>Abdominal CT Scan: An image is created by an abdominal CT scan using X-rays and computer technology.</li>
	<li>Abdominal MRI Scan:&nbsp;An abdominal MRI provides detailed pictures from many views and is&nbsp;often used to gain clarity on findings from previously done ultrasounds or CT scans. 
	&nbsp;</li>
</ul>

<h5>Other Examinations</h5>

These include:

&nbsp;

<ul>
	<li>Gastrointestinal System X-rays: You would be asked to drink a liquid which includes a Barium mixture and a liquid&nbsp;gastrografin (diatrizoate meglumine/diatrizoate sodium). It makes your digestive system stand out on X-ray scans.</li>
	<li>Endoscopy: An endoscopy involves a medical expert inserting a tube down your neck, into your esophagus, and into the stomach to view internal organs.</li>
</ul>

&nbsp;

Treatment

The extent of your hernia and the intensity of your symptoms determine whether you require surgery or not. Simply keeping an eye on your hernia for potential consequences might be enough for your doctor to diagnose it.&nbsp;

Unfortunately, no medication regimen is created to treat any type of hernia. However, surgery is a treatment option.

&nbsp;

Important!

There are some important points that we should keep in mind at this point:

<ul>
	<li>It&#39;s critical to understand the signs of a hernia and get checked out by a doctor if you think you have one.</li>
	<li>Hernias could lead to potentially deadly consequences and won&#39;t go away on their own if left unaddressed.&nbsp;</li>
	<li>A doctor examines your hernia and chooses the best course of action.</li>
	<li>Early medical attention and lifestyle modifications could help reduce symptoms.</li>
	<li>There&rsquo;s just one effective treatment for hernias: surgery.&nbsp;</li>
	<li>A surgeon would recommend the best hernia repair surgery for you out of the various options available.</li>
</ul>

&nbsp;

The prognosis for patients who have hernia repair surgery is typically excellent. However, it is important to mention that the type of hernia, your symptoms, and your general health all play a role in recovery. Chances of hernia recurrence are present post-surgery, albeit these recurrences are very low.&nbsp; 
&nbsp;

<h5>Truss Recommendation</h5>

Wearing a truss might occasionally assist in reducing the symptoms of a hernia. An undergarment that supports and helps retain the hernia in place is called a truss.&nbsp;

Remember, before using a truss, check with your doctor to ensure it fits properly.&nbsp; 
&nbsp;

<h5>Symptomatic Treatment</h5>

&nbsp;

<ul>
	<li>For Inguinal Hernia</li>
</ul>

Discomfort associated with this type of hernia could be eased with over-the-counter painkillers.&nbsp;Depending on personal choice, you could choose from either of the following:

<ol>
	<li>Acetaminophen (Tylenol)</li>
	<li>Ibuprofen</li>
	<li>Naproxen</li>
</ol>

&nbsp;

<ul>
	<li>For Hiatal Hernia</li>
</ul>

OTC and prescription medicines that lessen stomach acid could ease your discomfort if you suffer from a hiatal hernia. These include:

<ol>
	<li>Antacids</li>
	<li>Proton Pump Inhibitors</li>
	<li>H2 receptor blockers&nbsp; 
	&nbsp;</li>
</ol>

<h5>Home Remedies For Hernia</h5>

There are certain things you could do to reduce your symptoms, but remember home cures won&#39;t heal your hernia. Always consult your healthcare professionals before adopting any lifestyle. 
&nbsp;

<ol>
	<li>Constipation strains aggravate hernias. By consuming more fiber, you might be able to overcome constipation. Fruits, whole grains, and vegetables are just some foods high in fiber.</li>
	<li>A Hiatal hernia&#39;s symptoms could also be managed through dietary adjustments.</li>
	<li>Avoid eating large or heavy meals.</li>
	<li>Avoid lying down or bending over after eating, and maintain a healthy body weight.</li>
	<li>Avoid processed foods that could trigger heartburn, such as spicy cuisine and tomato-based dishes.&nbsp;</li>
	<li>If you smoke, avoiding it might also prove beneficial. 
	&nbsp;</li>
</ol>

<h5>Physical Workout For Hernia 
&nbsp;</h5>

<ol>
	<li>Exercise helps alleviate certain symptoms by promoting weight reduction and strengthening the muscles around the hernia. For example, an exercise program&#39;s benefits for obese patients having ventral hernia repair surgery were investigated in a 2018 study, revealing positive outcomes<a href="#accordion">[3]</a>.&nbsp;</li>
	<li>There is less probability of problems after surgery for those who follow the exercise regime. 
	&nbsp;</li>
</ol>

<h5>Precautions To Follow During Exercise</h5>

Keep in mind that some forms of exercise, such as weightlifting or workouts that stress the abdomen, could make the hernia more painful. These could also make the hernia bulge much more. The same holds for incorrectly performed exercises.

Discussing exercise with a doctor or physical therapist if you have a hernia is best. They could advise you with respect to the exercises that would be the most effective in your case and how you could carry out each to avoid aggravating your hernia. 
&nbsp;

<h5>Hernia Surgery</h5>

If your hernia is worsening or causing pain, your surgeon might determine if surgery is needed. The surgeon might decide to shut the abdominal wall opening to heal the hernia.&nbsp;If it leads to an additional hole in the abdominal wall, then in that case, the surgical mesh would be utilized to close it. In some circumstances, surgery could be performed to tighten the aperture. Hernias are treated surgically in both open and laparoscopic ways.

In most cases, local or spinal anesthesia could be used during hernia surgery, preferably safe than general (put-to-sleep) anesthesia. Even if a hospital stay is required, it&#39;s usually only for 1-2 days. The procedure is often performed on an outpatient basis. 
&nbsp;

<ul>
	<li>Open Surgery:&nbsp;A small incision is made near the hernia during open surgery, and the protruding tissue is pushed back into your abdomen. After that, they sew the area shut, occasionally adding surgical mesh for reinforcement.&nbsp;</li>
</ul>

&nbsp;

<ul>
	<li>Laparoscopic Surgery:&nbsp;The hernia is fixed during laparoscopic surgery using a tiny camera and tiny medical instruments. It simply needs a few little incisions and causes minimal harm to the nearby tissue. Before the surgery, you would undergo a general health assessment because this treatment is typically done under general anesthesia. That includes:&nbsp;</li>
</ul>

<ol>
	<li>A health history</li>
	<li>Physical exam (and potentially lab testing)</li>
	<li>An electrocardiogram 
	&nbsp;</li>
</ol>

Note: Not all hernias could be treated laparoscopically. Your surgeon would have an open discussion with you, detailing which procedure is most appropriate for your condition e.g., open surgery or laparoscopic surgery. 
&nbsp;

<ul>
	<li>Robotic Hernia Repair Surgery:&nbsp;Robotic surgery (RS) differs from the laparoscopic procedure in that the surgeon controls the specialized surgical equipment from a console seated in the operating room.&nbsp;Currently, robotic surgery is performed to repair the abdominal wall and also treat some smaller hernias or weak spots.</li>
</ul>

&nbsp;

One of the most significant differences between robotic and laparoscopic surgery is that the RS uses a robot to produce superior 3-dimensional images of the abdomen (vs the 2-dimensional images of laparoscopic surgery).&nbsp;It gives the surgeon an edge to quickly stitch tissue and meshes within the abdomen.

Other advantages of robotic hernia surgery include the absence of a single, major incision scar and the potential for reduced postoperative pain compared to open surgery. 
&nbsp;

<h5>Recovery From Surgery</h5>

You could suffer pain near the surgical site following your procedure. As you recover, your surgeon is going to prescribe medicines to help you deal with this discomfort.

&nbsp;

<ol>
	<li>Make sure to adhere to your surgeon&#39;s wound care instructions strictly.&nbsp;</li>
	<li>Call them immediately if you detect any infection-related symptoms like fever, swelling, discharge at the wound site, or pain that suddenly worsens.</li>
	<li>You might be unable to move around normally for a few weeks after your hernia surgery.&nbsp;</li>
	<li>Avoid engaging in any vigorous activities.&nbsp;</li>
	<li>You should also refrain from lifting anything weighing more than 10 pounds (4.5 kilos) during this time.&nbsp;</li>
	<li>Open surgery frequently has a lengthier recovery period as compared to laparoscopic surgery,</li>
	<li>When you can resume your daily chores, your surgeon would determine your regular schedule.</li>
</ol>

&nbsp;

Untreated hernias can occasionally be potentially life-threatening. Your hernia, for instance, could enlarge and develop other issues. Additionally, it might exert too much pressure on the adjacent tissues, resulting in pain and oedema.

What&rsquo;s more, a section of your intestine could get stuck in the abdominal wall. This is referred to as imprisonment. Constipation, nausea, and severe discomfort could all result from intestinal obstruction brought on by incarceration.

Strangulation happens if the confined portion of your intestines doesn&#39;t receive enough blood flow. The gut tissue might contract an infection and it might even perish due to this. A strangulated hernia poses a serious health risk and necessitates rapid medical attention. 
&nbsp;

You might experience the following signs if your hernia requires immediate medical attention:

<ul>
	<li>A bulge that changes color to red or purple</li>
	<li>Pain that progressively worsens</li>
	<li>Nausea&nbsp;</li>
	<li>Vomiting&nbsp;</li>
	<li>Fever&nbsp;</li>
	<li>Distressed digestive tract</li>
</ul>

&nbsp;

Other risk factors increase your possibility of developing a hernia. The most common type of risk factors for all types of hernia consists of:

&nbsp;

<ul>
	<li>Premature birth or born with low weight</li>
	<li>Older age</li>
	<li>Chronic cough (greater abdominal pressure increase its probability)</li>
	<li>Pregnancy&nbsp;</li>
	<li><a href="https://www.merisehat.pk/disease/cystic-fibrosis" target="_blank">Cystic fibrosis</a></li>
	<li>Chronic <a href="https://www.merisehat.pk/disease/constipation" target="_blank">constipation</a></li>
	<li>Overweight or obese</li>
	<li>Smoking, as it causes connective tissue to deteriorate</li>
	<li>History of hernia in the family or personally 
	&nbsp;</li>
</ul>

<h5>Incisional Hernia Risk Factors</h5>

The most obvious risk factor is a recent abdominal surgery because an incisional hernia results from surgery. It usually takes 3-6 months following the procedure, particularly if you are:

&nbsp;

<ul>
	<li>Engaged in demanding work</li>
	<li>Have put on more weight</li>
	<li>Pregnant</li>
</ul>

&nbsp;

All of these elements increase the strain on tissue as it recovers.

<h5> 
Inguinal Hernia Risk Factors</h5>

Inguinal hernias are more likely to occur in:

&nbsp;

<ul>
	<li>Older adults</li>
	<li>Males&nbsp;</li>
	<li>Individuals who have a family history of inguinal hernias&nbsp;</li>
	<li>People with a history of inguinal hernias</li>
	<li>Smokers because cigarette toxins damage tissues</li>
	<li>Chronic constipation sufferers</li>
	<li>Low birth weight and prematurely delivered babies</li>
	<li>Pregnant women</li>
</ul>

<h5> 
Umbilical Hernia Risk Factors</h5>

Premature babies and infants with low birth weights are more likely to develop umbilical hernias.&nbsp;

&nbsp;

<h5>Risk Factors For Adults</h5>

These include:

<ul>
	<li>Being overweight</li>
	<li>Being female</li>
	<li>Having multiple pregnancies</li>
</ul>

 
Hiatal Hernia Risk Factors

Hiatal hernia risk is increased in those who are:

<ul>
	<li>50 years or above</li>
	<li>Obese individuals</li>
</ul>

&nbsp;

A hernia cannot always be stopped from occurring. It could occasionally develop due to an inherited disease or a previous operation. However, you are less likely to develop a hernia by making a few easy lifestyle changes. These changes are meant to reduce the stress your body experiences. 
&nbsp;

Some general guidelines for prevention:

<ul>
	<li>If you smoke, think about giving it up. Consult your doctor to develop a smoking cessation plan that is ideal for you.</li>
	<li>If you&#39;re sick, visit a doctor to prevent the onset of a chronic cough.</li>
	<li>Maintain a healthy body weight.</li>
	<li>When urinating or having a bowel movement, remember not to strain.</li>
	<li>Consume enough foods high in fiber to avoid <a href="https://www.merisehat.pk/disease/constipation" target="_blank">constipation</a>.</li>
	<li>Perform abdominal strengthening exercises to help your muscles.</li>
	<li>Do not raise weights that are too difficult for you. If you must bend over to lift something heavy, do it at the knees rather than the waist or back.&nbsp;</li>
	<li>Additionally, when lifting large objects, try not to hold your breath. Exhale during the raise to lessen the possibility of developing a hiatal hernia.</li>
</ul>

&nbsp;

<h5>Laparoscopic Total Extraperitoneal Vs Lichtenstein Tension-Free Open Mesh For Inguinal Hernia Repair</h5>

Surgery is the only effective treatment for inguinal hernia. Over the years, different methods of inguinal hernia repair have been documented in the literature. Mesh usage has proved to significantly lower recurrence rates.

Compared to open mesh repair, laparoscopic TEP repair could be performed safely with similar results and benefits like less postoperative pain, early return to work, and superior cosmetic outcomes.&nbsp; 
Although the open Lichtenstein hernia repair has the lowest recurrence rates and is generally acknowledged by surgeons as simple to perform, patients might experience long-term consequences such as persistent groin pain and a delayed return to work.

In cases of bilateral and recurring inguinal hernias that require long-term follow-up investigations, laparoscopic TEP may be a superior option. Currently, if done by skilled surgeons, laparoscopic TEP hernia repair could be a better option than open surgery and is viable to execute with satisfactory results<a href="#accordion">[5]</a>.

&nbsp;

Key Points

<ul>
	<li>A hernia is described as a rupture in tissue through which an organ pushes or protrudes.</li>
	<li>There are different types of hernias depending on the reason and the organ affected.</li>
	<li>Causes, signs and symptoms depend upon the type of hernias (as discussed above).</li>
	<li>A surgical procedure is the most appropriate way to treat a hernia.&nbsp;</li>
	<li>Hernias frequently do not cause bothersome symptoms, although abdominal pain may be a warning of a major issue.</li>
	<li>By touching and searching for the bulge, they are typically easy to diagnose.</li>
	<li>Treatment options include corrective surgery using an open or laparoscopic procedure.</li>
</ul>

&nbsp;

[1] Kingsnorth A, LeBlanc K. Hernias: inguinal and incisional. Lancet. 2003;362(9395):1561-1571. doi:10.1016/S0140-6736(03)14746-0

[2] LeBlanc KA, Sanders DL, Kingsnorth AN. Management of Abdominal Hernias. Springer; 2018.

[3] Liang MK, Bernardi K, Holihan JL, et al. Modifying Risks in Ventral Hernia Patients With Prehabilitation: A Randomized Controlled Trial. Ann Surg. 2018;268(4):674-680. doi:10.1097/SLA.0000000000002961

[4] Langer S, Christiansen J. Long-term results after incisional hernia repair. Acta Chir Scand. 1985;151(3):217-219.

[5] Bringman S, Ramel S, Heikkinen TJ, Englund T, Westman B, Anderberg B. Tension-free inguinal hernia repair: TEP versus mesh-plug versus Lichtenstein: a prospective randomized controlled trial. Ann Surg. 2003;237(1):142-147. doi:10.1097/00000658-200301000-00020

[6] Townsend, C. M., Beauchamp, R. D., Evers, B. M., & Mattox, K. L. Sabiston textbook of surgery. (2016). Elsevier Health Sciences.

[7] Dahlstrand U, Wollert S, Nordin P, Sandblom G, Gunnarsson U. Emergency femoral hernia repair: a study based on a national register. Ann Surg. 2009;249(4):672-676. doi:10.1097/SLA.0b013e31819ed943