When there is a weakness in the layers that cover any body cavity, organs in that body cavity can protrude through that area of weakness to the outside of that cavity. When this happens, a hernia is said to have occurred. A hernia can occur in any part of the body, but abdominal hernias are more predominantly seen.
An abdominal hernia therefore, is defined as the bulging of a part of an abdominal organ (especially the intestine) or an abdominal tissue through a weakened abdominal wall which covers the organs. This can become a serious surgical emergency especially when there is a complication of strangulation which is accompanied by an acute pain. Uncomplicated hernia can continue for longer periods of months without any harm to the patient, although surgical intervention is necessitated to prevent the occurrence of complications.
A hernia can be described as direct or indirect and reducible or irreducible. A direct hernia is one in which the organ bulges directly through a weakness in the abdominal wall, whiles an indirect hernia refers to such that protrude outside the abdominal cavity through a physiological opening in the abdomen like inguinal or femoral canal. A hernia is said to be reducible if it can be pushed back into the abdominal cavity with the fingers, whiles irreducible hernias cannot be pushed back. They are usually going to lead to complications.
The groin is by far the most common site for hernias with about 25 million incidences and 32,500 deaths in 2013 and 18.5 million incidences and 59,800 deaths in 2015. Hernia affects all ages from 1 year to beyond 50 years of age. Hernias are however seen more in males (27% of males have hernia) and only about 3% of females have hernia.
Causes and Risk Factors
Hernias are caused by a combination of muscle weakness and strain in the abdomen. Any condition that leads to the weakness of the abdominal wall or can increase intra abdominal pressure can lead to a hernia. The risk factors for hernia include a range of lifestyle and patho-physiological situations like
- Age (abdominal wall weakens with advancement in age)
- Chronic coughing
- Lifting heavy weights
- Blows to the abdomen
- Previous or family history of hernia
- Poor nutrition
- Undescended testicles
- Previous surgery
- Congenital defects where the abdominal wall fails to close up properly
- Cystic fibrosis
- Collagen vascular disease
- Peritoneal dialysis
- Chronic obstructive pulmonary disease (COPD)
Symptoms of Hernia
Hernias present mostly asymptomatically apart from you noticing a bulge or lump in the affected area when standing, bending, coughing or crying (in babies).
Pain and discomfort, which improves when lying down, occurs usually when there is complication. They can be accompanied by nausea, vomiting, fever and heart burns.
Diagnosis of Hernia
The diagnosis of hernia is mainly through physical examination which is conducted by the doctor in his office. The doctor could also ask for further imaging studies like barium X-rays or endoscopy especially when suspecting a hiatal hernia and an ultrasound scan when suspecting umbilical hernia in babies.
Common Types of Hernia
Hernias are typified or classed based on the site of the herniation. The five most common types of hernia are:
1. Inguinal Hernia
This occurs when the intestine push through a weak spot in the lower abdomen around the inguinal canal located in the groin area. The inguinal canal is where the spermatic cord passed through into the scrotum to hold the testes in place in males, whiles in females, the ligament that holds the uterus in place passes through there.
Inguinal hernias can be direct or indirect and occur more on the right than on the left. It is the most common of all abdominal hernias (about 75% of all cases) and occur in both males and females.
2. Femoral Hernia
This occurs when the abdominal content (usually intestine) pass through a weak area in the femoral canal. The femoral canal is located in the groin area just below the inguinal ligament.
Femoral hernias can be difficult to differentiate with inguinal hernias. They usually appear more rounded than inguinal hernias and occurs more in females than in males with a very high incidence of complications like strangulation.
3. Umbilical Hernia
This is the protrusion of intestine through a weakness in the site of the umbilicus where the umbilical cord passes. It is more common in babies under 6 months. It is the only type of hernia that goes away on its own before the child reaches one year as the abdominal wall becomes stronger although surgery may be required if the hernia persists.
Umbilical hernia can affect adults too especially women who are obese or overweight and pregnant women who have multiple pregnancies.
4. Hiatal Hernia
This type of hernia occurs at the upper abdomen when part of the stomach or intestine protrude through the diaphragm into the chest cavity. The diaphragm is a muscle that helps in breathing and separates the organs of the abdomen from those of the chest.
Hiatal hernias are more common in individuals above 50 years and often results in heart burns.
5. Incisional Hernia
As the name implies, it is a hernia that occurs when the abdominal content bulges through an incision on the abdominal wall after an abdominal surgery.
Incisional hernias are common 3 to 6 months after an abdominal surgery and occurs when there is increased intra abdominal pressure and strenuous activities, weight gain or pregnancy. It can also occur when the surgical suturing technique was improperly done.
Treatment of Hernia
All the types of hernia would require surgical repair to prevent complications that is, if complications have not occurred already. It could be an open surgery or a laparosopic surgery which is done with a small camera.
Medications like antacids, H-2 receptor blockers and proton pump inhibitors can be used to improve heart burns that result from a hiatal hernia.
General lifestyle changes to prevent and manage uncomplicated hernias include
- Reduce food that cause heart burns or acid reflux
- Avoid eating large or heavy meals
- Don’t lie or bend over after meals
- Keep body weight in a healthy range
- Don’t indulge in strenuous exercises or lifting of heavy weights
- Give up cigarette smoking
The major complications of hernia to be avoided is strangulation of the intestine which can result in gangrene and necrosis of the intestine and can be very fatal. Other complications include hydrocele, bowel obstruction, haemorrhage, inflammation and autoimmune problems.
Categories: Emergency Medicine