What Is A Hernia? What Are The Symptoms Of Hernia?

Editor's Choice Main Category: GastroIntestinal / Gastroenterology Article Date: 16 Mar 2009 - 0:00 PDT email to a friend
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A hernia is a general term which refers to a protrusion of a tissue through a structure or part of an organ. In other words, when something penetrates through muscle tissue or a membrane and sticks out. A hernia has three parts - the hernia's contents, the hernia sac, and the orifice (the hole). The Latin word hernia means "a rupture". Ahernia is also medically known as arupture. Hernias most commonly occur in the abdomen. A part of the abdominal wall may be weak and allows a localized hole to develop - this hole is also known as a defect. Tissue, or abdominal organs may stick out through this hole. A hernia that involves the spinal discs commonly causes pain in the lower back, the pain can radiate down one or both legs (sciatica). Not all hernias cause pain. Some people may have a hernia and not be aware of it. In most cases, however patients with a hernia do feel some pain or discomfort, and typically sense a lump in the affected area. Fatty tissue will usually jut through first, then an organ may protrude later. According to Medilexicon's medical dictionary, a Hernia is a:

"Protrusion of a part or structure through the tissues normally containing it."

Why do hernias occur?

In most cases a hernia will occur when the compartment which envelopes an organ receives increased pressure, this weakens the boundary. This may happen for several reasons, including:

Genetic propensity - if either or both of your parents had a hernia you are more likely to develop one.

Age - the older you are the higher is your risk of developing a hernia.

Ehlers-Danlos syndrome - a group of uncommon genetic disorders that affect humans and domestic animals caused by a defect in collagen synthesis.

Marfan syndrome - a is genetic disorder of the connective tissue.

Pregnancy - the muscles of the mother stretch, making it easier for tissue to poke through.

Drastic weight loss - when obese people lose weight they may be more prone to developing hernias.

COPD, Whooping cough - the patient may cough a lot. Coughing raises pressure in the abdomen. Any illness that includes severe coughing can cause hernias to occur. A severe bout of flu may sometimes cause a hernia to develop.

Ascites - the buildup of extra fluid in the abdomen (peritoneal cavity).

Benign prostatic hypertrophy - the prostate gland enlarges, increasing pressure around it.

Sports hernias (athletic pubalgia) are more common among people with a mechanical disorder of the hip, researchers from the Center for Hip Pain and Preservation at the Hospital for Special Surgery, New York, USA, explained after carrying out a study. The problem can often be resolved with surgery to fix the hip disorder.

Intracranial pressure - if intracranial pressure rises parts of the brain may develop hernias which protrude through the cranial cavity.

Excessive lifting - raises pressure on the abdomen and others parts of the body.

Prior surgery - some surgeries may result in the weakening of membranes.

Obesity - if a person is obese his chances of developing a hernia are significantly higher, compared to people who are not obese.

What types of hernias are there?

There are many types of hernias. Below is a list of some of the most common hernias:

Abdominal Hernia - an abdominal organ or fatty tissue juts through a weakened area of the abdominal wall, resulting in a protrusion

Anal Hernia - tissue protrudes through the membrane around the anal region.

Diaphragmatic Hernia - hernia resulting from the protrusion of part of the stomach through the diaphragm - a hole in the diaphragm which the bowel can pass through, also known as congenital diaphragmatic hernia.

Hiatal Hernia - forms at the opening in the diaphragm where the esophagus (food pipe) joins the stomach. A part of the stomach pushes through this opening.

Herniatied Disc - the cushion that lies between the spinal vertebra is squeezed outside its normal position. As the spinal disc loses its elasticity, it may rupture - rupturing may cause a portion of the spinal disc to push outside its normal boundary - resulting in aherniated disc

Intracranial Hernia (in the brain) - caused by extreme intracranial pressure. This is a protrusion of brain from the cranial vault through the foramina (tentorial notch or foramen magnum) or ventral dural septae. The patient may need immediate medical attention as intracranial hernias might be

life-threatening, especially if the hernia takes place in the brain stem region. Usually caused by brain edema or hemorrhage which results in increased intracranial pressure.

Pelvic Hernia, Inguinal Hernia - an interstitial hernia (happens in the small opening between tissues or parts of an organ) projecting into the pelvis from the internal inguinal ring. The inguinal ring is at the entrance to the inguinal canal. The inguinal canal is an oblique canal through the lower abdominal wall; in males it is the passage through which the testicles move down into the scrotum, it contains the spermatic cord; in females it transmits around the ligament of the uterus.

Femoral Hernias - more common among females. Occurs when part of the intestine protrudes through the femoral canal, it juts through at the top of the thigh. Blood vessels that supply the legs with blood go through the femoral canal.

Umbilical Hernia - more common among children. The abdominal wall is weakened where the umbilical cord enters/leaves the body (the belly button, the naval). Umbilical herniascan also be found in puppies.

Epigastric Hernia - occurs between the naval and the breastbone. Fat protrudes through the abdominal wall.

Ventral Hernia - most commonly after a surgical operation or trauma (e.g. car accident or bad fall). When tissue is scarred it weakens the abdominal wall, leading to hernia.

Obtuator Hernia - bits of intestine penetrates through the space between bones in the front part of the pelvis.

Treatment for hernia

Your GP may initially try to push the hernia back, if he/she thinks it is possible. In many cases surgery is required to repair a hernia. During the operation the surgeon will put the protrusion back. If the protrusion is through the abdominal wall, for example, a synthetic mesh may be fixed to the muscles to strengthen the area. Surgery can be either open surgery, where a large incision is made, or keyhole (laparoscopic) surgery, where only a tiny incision is made, using a specially designed camera and instruments to carry out the operation. Advantages and disadvantages of open surgery and laparoscopic surgery Both open surgery and keyhole surgeries have their own advantages and disadvantages. Although open surgery involves a longer recovery time and more post-operative pain, it can be done with a local anesthetic. A patient who undergoes keyhole surgery will recover faster and experience less pain. However, keyhole surgery requires a general anesthetic. Elderly patients, or those with bad health may be too weak to undergo a general anesthetic. Gastrointestinal experts say that despite faster recovery time and less pain after the operation, laparoscopic surgery carries a higher risk of damage to the bowel. A European study found that laparoscopic hernia surgery has a 5 in 1000 risk of serious complications, compared to 1 in 1000 with open hernia surgery (NHS Choices, UK) . Researchers from Erasmus Medical Center, Rotterdam, the Netherlands, reported in Archives of Surgery that total extraperitoneal inguinal hernioplasty, a minimally invasive surgery for hernia repair, tends to result in significantly less damage to groin (inguinal) sensation than open Lichtenstein repair. With the minimally invasive procedure, patient satisfaction rates are much higher, and considerably fewer report chronic pain. In the UK approximately 2% of hernia surgery patients will require further surgery later on. The 2% risk is the same for both types of surgery (NHS Choices, UK) . If you have to wait a long time for your surgery your doctor may recommend you wear a truss till the day of your operation. Trusses keep many hernias in place.

Prevention of hernias
In many cases, hernias are due to age and your genetic propensity. There is not much you can do about that. However, there are some factors which can raise your risks of developing a hernia. Heavy lifting - heavy lifting is known to cause hernias. Try to avoid heavy lifting. If you can't, learn how to position yourself for lifting. According to www.bodybuilding.com, if you are weight training you

should use an appropriate amount of weight relative to your strength. You should make sure you are warmed up before lifting any weights. Make sure you bend at the knees when lifting a weight - do not bend at the waist as this will cause excessive pressure. If you are lifting a heavy object in the gym (or anywhere) take a squatting position, keep your back straight and as vertical as you can. Make sure your bodyweight is centered over your feet when you start your lift. Frequent abdominal training will strengthen those areas most susceptible to hernias. Smoking and coughing - coughing, especially persistent coughing can cause a hernia to develop. Anything you can do to reduce or eliminate your cough will help enormously. If you smoke, try to give up, or at least cut down. Quitting smoking will prevent several other serious diseases. Studies indicate that your chances of succeeding in giving up smoking are significantly greater if you seek help from your GP (primary care physician) and join a support group. Nutrition - a diet that is high in fiber will help your bowel movements. Constipation, especially if the person is often constipated, greatly increases hernia risk. Eat plenty of fruits, vegetables and wholegrains. Make sure you drink plenty of fluids. Obesity - being overweight can increase your risk of developing a hernia considerably. The more overweight you are, the higher your risk. Try to lose weight. Make sure, if you are obese, that you lose weight gradually. It is always advisable to seek professional help before you embark on any exercise program. Ask your doctor for advice on diet and exercise.

How common are hernias?

England According to the National Health Service, approximately 70,000 people undergo a surgical operation for inguinal hernias each year - 98% of these patients are men. 16 out of every 100,000 people develop femoral hernias. Incisional hernias, which develop as a complication of abdominal surgery, occur in 0.5% to 10% of patients, depending on the type of surgery involved. Children of blackAfrican descent are ten times more likely to have an umbilical hernia compared to white children (in most cases umbilical hernias do not need treatment and get better as the child becomes older). USA Approximately 5 million Americans have a hernia (National Center for Health Statistics, USA). However, only about 750,000 of them seek treatment each year. Most common male and female hernias Inguinal hernias (hernias in the groin area) are most common among men - mainly because there is unsupported space in the groin area after the testes descend in the scrotum. Femoral hernia is most common among women. Written by Christian Nordqvist Original article date: 16th March 2009. Article updated: 18th September 2012. Copyright: Medical News Today Not to be reproduced without permission of Medical News Today

What Is An Umbilical Hernia? What Causes An Umbilical Hernia?

Editor's Choice Main Category: Pediatrics / Children's Health Also Included In: GastroIntestinal / Gastroenterology Article Date: 22 May 2010 - 0:00 PDT email to a friend
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An umbilical hernia occurs when part of the bowel or fatty tissue pokes through an area near the belly button (navel, umbilicus), pushing through a weak spot in the surrounding abdominal wall. Approximately 1 in every 10 infants is affected by an umbilical hernia - they are common in premature babies. While the developing fetus is in the uterus (womb), the umbilical cord passes through an opening in the abdominal wall, which should close before the baby is born, or soon after. However, sometimes the muscles do not completely seal, leaving a weak spot through which an umbilical hernia can develop. The hernia looks like a lump in the navel, which may become more evident when the baby is laughing, crying, heaving (going to the toilet), or coughing. When the child is lying down or relaxed the lump may shrink. It is not usually painful. In the majority of cases an infant's umbilical hernia closes on its own by the age of 12 months. If the hernia is still there by the time the child is 4 years old, the doctor may recommend surgery. Umbilical hernias may also develop in adults, especially if they are very overweight, lifting heavy objects, or have a persistent cough. Women who have had multiple pregnancies have a higher risk of developing an umbilical hernia. In adults, hernias are much more common in females. Among infants, the risk is about the same for boys and girls. According to Medilexicon's medical dictionary: an umbilical hernia is

a hernia in which bowel or omentum protrudes through the abdominal wall under the skin at the umbilicus.

What are the signs and symptoms of an umbilical hernia?

A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign. There may be a soft bulge/swelling near the umbilicus (navel), ranging from about 1 to 5 cms in diameter (0.5 to 2 inches). The bulge is usually more noticeable if the baby cries, laughs, coughs or strains. Pain - in children and infants umbilical hernias are not usually painful. Adults may feel pain or discomfort. When to see a doctor:

If you see a bulge and would like to know what it is The bulge becomes painful The infant/adult vomits (and there is a bulge) The bulge swells up more The bulge becomes discolored

What are the risk factors for umbilical hernias?

A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2.
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What causes an umbilical hernia?

Babies - as the fetus develops in the mother's uterus (womb), there is a small opening in the abdominal muscles allowing the umbilical cord to pass through - this connects the mother to the

baby. Around the time of birth, or shortly afterwards, this opening in the abdominal muscles should close. When this does not happen - if the opening does not close completely, fatty tissue or part of the bowel can protrude (poke through), causing an umbilical hernia. Adults - if there is too much pressure on the abdominal wall, fatty tissue or a part of the bowel can poke through a weak part of the abdominal muscle. Individuals at high risk (see Risk Factors) are more likely to have higher-than-normal pressure in areas where fatty tissue or parts of the gut can protrude.

How is an umbilical hernia diagnosed?

A doctor will be able to diagnose an umbilical hernia during a physical examination. He/she may also be able to determine what is protruding; what is caught in the hernia sac. If the doctor wants to screen for complications, an abdominal ultrasound, X-ray or blood tests may be ordered.

What are the treatment options for umbilical hernia?

Babies and children - in the majority of cases the hernia closes on its own by the age of 12 months. Sometimes the doctor may be able to push the lump back into the abdomen (it is important that only the doctor do this). Surgery may be ordered if:

The hernia grows after the child is one or two years old The bulge is still there by the age of four years If the hernia blocks the intestines If the hernia becomes trapped Adults - surgery is usually recommended, to prevent potential complications, especially if the hernia grows or starts to hurt. Surgery - this is a small, quick operation to push the bulge back into place and to make the abdominal wall stronger. In most cases the child (patient) will be able to go home on the same day. The surgeon makes an incision at the base of the belly button and pushes either the fatty lump or bowel back into the abdomen. Muscle layers are stitched over the weak area in the abdomen wall, effectively strengthening it. Dissolvable stitches or a special glue are used to close the wound. Sometimes the surgeon will place a pressure dressing, which remains there for four to five days. An umbilical hernia operation usually takes about 20 or 30 minutes.

What are the possible complications of an umbilical hernia?

Umbilical hernia complications are very rare in children. If the protrusion becomes incarcerated (trapped) and cannot be pushed back into the abdominal cavity it may lose some of its blood supply

and become damaged. If the blood supply is completely cut off there is a risk ofgangrene, and lifethreatening infection. Incarceration is also rare in adults, but more common than in children. Written by Christian Nordqvist Copyright: Medical News Today Not to be reproduced without permission of Medical News Today