Hernia Overview: Causes, Symptoms and Diagnosis
Hernias are simply a hole or defect in the wall of the abdominal cavity that allows protrusion of an organ or abdominal content through it. The fascia is a thick layer of tissue that keeps the contents of the abdomen in place. There are certain areas of the abdominal wall which are considered sites of weakness, these are inguinal, femoral and umbilical areas. The groin represents the area where approximately 75% of hernias develop.
Whether due to excess abdominal strain, age, genetics or congenital disorders, this tissue can weaken and intestinal contents may begin to push through. Most commonly, fatty tissue and loops of large intestine may push into, and ultimately become trapped in, the hernia defect.
What causes a hernia?
There are several potential causes of a hernia which can include:
- It has been shown that children of people who have had hernias are predisposed to get hernias as well
- Congenital defects. Some hernias are caused by unavoidable circumstances from birth or from a very young age. Umbilical hernias are the most common congenital hernias
- Excessive Strain. Most hernias occur because of added pressure on the abdomen. This can be caused by excess weight and obesity, weightlifting or pregnancy. Smoking and diabetes can also increase the risk of developing a hernia.
- Advanced age. As we age, our fascia can also weaken, therefore increasing hernia risk
Types of Hernia
There are many hernias, usually named for the area in which they occur, as well as the reason for their occurrence. The most common hernias include:
Inguinal hernia. Also known as a groin hernia, inguinal hernias affect men far more than they do women. Approximately 800,000 of the 1 million hernia surgeries performed every year in the US are to repair inguinal hernias.
Femoral hernias are characterized by a bulge appearing in the upper thigh. Femoral hernias affect women more than they do men and have a very high risk of strangulation – upwards of 25 percent. It is, therefore, always advisable that surgery be performed urgently.
Umbilical hernias are found in the umbilicus or belly button and are a result of the natural weak point in our abdomens created by the umbilical cord. For some, this area remains weak, and they may develop a hernia later in life. For others, the hernia comes about because of pregnancy or excessive abdominal strain.
Incisional hernias are caused by a prior surgery. Any time the abdominal wall is punctured, no matter how small the incision, there is a risk for a hernia to develop at the surgical site. With laparoscopic surgery, this risk has been reduced immensely, but still exists.
Hiatal hernias are very common, especially in obese patients. This is when the top of the stomach pushes through the hiatus, a small hole in the diaphragm allowing space for the esophagus. Most hiatal hernias are asymptomatic, but some will cause moderate to severe acid reflux. Typically, hiatal hernias are discovered and repaired during a primary bariatric surgery or during a Nissen Fundoplication.
Symptoms of a Hernia
Not all hernias are symptomatic. Hernias that do not cause symptoms are often never found, and patients can live their entire life never knowing that they have one. A symptomatic hernia usually manifests in the form of a lump or protrusion in the area of the hernia. This usually reduces back into the abdomen when the patient lies down and is not putting strain on the abdomen.
Some, but not all, patients will experience discomfort associated with the hernia. This may be dull or sharp pain, burning, heaviness and more. The degree of pain, however, is not indicative of the size of the hernia. Smaller hernias may be more painful while larger hernias may not hurt as much.
When the abdominal contents become trapped in the hernia, this is known as incarceration. When blood flow is cut off, it is strangulation. Both of these situations require urgent medical and surgical attention. Incarcerated and strangulated hernias may cause severe pain, redness, fever and more.
Treatment Options for Hernias
The definitive curative treatment for hernia is surgery – there is no other way to eliminate the hernia defect. Hernia belts and trusses are not effective and can potentially cause more harm if not used properly.While hernia repair is, in most cases, an elective procedure, hernias do not get better on their own and most patients will eventually have surgery. It is worth noting that a larger hernia is both harder to repair, and creates a higher risk of complications. However, it does present a lower risk of strangulation.