A hernia is an abnormal protrusion of internal organs through an abnormal opening in the wall of the cavity. A combination of increased pressure inside the body with weakness in the wall is responsible for this condition.
In this condition internal organs or parts of organs are protruded out developing a swelling which will increase the size with hacking and coughing and lifting weight and when passing a stool and urine. With a laying down posture the swelling will go within except in strangulated and irreducible hernia.
What causes hernias?
Common locations for hernias
- Some weakness in the body wall: Congenital weakness acquired weakness on account of injuries, wasting of muscles, suppurative lesions in the wall and presence of weak natural openings, obesity, lack of exercise, repeated pregnancy, surgical intervention with improper suturing or sepsis of operated site.
- Increased pressure inside the body: Chronic constipation, chronic cough, weight lifting, stricture of urethra.
A hernia might happen anywhere in the body. Even so there are a few widespread sites for hernia. On account of the presence of a hard bony covering, the chest wall is normally not affected. Hernia in the lower back is also exceptional due to spine and back muscles and tough ligaments and sheaths.
The most prevalent site for hernia is the abdominal wall. In comparison with other parts, the abdominal wall is weak due to the presence of some natural orifices. There are some areas in which the abdominal muscles are weaker and thin and all these factors create a chance for herniation. The common locations for hernia are following:
Complications of hernia
- Inguinal hernia: Here the abdominal contents protrude through the inguinal canal (passage in the lower abdominal wall just above the inguinal ligament. It is seen on either side).This type is prevalent in males. Initially the swelling comes only while straining and goes back while lying down. Later the large portion of intestine may come out which may not go back easily.
- Femoral hernia: This sort of hernia is more in females. Here the abdominal contents pass through the femoral canal which is seen just below the junction between the thigh and lower abdominal wall (inside the femoral triangle). The contents pass downwards and come out through the saphenous opening in the thigh and form a bump beneath the skin.
- Umbilical hernia: This is well-known in children. The umbilicus is the weaker part of the abdomen. The contents of the abdomen may protrude as a bulb-like swelling during crying and defecating.
- Incisional hernia: These hernias are seen in operated sites. Due to improper suturing or sepsis the operated site becomes weak resulting in hernia.
- Epigastric hernia: Here the herniation occurs in the epigastrium. It is a rare type.
- Lumbar hernia: Here the hernia appears in the lumbar area on either side of the lumbar spine (in the lumbar triangle). This is also an unusual type.
- Obturator hernia: This is yet another uncommon type of hernia. Here the contents pass through obturator foramen in the pelvic bone.
Initial treatment options for hernia
- Strangulation: If the hernial orifice is narrow the abdominal contents may not go back again easily, and later the blood flow to the herniated tissues may be blocked due to constriction. This can cause the death of the protruded intestine.
- Intestinal obstruction: This takes place when the whole portion of the intestine is protruded in to the hernial sac. The narrow hernial orifice will block the passage of bowels.
- Infection and peritonitis: If there is strangulation with death of a portion of intestine, there will be a spread of infection to the abdomen leading to peritonitis.
In the early stages of hernia the following steps may be useful:
Surgical treatment options for hernia
- Use of hernia belt. Special types of hernia belts are offered for each type of hernia. This will prevent the protrusion and will shrink pain.
- Constipation, recurrent cough, urinary obstruction etc. should be treated.
- Fat reduction will increase the strength of abdominal wall.
- Abdominal exercises to improve the muscle tone.
- Take a good amount of leafy vegetables, fruit and fibrous diet for easy bowel movements.
- Try some other systems like homoeopathy, herbal medicine, etc. If there is no relief from taking the above steps, consult a general surgeon for surgical management.
The following operations are done depending up on the type and nature of hernia:
- Herniotomy: In this operation the contents of hernial sac are pushed into the abdomen and the neck of the sac is ligated with transfixion ligature and the sac is cut off.
- Herniorrhaphy: Here, along with herniotomy, the posterior wall is repaired.
- Hernioplasty: This surgical treatment is done if herniotomy is not possible due to a wide neck of the sac. In this procedure, the repair is done with the help of non absorbable materials like tantalum gauze, polypropylene mesh or stainless steel mesh.