Hernia is a medical term refers to any disease causing protrusion of a body part out of the cavity in which it is normally contained. There are several types of hernias; the most common include abdominal hernias (hernia inguinal hernia femoral, umbilical hernia), diaphragmatic hernias (congenital diaphragmatic hernia, hiatal hernia) and lumbar herniated disc. Although hernia can affect different organs, most of them occur in the abdomen.
Abdominal hernias –are the most common types of hernias. They are characterized by protrusion of contents of your abdomen through a defect in the normally restraining muscles of your abdomen and pelvis, according to American Journal of Roentgenology. Although abdominal hernias affect both men and women, they are more common in men. Most common abdominal hernias include femoral hernia, inguinal hernia, epigastric hernia, Spigelian hernia and umbilical hernia
- Femoral hernia is an externalization of an organ of your abdominal cavity due to an abnormality in the muscle wall. It is characterized by protrusion of a portion of your intestines under the inguinal ligament through which the femoral artery and veins move from the abdomen to the thigh. Unlike most hernias, femoral hernia is often small and less painful. It occurs mostly in obese women.
- Inguinal hernia – this form of hernia is very common in men. It is characterized by the protrusion of a part of your intestine through the inguinal canal, oblique passage through the lower abdominal wall that delivers passage to spermatic cord in men, and round ligament in women. Inguinal hernia can be congenital or acquired. When it is acquired, it mostly due to the weakening of the muscles of the abdominal wall. It develops at the end of the groin in women, and down to the scrotum in men.
- Umbilical hernia –it is a congenital disorder occurs mostly in infants. It involves an outward bulging of a part of the intestine at the navel area (belly button). The protrusion often occurs when the child sits up, cries or strains, and tends to disappear spontaneously. The bulging is often small (less than 5 centimeters). In most infants, the bulge closes on its own by 13 months of age. Scientists believe umbilical hernia results from intra-abdominal pressure.
- Epigastric hernia (also called ventral hernia) – this is a type of hernia developed at the upper central region of the abdomen, visible at the belly bottom area. It is very common in weightlifters and athletes; especially among men aged 20 to 50 years. Epigastric hernia is quasi-asymptomatic; you may have it for years without feeling any pain.
- Spigelian hernia – Spigelian hernia is a rare form of hernia of the anterior abdominal wall. It has serious complications in a high percentage of cases. The diagnosis is often difficult because the symptoms can be similar to those of other abdominal diseases. In addition, the clinical findings are often nonspecific, which makes the diagnosis and treatment often challenging.
Diaphragmatic hernia is an abnormal joining between the abdomen and chest cavity due to a gap in the Pleuroperitoneal cavity (cavity containing the lungs, stomach, intestines, liver, spleen, pancreas, and parts of the urinary and reproductive tracts). The disease is, most of times, congenital occurring between 9 and 10 weeks of pregnancy, congenital diaphragmatic hernia. In rare cases, diaphragmatic hernia can be the result of blunt and penetrating traumas, acquired diaphragmatic hernia.
Hiatal hernia is a form of diaphragmatic hernia characterized by protrusion of the stomach in the thorax through a tear in the diaphragmatic muscle. Although the cause is not well known, it is believed that obesity plays a major role in its developing. Small hiatal hernia is most of times asymptomatic, but large hiatal hernia can produce chest pain, abdominal pain, and gastro-esophageal reflux.
Herniated disc – also called herniation of the nucleus pulposus, is a slip or rupture of the intervertebral disc. It is slightly more common in men than in women, and affects mostly people aged 30 to 50 years. Slipped disc occurs at the lumbar between the fourth and fifth lumbar vertebrae or between the fifth lumbar and the sacrum. Herniated disc rarely affects the cervical vertebrae.
Hernia Causes and Risk Factors
The causes and risk factors of hernia vary from one type to another. Thus, common causes and risks that can lead to hernias include:
- Persistent coughing
- Straining during urination due to enlarged prostate or UTI
- Straining to pass faeces due to Constipation
- Excessive weight gain
- Weakness of the abdominal wall due to congenital factors
- Heavyweight lifting
- Diet low in fiber and fluids
- Any physical factors causing straining of abdominal muscles
- Disease – Down syndrome, mucopolysaccharide storage diseases, Beckwith-Wiedemann syndrome, (mostly umbilical hernia).
- Blunt and penetrating traumas
- Abnormal joining between the abdomen and chest cavity due to a gap in the Pleuroperitoneal cavity.
In hiatal hernia, there is a separation between the chest cavity and abdomen by the diaphragm. The causes of the disorder are not well-known. However, the following factors are sometimes suspected:
- Congenital defects
- Injury to the stomach
- Persistent coughing
- Heavy weight lifting.
- Repeated overworked
- Heavy weight lifting
- Increased pressure to the lower back
- Sudden twisting movement
- Persistent sneeze or coughing
- sports-related injuries.
Hernia Symptoms and Warning Signs
In absence of complications, symptoms are rare in most hernias. At early stage, you can have symptoms of discomfort or pain during physical movements, which can be neglected. Some other common signs and symptoms include:
- Feeling of fullness
- Protrusion in the abdomen or groin area
- Gastro-esophageal reflux (In hiatal hernia)
- Shortness of breath (dyspnea)
- Increased heart beat
- Abdominal discomfort or pain
- Bladder Problems (observed mostly in herniated disc)
- Electric Shock Pain (observed mostly in herniated disc)
- Tingling & Numbness (observed mostly in herniated disc)
- Muscle Weakness
- Blue coloration of the skin (cyanosis)
- Concave appearance of the abdomen(in diaphragmatic hernia)
- Abnormal chest development(congenital diaphragmatic Hernia)
In case of diaphragmatic hernia, your doctor can recommend echocardiogram (cardiac ultrasound) and blood test to determine if there is a genetic problem. Although rare, your physician can suggest arterial blood gas (ABG) if he suspects signs of O2/CO2 or pH imbalance.
In herniated disc, the diagnosis is based on neurological examination, testing sensation, muscle strength, reflexes, etc. If physical exam is insufficient, an electromyography or MRI can be done to detect presence of abnormalities in your intervertebral disc.
Certain hernias such as umbilical hernia and inguinal hernia are diagnosed during a physical exam. For all other types of hernia, your doctor can recommend:
Barium X-ray, a medical procedure that allows your physician to detecting abnormalities in your esophagus and stomach
Endoscopy, examination of your esophagus, stomach and duodenum using a using a thin, flexible tube containing a tiny TV camera at the end;
Esophageal manometry, a test used to measure the pressure inside the lower part of your esophagus.
The treatment depends greatly on the type of hernia; thus in moderate or non-strangulated hernias, the treatment can be that of the symptoms and application of all measuring aimed at reducing complications. To prevent symptoms such as abdominal pain and gastro-esophageal reflux, you should not go to bed soon after meals, stop or decrease alcohol consumption, do not eat large meal (which prevents good digestion and increases intra-abdominal pressure), avoid eating meals rich in fat, avoid drinking soon after meal and all factors increasing intra-abdominal pressure.
Hiatal hernias – All these measures above can be used to control small hiatal hernias. In case of large hiatal hernias or in serious complications where all other treatments fail to produce positive results, herniorrhaphy (surgical procedure for repairing hernias) is then considered.
Herniated disc may be required especial therapies. The priority of the treatment is to alleviate any vertebral pain and irritation or damage of nerve (neuralgia). Your doctor can recommend bed rest along with analgesics, non-steroidal anti inflammatory, and if necessary, epidural steroid injections (ESIs). In some cases, to reduce chronic pain and relapses, your doctor can suggest massage, physiotherapy sessions, and wearing of a cervical collar. If these bring no satisfying results, your surgeon will perform a surgery or chemonucleolysis, injection in your intervertebral disk of a protein-digesting enzyme called chymopapain.
Abdominal hernias – trusses (a tight elastic belt worn over a hernia to prevent it from enlarging) and herniorrhaphy are two methods most commonly used to treat all abdominal hernias. However, in recent years, most doctors do not recommend trusses. A truss can only provide comfort or support when worn over small hernias; it does not prevent pain or strangulation attacks. Herniorrhaphy is by far the only effective treatment of abdominal hernias.
What are the complications of hernia?
If left untreated, certain types of hernia such as hiatal hernia can lead to narrowing of the esophagus, ulceration, bleeding and even cardiorespiratory disorders.
Although some hernias are not preventable, there are steps you can take to prevent the development of most of them:
Do with prudence all physical activities capable of causing straining of your abdominal muscles. Activities such as Weight lifting, playing football, golfing, and Persistent sneeze are shown to be able to tear the abdominal muscles, which can lead to the development of certain hernias
Maintain a normal weight. Abnormal weight gain or loss can increase the risk of certain hernias. Scientists have discovered a link between some hernias with excessive and rapid weight gain/loss.
Treatment of hernias’ causing diseases – If possible, treat all diseases that can lead to hernias: Down syndrome, mucopolysaccharide storage diseases, Beckwith-Wiedemann syndrome, etc.
Treat or prevent constipation – chronic constipation causes you to straining to pass faeces. This produces pressure on the abdominal muscles leading to abdominal hernias. In addition, strain during bowel movement can also increase the size of the hernia.
Quit smoking – besides cardiovascular disease and cancer, cigarette smoke can trigger persistent cough, which may cause and increase the size of hernias.
Increase your fluids and fiber intake – Drink plenty of fluids and increase your daily fiber intake (20-30 grams a day) by eating a healthy diet rich in whole grains, vegetables, and fruits.
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