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Hernia

HAug 18 04

 

What Is It?

A hernia occurs when part of an internal organ or body part protrudes through an opening into another area where it shouldn’t. Many different types of hernias can develop, but the most common occur when a piece of the intestine pokes through a weak area in the wall of the abdomen. This causes an abnormal bulge under the skin of the abdomen, usually near the groin or the navel.

Each type of hernia has a particular location and tends to occur for different reasons. Some hernias are present at birth while others develop in adulthood. Many hernias grow bigger when there is frequent pressure buildup in the abdomen, for example during straining, lifting or coughing.

  • Inguinal hernia — A piece of intestine pokes through a weakness in the inguinal canal, a natural passageway through the abdominal wall near the groin. In males, it is the normal route for the testes to descend into the scrotum before birth. Inguinal hernias account for 75 percent of all hernias, and are five times more common in males than females. They usually are present at birth, but can develop in adults.


  • Femoral hernia — A piece of intestine pokes through the passage that normally is used by large blood vessels (the femoral artery and vein) when they pass between the abdomen and the leg. This type of hernia causes a bulge in the upper thigh, and is more common in women than men.


  • Epigastric, or ventral, hernia — A piece of intestine bulges through a weakness in abdominal muscles between the navel and breastbone. Most people with ventral hernias are men, usually between ages 20 and 50.


  • Umbilical hernia — A piece of intestine bulges through the abdominal wall next to the navel. The area of weakness in the abdominal wall can be very small (less than half an inch) or it can be as large as 2 to 3 inches. Umbilical hernias are common in newborns, but may disappear gradually over time.


  • Parumbilical hernia — This looks like an umbilical hernia, but it is not present at birth. Parumbilical hernias often are caused by long standing strain on the abdominal muscles, which commonly occurs in people who are overweight, or in women who have been pregnant many times.


  • Incisional hernia — A piece of the intestine bulges through a weakness in the abdominal wall in an area where surgery has been done previously.


  • Hiatal hernia — This hernia involves the stomach rather than the intestines. A piece of the stomach slips through a normal opening in the diaphragm and passes upward into the chest.

Symptoms

Most hernias cause a bulge under the skin. The location of this bulge depends on the specific type of hernia. For example, an inguinal hernia appears as a bulge in the groin, while an umbilical hernia appears as a bulge near the navel. Some hernias can cause twinges of pain or a pulling sensation, while others do not cause any symptoms. Hernias are usually easier to see and cause more symptoms when you cough or strain.

A hernia is considered incarcerated if a portion of intestine becomes trapped and is unable to slide back into the abdomen. Rarely, the trapped intestine can strangulate — twist and die because its blood supply is cut off. This causes severe pain and requires immediate treatment.

Diagnosis

Most people discover their own hernias, although sometimes your doctor will find a hernia as part of a routine examination. Your doctor will confirm the diagnosis by a simple physical examination. He or she may ask you to strain or cough, which may make the bulge easier to see or feel.

Rarely, you may have symptoms of a hernia, but the doctor will be unable to find it at the time of examination. In these circumstances, your doctor may recommend an ultrasound of the abdomen or even exploratory surgery.

Expected Duration

Most hernias stay the same or get larger over time. Umbilical hernias, however, are a special case. Most small umbilical hernias that appear before a baby is 6 months old will disappear before the child’s first birthday. Even larger umbilical hernias may disappear before age 5 or 6.

Prevention

To prevent hernias associated with increased abdominal pressure, avoid activities that cause abdominal strain, such as lifting heavy weights. Losing weight is helpful if you are overweight. If you frequently need to strain when you move your bowels, speak to your doctor. Your doctor may prescribe stool softening medication or suggest that you modify your diet to include more high fiber foods.

Treatment

Although not all hernias need to be repaired, hernias that cause symptoms or become larger should be repaired by a surgeon. The technique used to repair your hernia depends on its type, size and location. There are many options, including standard surgery, surgery using mesh plugs or patches, and surgery done through a small incision using a telescope (laparoscopic surgery). If you are considering having a hernia repaired, speak to your doctor about the advantages and disadvantages of each technique.

Hernias that become incarcerated or strangulated require immediate medical attention. Your doctor will try to push the hernia back through the hole in which it is stuck. If this can’t be done, emergency surgery may be needed. Otherwise, most hernia repairs can be done on an outpatient basis at a convenient place and time.

Umbilical hernias usually are not treated surgically unless the hernia continues past the child’s third or fourth birthday, becomes larger, causes symptoms or strangulates. Umbilical hernias are more likely to need surgery if the opening through which the hernia passes is greater than 2 centimeters.

Most hiatal hernias are treated by changing the diet or by taking medications that reduce acid produced in the stomach. Surgery occasionally may be recommended for large hiatal hernias that cause continuing symptoms, or for hernias that become stuck inside the chest.

When To Call A Professional

Call your doctor right away if there is pain at the site of a hernia. This can be the first sign that a hernia is incarcerated or strangulated. See your doctor if you notice a new, painless lump or swelling in a location where hernias typically occur.

Prognosis

When surgery is used to repair hernias, the outlook is generally good. For example, of the more than 70,000 inguinal hernias repaired every year in the United States, only 10 percent to 15 percent return after surgery.

Johns Hopkins patient information

Last revised: December 3, 2007
by Levon Ter-Petrosyan, D.M.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.
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