Hernia

A hernia results when the supportive muscle layer that covers the intestines is weakened or ruptures, allowing a portion of the intestine or tissue to protrude through it.  A hernia may or may not cause symptoms.  It may appear as a lump or bulge and cause discomfort.  Surgery may be used to correct some types of hernias.

Anatomy Your intestines are protected, supported, and held in place by fat, tissues, and a thin muscle layer.  Fat tissue and your skin cover the muscle layer.

Causes A hernia occurs when an area of the thin muscle layer that covers the intestines weakens and ruptures, allowing a portion of the intestines to bulge through it.  In some cases, the protruding intestine may appear as a lump or a bulge beneath the skin.  Heavy lifting may contribute to some types of hernias, but in other cases, there may be no identifiable cause.There are different types of hernias, including: Inguinal Hernia An inguinal hernia is the most common type of hernia to require surgery.  It occurs more frequently in men than in women.  It may appear in the groin area or scrotum (in men). Femoral Hernia A femoral hernia is the most frequently occurs in women.  It is the most common type of hernia to become strangulated, a life-threatening complication when the blood supply is cut off.  More information about strangulated hernias appears in the “Complications” section of this article.  A femoral hernia appears in the upper thigh. Incisional Hernia An incisional hernia develops in the abdominal wall at a place where a surgical incision did not heal properly.  An incisional hernia may cause discomfort, but is rarely associated with serious complications. Umbilical Hernia Some people are born with an umbilical hernia.  It results from a weakness in the abdominal wall surrounding the umbilicus, where the belly button is located.  Umbilical hernias are more common in boys than girls and usually do not cause symptoms until adulthood.

Symptoms Some people with a hernia do not experience symptoms.  A hernia may cause groin tenderness and pain.  The pain may become worse when you bend or lift.  You may notice a lump in your lower abdomen, groin area, or scrotum (in males).  Children may have a bulge or lump without pain or tenderness.  The hernia bulge may become larger when you cough, bend, lift, strain, or cry.  A hernia bulge may not be noticeable in infants and children until they cry or cough.

Diagnosis In some cases, minor hernias are discovered during a regular physical examination.  However, you should contact your doctor if you suspect that you have a hernia.  Your doctor can begin to diagnose a hernia by reviewing your medical history and conducting a physical examination.  Your doctor will palpate or feel for a mass.  Your doctor will check and see if the mass increases in size when you cough, bend, or lift.

Treatment Most hernias can be manually pushed back into place.  Some hernias that cannot be pushed back into place may pose a health risk and surgery may be recommended based on the specific condition and patient’s preferences.  Surgical hernia repair is an outpatient surgery that may use general or local anesthesia.  Traditional surgery methods for hernia repair involve making an incision and placing the tissue or organ back in place beneath the muscle wall.  The muscle tissue is repaired, sometimes with reinforcement from a mesh screen, and the incision is closed.  Following your surgery, you may temporarily wear a corset to provide support.  Your doctor will inform you of temporary activity restrictions. Laparoscopic surgery may be an alternative surgery method for some people.  Laparoscopic surgery uses a laparoscope to guide the surgery.  A laparoscope is a thin tube with a miniature viewing instrument.  The laparoscope is inserted through small incisions.  Thin surgical instruments are inserted through the laparoscope during the surgery.  Because laparoscopic surgery is less invasive and requires smaller incisions than traditional surgery methods, it is associated with less pain, less scarring, and quicker recovery.

Prevention You may help prevent a hernia by using proper lifting techniques and avoiding heavy lifting.  It can be helpful to attain and maintain a healthy body weight.  You may reduce constipation and straining during a bowel movement by eating a high-fiber diet, drinking plenty of water, exercising regularly, and going to the bathroom as soon as you are aware of the need to have a bowel movement.

Am I at Risk Risk factors for developing a hernia include:_____ People with a family history of hernias have an increased risk of developing a hernia. _____ Being overweight increases the risk of a hernia. _____  People with cystic fibrosis have an increased risk of developing a hernia. _____ Men with undescended testicles or enlarged prostate have an increased risk for a hernia. _____ Straining from chronic constipation can contribute to a hernia. _____ Chronic coughing increases the risk of a hernia.

Complications A strangulated hernia can occur if the blood supply is cut off from a trapped portion of the intestine.  A strangulated hernia causes excruciating pain and serious illness.  A strangulated hernia is an emergency medical condition, and you should seek immediate treatment in the emergency room of a hospital.  You should contact your doctor immediately if you experience nausea, vomiting, fever, or if your hernia appears red, purple, dark, or discolored.