A hernia occurs when an organ pushes through an opening in the muscle or tissue that holds it in place. For example, the intestines may break through a weakened area in the abdominal wall.Hernias are most common in the abdomen, but they can also appear in the upper thigh, belly button, and groin areas. Most hernias aren’t immediately life-threatening, but they don’t go away on their own. Sometimes they can require surgery to prevent potentially dangerous complications.

A hernia occurs when there is a weakness or hole in the peritoneum, the muscular wall that usually keeps abdominal organs in place.

This defect in the peritoneum allows organs and tissues to push through, or herniate, producing a bulge.

The lump may disappear when the person lies down, and sometimes it can be pushed back into. Coughing may make it reappear.

Hernias can commonly be found in the following areas

Groin: A femoral hernia creates a bulge just below the groin. This is more common in women. An inguinal hernia is more common in men. It is a bulge in the groin that may reach the scrotum.

Upper part of the stomach: A hiatal or hiatus hernia is caused by the upper part of the stomach pushing out of the abdominal cavity and into the chest cavity through an opening in the diaphragm.

Belly button: A bulge in this region is produced by an umbilical or periumbilical hernia.

Surgical scar: Past abdominal surgery can lead to an incisional hernia through the scar.

Common hernia types

Inguinal hernia

Inguinal hernias are the most common type of hernia. They make up about 70 percent of all hernias, according to the British Hernia Centre (BHC). These hernias occur

when the intestines push through a weak spot or tear in the lower abdominal wall, often in the inguinal canal.

The inguinal canal is found in your groin. In men, it’s the area where the spermatic cord passes from the abdomen to the scrotum. This cord holds up the testicles. In women, the inguinal canal contains a ligament that helps hold the uterus in place.

This type of hernia is more common in men than women. This is because a man’s testicles descend through the inguinal canal shortly after birth, and the canal is supposed to close almost completely behind them. Sometimes, the canal doesn’t close properly and leaves a weakened area prone to hernias.

Hiatal hernia

A hiatal hernia occurs when part of your stomach protrudes up through the diaphragm into your chest cavity. The diaphragm is a sheet of muscle that helps you breathe by contracting and drawing air into the lungs. It separates the organs in your abdomen from those in your chest.

This type of hernia is most common in people over 50 years old. If a child has the condition, it’s typically caused by a congenital birth defect. Hiatal hernias almost always cause gastrointestinal reflex, which is when the stomach contents leak backward into the esophagus, causing a burning sensation.

Umbilical hernia

Umbilical hernias can occur in children and babies under 6 months old. This happens when their intestines bulge through their abdominal wall near their bellybutton. You may notice a bulge in or near your child’s bellybutton, especially when they’re crying.

An umbilical hernia is the only kind that often goes away on its own as the abdominal wall muscles get stronger, typically by the time the child is 1 years old. If the hernia

hasn’t gone away by this point, surgery may be used to correct it.

Incisional hernia

Incisional hernias can occur after you’ve had abdominal surgery. Your intestines may push through the incision scar or the surrounding, weakened tissue.

Causes

Hernias are caused by a combination of

muscle weakness and strain. Depending on its cause, a hernia can develop quickly or over a long period of time.

Common causes of muscle weakness include:

  • Failure of the abdominal wall to close properly in the womb, which is a congenital defect
  • Age
  • Chronic coughing
  • Damage from injury or surgery

Factors that strain your body and may cause a hernia, especially if your muscles are weak, include:

  • Being pregnant, which puts pressure on your abdomen
  • Being constipated, which causes you to strain when having a bowel movement
  • Lifting heavy weight
  • Fluid in the abdomen, or ascites
  • Suddenly gaining weight
  • Surgery in the area
  • Persistent coughing or sneezing

Activities and medical problems that increase pressure on the abdominal wall can lead to a hernia. These include:

  • Straining on the toilet (due to long-term constipation, for example)
  • Persistent cough
  • Cystic fibrosis
  • Enlarged prostate
  • Straining to urinate
  • Being overweight or obese
  • Abdominal fluid
  • Lifting heavy items
  • Peritoneal dialysis
  • Poor nutrition
  • Smoking
  • Physical exertion
  • Undescended testicles

Risk factors for hernia

The risk factors can be broken down by hernia type:

Incisional hernia risk factors

Because an incisional hernia is the result of surgery, the clearest risk factor is a recent surgical procedure on the abdomen.

People are most susceptible 3-6 months after the procedure, especially if:

  • They are involved in strenuous activity
  • Have gained additional weight
  • Become pregnant

These factors all put extra stress on tissue as it heals.

Inguinal hernia risk factors

Those with a higher risk of inguinal hernia include

Smoking tobacco increases the risk of inguinal hernias.

  • Older adults
  • People with close relatives who have had inguinal hernias
  • People who have had inguinal hernias previously
  • Males
  • Smokers, as chemicals in tobacco weaken tissues, making a hernia more likely
  • People with chronic constipation
  • Premature birth and low birth weight
  • Pregnancy

Umbilical hernia risk factors

Umbilical hernias are most common in babies with a low birth weight and premature babies.

In adults, the risk factors include:

  • Being overweight
  • Having multiple pregnancies
  • Being female

Hiatal hernia risk factors

Therisk of hiatal hernia is higher in people who:

  • Are aged 50 years or over
  • Have obesity

Symptoms

The most common symptom of a hernia is a bulge

or lump in the affected area. In the case of an inguinal hernia, you may notice a lump on either side of your pubic bone where your groin and thigh meet.

You’re more likely to feel your hernia through touch when you’re standing up, bending down, or coughing.

If your baby has a hernia, you may only be able to feel the bulge when their crying. A bulge is typically the only symptom of an umbilical hernia.

Other common symptoms of an inguinal hernia include:

  • Pain or discomfort in the affected area (usually the lower abdomen), especially when bending over, coughing, or lifting
  • Weakness, pressure, or a feeling of heaviness in the abdomen
  • A burning, gurgling, or aching sensation at the site of the bulge

Other symptoms of a hiatal hernia include:

  • Acid reflux, which is when stomach acid moves backward into the esophagus causing a burning sensation
  • Chest pain
  • Difficulty swallowing

In some cases, hernias have no symptoms. You may not know you have a hernia unless it shows up during

a routine physical or a medical exam for an unrelated problem.

Diagnosis

Inguinal or incisional hernias are usually diagnosed through a physical examination. Your doctor may feel for a bulge in your abdomen or groin that gets larger when you stand, cough, or strain.

If you have a hiatal hernia, your doctor may diagnose it with a barium X-ray or endoscopy.

A barium X-ray is a series of X-ray pictures of your digestive tract. The pictures are recorded after you’ve

finished drinking a liquid solution containing barium, which shows up well on the X-ray images.

An endoscopy involves threading a small camera attached to a tube down your throat and into your esophagus and stomach.

These tests both allow your doctor to see the internal location of your stomach.

If your child has an umbilical hernia, your doctor may perform an ultrasound. An ultrasound uses high-frequency sound waves to create an image of the structures inside the body.

Treatment

Whether or not you need treatment depends on the size of your hernia and the severity of your symptoms. Your doctor may simply monitor your hernia for possible complications. Treatment options for a hernia include lifestyle changes, medication, or surgery.

Lifestyle changes

Dietary changes can often treat the symptoms of a hiatal hernia, but won’t make the hernia go away. Avoid large or heavy meals, don’t lie down or bend over after a meal, and keep your body weight in a healthy range.

Certain exercises may help strengthen the muscles around the hernia site, which may reduce some symptoms. However, exercises done improperly can increase pressure at that area and may actually cause the hernia to bulge more. It’s best to discuss what exercises to do and not do with your doctor or physical therapist.

If these changes don’t eliminate your discomfort, you may need surgery to correct the hernia. You can also improve symptoms by avoiding foods that cause acid reflux or heartburn, such as spicy foods and tomato-based foods. Additionally, you can avoid acid reflux by losing weightand giving up cigarettes.

Medication

If you have a hiatal hernia, over-the-counter and prescription medications that reduce stomach acid can relieve your discomfort and improve symptoms. These

include antacids, H-2 receptor blockers, and proton pump inhibitors.

If you experience heartburn and acid reflux, your doctor may recommend:

  • Antacids that neutralize stomach acid. Antacids, such as Mylanta, Rolaids and Tums, may provide quick relief. Overuse of some antacids can cause side effects, such as diarrhea or sometimes kidney problems.
  • Medications to reduce acid production. These medications — known as H-2-receptor blockers — include cimetidine (Tagamet famotidine (Pepcid), nizatidine (Axid ) and ranitidine (Zantac). Stronger versions are available by prescription.
  • Medications that block acid production and heal the esophagus. These medications — known as proton pump inhibitors — are stronger acid blockers than H-2-receptor blockers and allow time for damaged esophageal tissue to heal. Over-the-counter proton pump inhibitors include lansoprazole (Prevacid 24HR) and omeprazole (Prilosec, Zegerid). Stronger versions are available in prescription form

Surgery

Although surgical options depend on individual circumstances, including the location of the hernia, there are two main types of surgical intervention for hernia:

  • Open surgery
  • Laparoscopic operation (keyhole surgery)

Open surgical repair closes the hernia using sutures, mesh, or both, and the surgical wound in the skin is closed with sutures, staples, or surgical glue.

Laparoscopic repair is used for repeat operations to avoid previous scars, and while usually more expensive, is less likely to cause complications such as infection.

Surgical repair of a hernia guided by a laparoscope allows for the use of smaller incisions, enabling a faster recovery from the operation.

The hernia is repaired in the same way as in open surgery, but it is guided by a small camera and a light introduced through a tube. Surgical instruments are inserted through another small incision. The abdomen is inflated with gas to help the surgeon see better and give

them space to work; the whole operation is performed under general anesthetic.

Hernia in children

Inguinal hernia is one of the most common surgical conditions in infants and children.

A 2014 systematic review of 20 years of data on conventional open hernia repair (herniorrhaphy) and laparoscopic hernia repair (herniorrhaphy) in infants and children found that laparoscopic surgery is faster than open surgery for bilateral hernias, but that there is no significant difference in operating time for unilateral inguinal hernia repair.

The rate of recurrence is similar for both types of procedure, but complications, such as wound infection, are more likely with open surgery, especially in infants.

Complications

If left untreated, your hernia may grow and become more painful. A portion of your intestine could become trapped in the abdominal wall. This can obstruct your

bowel and cause severe pain, nausea, or constipation. An untreated hernia can also put too much pressure on nearby tissues. This can cause swelling and pain in the surrounding area.

If the trapped section of your intestines doesn’t get enough blood flow, strangulation occurs. This can cause the intestinal tissue to become infected or die. A strangulated hernia is life-threatening and requires immediate medical care.

Fast facts on hernias

  • Hernias often produce no troublesome symptoms, but abdominal complaints may signal a serious problem.
  • They are usually straightforward to diagnose, simply by feeling and looking for the bulge.
  • Treatment is a choice between watchful waiting and corrective surgery, either via an open or keyhole operation.
  • Inguinal hernia surgery is more common in childhood and old age, while the likelihood of femoral hernia surgery increases throughout life.

Preventing a hernia

You can’t always prevent the muscle weakness that allows a hernia to occur. However, you can reduce the amount of strain you place on your body. This may help you avoid a hernia or keep an existing hernia from getting worse. Prevention tips include:

  • Not smoking
  • Seeing your doctor when you’re sick to avoid developing a persistent cough
  • Maintaining a healthy body weight
  • Avoiding straining during bowel movements or urination
  • Lifting objects with your knees and not your back
  • Avoiding lifting weights that are too heavy for you.

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