Description

The word "hernia" most frequently refers to the organ being a loop of intestine and the weakness being part of the abdominal wall, thereby producing a lump or a mass. This lump is usually a soft, sometimes painless and sometimes painful lump under the skin which can sometimes be reducible (you can push the lump back through the weakness and get rid of it) or irreducible (it cannot be pushed back).

However, less commonly, other organs may be involved to produce herniae. Examples include a "slipped disc" or "disc herniation where the spongy disc which is usually sandwiched between two bony vertebrae of the spine, bulges out. This can then cause compression of the nerve root nearby, causing pain. An example of this process is the pain of sciatic.

The following refers to "hernia" as meaning a loop of bowel passing through an abdominal wall weakness.

1. Inguinal Hernia: this is the commonest type of hernia and occurs mostly in men or baby boys. A loop of bowl passes through a weakness in the inguinal canal which is situated between different muscle layers of the abdominal wall near the groin. A mass therefore appears near the scrotum or actually inside the scrotum.
2. Femoral Hernia: this occurs mostly in overweight women where a loop of bowel passes through the femoral canal which is located in the upper thigh where large blood vessels pass into the leg. A mass therefore appears in the upper and inner part of the thigh.
3. Epigastric Hernia: this occurs as a lump in the midline over the upper abdomen between the breast bone and naval. Weakness of the fibrous tissues between the tummy muscles causes the underlying portion of bowel to protrude.
4. Incisional Hernia: this occurs as a result of weakness from an operation wound or scar on the abdomen and a portion of bowel passing through the weakness.
5. Hiatus Hernia: this occurs when part of the stomach penetrates through the diaphragm and ends up in the thorax (chest cavity). This occurs either by the stomach pushing up so that it sits beside the oesophagus (food pipe) or it herniates directly and slides up through the diaphragm. In both cases, there is no palpable mass but patient may complain of chest or abdominal discomfort, especially after eating. These symptoms can resemble heartburn or indigestion. Sometimes, there are no symptoms and a hiatus hernia is diagnosed inccidentally.
6. Epigastric Hernia: this occurs as a lump in the midline over the upper abdomen between the breast bone and naval. Weakness of the fibrous tissues between the tummy muscles causes the underlying portion of bowel to protrude.
7. Umbilical Hernia: this happens where a portion of bowel passes through a weakness at the naval or belly button producing a lump under the naval. This can occur at any age although is common in babies.

There are several risk factors for herniae. Typically in adults, herniae develop with straining during heavy lifting, straining to move bowels with constipation, sneezing and chronic coughing. It is also more likely in those who are over weight or who have had previous abdominal surgery.

In babies, herniae appear due to congenital muscle wall weakness, such as at the umbilicus (naval).

There are several risk factors for herniae. Typically in adults, herniae develop with straining during heavy lifting, straining to move bowels with constipation, sneezing and chronic coughing. It is also more likely in those who are over weight or who have had previous abdominal surgery.

In babies, herniae appear due to congenital muscle wall weakness, such as at the umbilicus (naval).

Treatment of a hernia usually involves surgery to repair the weakness or defect of the abdominal wall, either by stitching the weakness together or by using a steel or nylon mesh so that a further loop of bowel cannot escape again. This surgery can be done with an open incision or through keyhole surgery. Umbilical herniae in babies are usually left at least until the age of 2-3 years as most correct themselves. Occasioanally, surgery is required after this age.
In the past a truss was worn to prevent a lump appearing through the defect but this is rarely satisfactory these days unless surgery is not possible.

A few days bed rest is usually recommended although patients can go home as soon as they are able to walk. Patients can return to work after 4 weeks for light duties and to full activity after 8-12 weeks.

Complications from the operation itself include infection, bruising, swelling, mild discomfort (usually controlled by pain killers), and damage to the surround tissues.

Treatment of a hernia usually involves surgery to repair the weakness or defect of the abdominal wall, either by stitching the weakness together or by using a steel or nylon mesh so that a further loop of bowel cannot escape again. This surgery can be done with an open incision or through keyhole surgery. Umbilical herniae in babies are usually left at least until the age of 2-3 years as most correct themselves. Occasioanally, surgery is required after this age.

In the past a truss was worn to prevent a lump appearing through the defect but this is rarely satisfactory these days unless surgery is not possible.
There are several other less common herniae which can occur.

Complications of a hernia include obstruction of the bowel and strangulation of the bowel. In the case of strangulation, the blood supply to the bowel is cut off and the bowel begins to turn gangrenous. This is usually acutely painful and is a surgical emergency.

Surgery is usually done under general anaesthetic although a local anaesthetic can be used in some circumstances.