Understanding Hernia: Symptoms, Causes, and Treatment Options

Hernias can be a problem for many people, especially the elderly. In some cases, it can be quite painful, which is why it is important to know how to deal with this issue.

What Is Hernia?

Hernia occurs when there is a gap or weakness in the muscular wall that holds tissues, such as intestines or organs, in place. This allows the contents inside the abdomen to protrude outward. A hernia typically develops when the abdominal muscles weaken, causing a bulge or tear. 

In the same way that an inner tube pushes through a damaged tire, the inner lining of the abdominal cavity pushes through the weakened area of the abdominal wall to form a small balloon-like sac. This can allow a loop of intestine or abdominal tissue to push into the sac.

Hernia can occur in both men and women. A person may be born with a hernia (congenital) or develop one over time (acquired).

The common areas where hernias occur are in the groin (inguinal), belly button (umbilical), and the site of previous abdominal surgery (incisional).

Types of Hernia

The following are the most common types of hernia:

1. Inguinal Hernia

The inguinal canal in men allows for the passage of the spermatic chord and other blood vessels to the testicles. On the other hand, for women, it is the passage for the ligament that supports the uterus. This type of hernia can be classified into two different types, which are direct and indirect inguinal hernia. It happens when fatty tissue (or a part of the intestine) pushes through the groin. Inguinal hernias are more common in men.

2. Femoral Hernia

A femoral hernia occurs when a part of the intestine pushes the inner thigh or top of the femur. Femoral hernias are more common in older women, and are generally located below the inguinal canal. Femoral hernias can cause a bulge or discomfort in the groin area and may require surgical hernia repair.

3. Umbilical Hernia

Umbilical hernias occur when part of the fatty tissue pushes through the navel area, often due to increased pressure in the abdomen. This type is common in infants if the opening in the tummy that the umbilical cord passes through does not seal properly after birth. Adults can also be affected, possibly as a result of repeated strain on the tummy.

4. Hiatal Hernia

Hiatal hernias occur when part of the stomach pushes through the diaphragm towards the chest cavity. It can lead to symptoms like heartburn and acid reflux, and surgery may be required if the condition worsens. It's not exactly clear what causes hiatus hernias, but it may be the result of the diaphragm becoming weak with age or pressure on the tummy.

5. Incisional Hernia

Incisional hernias develop at the site of a previous abdominal surgery, where part of the internal tissue pushes through the weakened area in the abdominal wall. This often happens after surgeries like a C-section or appendectomy. Hernia repair in such cases is typically performed via open or laparoscopic surgery.

6. Epigastric Hernia

Epigastric hernias occur when fatty tissue pushes through the abdominal muscles between the navel and breastbone.

7. Spigelian Hernia

Spigelian hernias occur when a part of the intestine pushes through the side of the abdomen below the navel area.

Hernia Risk Factors

The wall of the abdomen has natural areas of potential weakness. Hernias can develop at these or other areas due to heavy strain on the abdominal wall due to lifting heavy weights, sports, aging, injury, an old incision, or a weakness present from birth.

Anyone can develop a hernia at any age. Most hernias in children are congenital. In adults, a natural weakness or strain from heavy lifting, persistent coughing, difficulty with bowel movements or urination can cause the abdominal wall to weaken or separate.

Hernia Symptoms

If you have a hernia and experience any of the following symptoms, you should immediately visit your nearest A&E.

• Bulge under the skin
• Pain or discomfort when lifting heavy objects
• Cough
• Strain during urination or bowel movements, or during prolonged standing or sitting

The pain may be sharp and immediate or may be a dull ache that gets worse towards the end of the day. Severe, continuous pain, redness, and tenderness are signs that the hernia may be entrapped or strangulated like strangulated hernia.

Another sign is if the bulge used to come and go but is now stuck and cannot be reduced. These symptoms, including inguinal hernia symptoms, are a cause for concern, and you should immediately contact your physician or surgeon.

Hernia Diagnosis

Hernias can usually be diagnosed within a physical exam and can be seen bulging out in the area where it has occurred. However, in some cases, imaging like CT scans may be required for an accurate diagnosis, especially complicated cases like inguinal hernias or strangulated hernias.

A general practitioner will usually be able to identify a hernia by examining the affected area. In some cases, they may refer you to a nearby hospital for an ultrasound scan to confirm the diagnosis or assess the extent of the problem. This is a painless scan where high-frequency sound waves are used to create an image of part of the inside of the body.

Once a diagnosis has been confirmed, a doctor will determine whether surgery to repair the hernia is necessary. A number of factors will be considered when deciding whether surgery is appropriate, including:

• The type of hernia: Some types of hernias are more likely to become strangulated or cause a bowel obstruction than others.
• The content of your hernia: If the hernia contains a part of your bowel, muscle, or other tissue, there may be a risk of strangulation or obstruction.
• Your symptoms and the impact on your daily life: Surgery may be recommended if your symptoms are severe or getting worse, or if the hernia is affecting your ability to carry out your normal activities.
• Your general health: Surgery may be too much of a risk if your general health is poor.

Although most hernias will not get better without surgery, they will not necessarily get worse. In some cases, the risks of surgery may outweigh the potential benefits.

Complications of Untreated Hernia

Except for umbilical hernias in newborns and babies, other hernias do not go away on their own if not treated. They only grow more painful with time and can cause more complications with time. Some of these include:

• Obstructions - this may happen when a part of the intestine gets deeply stuck within the inguinal canal causing issues in digestion and leading to nausea, stomach pain, and vomiting.
• Blood circulation issues - these happen when the intestine gets trapped in a way to cut off the blood supply. These are medical emergencies and may need immediate surgical intervention.

Treatment Options for Hernia

A hernia does not get better over time, nor will it go away by itself. There are no exercises or physiotherapy regimens that can treat hernia.

A hernia may be detected by your doctor on a routine physical examination. It may lead to potentially serious problems, such as intestinal obstruction or strangulated bowel, and may require emergency hernia surgery.

The following are the commonly used treatment options for Hernia:

• Open surgery: As the name implies, it is done by making an incision in the body at the impacted area and pushing the protruding tissue back to its original place and stitching the weakened muscles back together.
• Laparoscopic Hernia Repair: Laparoscopic Hernia Repair is a technique to repair the defects in the abdominal wall using small incisions, telescopes, and a patch. Compared to conventional surgery, laparoscopic surgery offers a shorter hospital stay, less pain after surgery, faster return to work and normal activity for most patients.

Take the First Step Towards Hernia Relief at Gleneagles Hospital Penang

If you're experiencing symptoms of a hernia or need advice on treatment options, our expert team of general surgeons at Gleneagles Hospital Penang is here to help. Don’t let discomfort or complications worsen, schedule an appointment with our specialists today to discuss the best treatment for your needs, whether it’s lifestyle adjustments, non-invasive procedures, or hernia repair surgery. Your health and well-being are our top priority!