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Hernia is a separation or tear in the fibers of a MUSCLE that allows the underlying tissue or structure to bulge through. Hernias may occur as a result of congenital weakness or incomplete closure of a channel in the muscle (such as an umbilical or inguinal hernia) or because of injury (unintended or surgical). The common types of hernia are
Types of Hernia
- inguinal hernia, which occurs in the inguinal canal (groin)
- femoral hernia, which occurs in the upper thigh
- umbilical hernia, which occurs at the umbilicus (belly button)
- HIATAL HERNIA, which occurs in the DIAPHRAGM and is not visually perceptible
- incisional hernia, which occurs at the site of a surgical incision, usually abdominal
Hernias present in children often heal as the child grows. Hernias in adults are often present from childhood and become problematic when some sort of strain puts pressure on them. Hernias are somewhat more common in men. When the person or doctor can push the hernia back into the muscle wall it is reducible; an incarcerated hernia is a hernia that will not recede. When the hernia traps a segment of intestine or other tissue to the extent that it cuts off the BLOOD supply, it is a strangulated hernia. Though some hernias, particularly in children, may correct themselves, most hernias require surgery to repair the defect in the muscle wall.
Symptoms of Hernia and Diagnostic Path
A hernia may appear as a painless bulge or may cause discomfort, depending on its location and the extent to which it allows intestinal structure to protrude through the muscle wall. Many abdominal hernias are more prominent with coughing or bearing down. Symptoms of hiatal hernia may include DYSPEPSIA (heartburn) and difficulty swallowing. Diagnosis is primarily clinical, based on the appearance of the symptoms. The doctor may request an ULTRASOUND examination to confirm the presence of the hernia and to create a visual image to help assess the appropriate therapeutic course.
Hernia Treatment Options and Outlook
Most hernias require surgery to repair the weakness in the muscle wall. The doctor may decide to take an approach of watchful waiting when the hernia is very small, in a young child, or in a person for whom surgery is a significant risk. Nonsurgical approaches such as a truss (a supportive device that places pressure against the hernia to keep it within the abdominal wall) may relieve symptoms for the short term but cannot correct the hernia. Though some hernias may remain small and inconsequential for long periods of time they may become problematic without warning, at which point they may require immediate or urgent medical attention. An incarcerated hernia is a medical emergency that requires immediate surgery, otherwise the strangulated tissue dies and is at very high risk for GANGRENE.
Hernia repair surgery, called herniorrhaphy or hernioplasty, can be OPEN SURGERY (an OPERATION in which the surgeon makes a two- to three-inchlong incision over the site of the hernia and directly exposes the involved muscles) or MINIMALLY INVASIVE SURGERY (an operation in which the surgeon uses a laparoscope and special instruments to operate through one to three small incisions). ANESTHESIA may be regional, epidural, or general. Variables that influence the surgeon’s decision about the type of operation include the location and size of the hernia, the person’s age and general health status, and whether the hernia is reducible or incarcerated.
For most hernia repairs the surgeon places a small piece of plastic mesh behind the opening in the muscle wall to help support the muscle layers. The surgeon then sutures those layers together to restore stability and STRENGTH to the muscle wall. Recovery takes about two weeks for a laparoscopic surgery and up to six weeks for an open surgery. Once repaired, hernias do not generally recur though it is common to feel twinges of discomfort and even PAIN periodically at the site up to several years after the surgery.
Hernia Risk Factors and Preventive Measures
Repeated straining, such as with bowel movements or because of chronic COUGH, can pressure a weak place in the abdominal wall. Though sudden, strenuous movement can bring out a hernia, such movement can occur with a strong SNEEZE or cough as easily as lifting too heavy a weight. Regardless of the activity that bears blame, the underlying cause of a hernia is a weakness in the muscle structure. Though exercises to improve muscle strength may prevent injuries such as strains and muscle tears, exercises cannot prevent or treat hernia. There are no known measures for preventing hernia.
See also SURGERY BENEFIT AND RISK ASSESSMENT; SWALLOWING DISORDERS.