A hernia is a condition in which there is a defect in the wall of a part of the body (like the abdomen), through which the internal contents (like intestines) leak out.
Hernias usually occur in the abdomen. The most common site is the groin or scrotal area (called inguinal hernia), followed by the belly button, the upper thigh and through previous operation scars (also known as incisional hernia).
The defect in the wall of the abdomen is due to a weakness in the muscle layers. This can be due to a weakness:
- Present since birth. In the fetus, the testis develops inside the abdomen. Just before birth, the testis moves out through the abdominal wall and enters its final position in the scrotum. This creates a weakness in the abdominal wall muscles. This weak spot usually seals off shortly after birth. However, in some people the weakness remains. This can result in a hernia. Sometimes this type of hernia occurs as early as in infancy or may only appear later in life.
- Following an injury. If the muscle of the abdominal wall is injured or weakened, this can cause a hernia. Examples of this include straining the abdominal wall muscles like in lifting heavy objects, coughing violently, excessive straining while moving the bowels or trying to pass urine. Other causes of “injury” include previous abdominal surgery, where the operation wound site is a potential weakness, especially if it fails to heal properly.
Through the defect, the contents from within the body will protrude out and come to lie under the skin. These contents include internal body fat, intestines, urinary bladder or other organs. A person with a hernia first becomes aware of it as a swelling in the affected area. The swelling is often “reducible”, meaning that it will disappear or get smaller on pushing on it or when the person lies down, because the contents slip back inside the abdomen. However, in some cases the contents of the hernia may remain stuck, a condition referred to as incarcerated hernia. This condition is associated with serious complications like obstruction of the intestine, and later, loss of blood supply with gangrene and rupture of the stuck intestine – a potentially fatal situation.
Most patients with hernia have a feeling of discomfort or dragging sensation at the site of the hernia. Some may even feel nothing apart from the noticing the swelling. If the hernia is incarcerated, it may become quite painful. Severe pain and bloating of the abdomen with vomiting are late signs of worsening complications.
The diagnosis of hernia can usually be made on simple physical examination by an experienced doctor. However, difficult cases may be diagnosed on ultrasound or CT scanning of the area.
Should all hernias be treated? Generally yes. This is simply because of the risk of complications mentioned above.
Hernias can only be treated by surgery. Two methods are available:
- Open surgery – where a small incision is made directly over the site of the hernia, and the hernia is repaired by stitching the defect with strong sutures or by using a mesh (like a piece of woven material).
- Laparoscopic surgery – where using 3 or more key-holes, at a distance away from the hernia, getting under the hernia and repairing it from the inside, usually with a mesh.
There are pros and cons of both methods. Key-hole surgery has the advantages of smaller incisions and quicker recovery, but costs more, is more invasive and may have a higher risk of recurrence. Also not all hernias are best treated with either method – e.g. recurrent hernias are better treated by key-hole surgery, while large incarcerated hernias are better treated with open surgery.
Hernia surgery is done under general anesthesia usually and takes about one hour. Usually one day’s stay in hospital is sufficient. Most patients are able to walk about, eat and have normal urine and bowel habits by the next day. Medical leave from work for one to two weeks is recommended. Light exercise like jogging and swimming can be resumed after about 3 to 4 weeks, but avoidance of heavy physical activities, especially lifting of heavy objects or straining of the abdominal muscles should be avoided for at least six months.
