Protrusion of an internal organ through muscle covering it.

 

Causes of Hernia

The common types of hernia occur in the groin, where there is always a weakness of the muscle wall. A hernia here is called an inguinal hernia. In men the testicles descend from the abdomen into the scrotum a few weeks before birth or shortly afterward. They descend along a path called the inguinal canal, which always remains a little weak. Anything that increases abdominal pressure pushes away at that potential weakness, for example chronic bronchitis with its persistent cough, or constant heavy lifting. Eventually the muscle weakens so much that a loop of intestine gets inside and appears as a bulge. Women do get inguinal hernias but much less often.

For similar reasons the other common sites for hernias are the umbilicus (belly button), which passes through the muscles of the abdominal wall, and at the site of surgery over a muscle – an incisional hernia.

Symptoms of Hernia

An inguinal hernia begins as a small uncomfortable bulge in the groin, which steadily increases in size. It aches when the person is standing, becoming particularly uncomfortable if he is straining, but disappears when he is lying flat and relaxing.

A hernia is termed incarcerated if a loop of intestine becomes stuck, unable to retract back inside the abdomen: the lump is firm and feels tender. More serious again is a strangulated hernia, when the loop of intestine is not only stuck but its blood supply has become obstructed; the lump is then extremely painful and hard. This is a surgical emergency, marked by severe pain then vomiting from bowel obstruction. In theory hernias elsewhere can become incarcerated or obstructed, but this is much less common.

Inguinal hernias are quite common in baby boys and often grow smaller without treatment or even disappear.

Treatment of Hernia

Once an inguinal hernia has appeared in an adult it is only a matter of time before it gets bigger and needs repairing. Although trusses were once the vogue treatment, most doctors now regard them as obsolete and recommend surgery. In surgery the weakness in the muscle layer is repaired either by stitching it together or using an artificial plastic or metal mesh. Laparoscopic (key hole) surgery now allows this with just a tiny incision and internal stitching.

An incarcerated hernia can be treated by a whiff of general anesthetic which makes the surrounding muscles relax. A strangulated hernia has to be dealt with as an emergency before the bowel dies through lack of blood flow. There is a chance of a hernia recurring in people who are constantly coughing or who are overweight, although improved surgical techniques are making this less likely.

Hernias elsewhere are in general less likely to run into problems of pain or obstruction so surgical repair is not essential.

QUESTIONS

What are the advantages of key-hole surgery?

It is as strong as conventional repair; less painful and recovery is much quicker – a matter of days if not hours. Technically it is more complicated than open surgery, so choose an experienced surgeon.

Must hernias be repaired?

Other than in cases of incarceration or strangulation, there is no medical need for repair except for the knowledge that you may eventually have too much discomfort to hear. This is bound to happen at the most inconvenient time for you.

Complementary Treatment

Alexander Technique – hernias can be helped by improved postural balance and a decrease in contractions along the spinal column. Reflexology treatment is aimed at reflex points associated with the adrenal glands and the affected area. Homeopathy – depending on circumstances, suggested remedies might include nux or aesculus. Hypnotherapy can lessen anxiety and hence help reduce problems. General self-help – avoid lifting heavy objects.

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