Hernias may have some life threatening complications like strangulation (stopped blood flow and supply by the hernia opening and bowel can necrotise).In general :every hernia grows and becomes bigger and bigger year by year. Smaller hernia means easier operation with better outcomes. As a hernia been diagnosed better to have surgery.
Types of hernias
Groin or inguinal hernia
Inguinal hernias are the most common type of hernia. They gives about 70 percent of all hernias. These hernias occur when the intestines go through a weakened area in the lower abdominal wall, or in the inguinal canal.
In male patients, it is the passage where the spermatic chord goes through from the abdominal cavity to the scrotum. This chord will supply with blood and suspense the testicles.
This type of hernia is more common in men than in women. This is because a man’s testicles descend through the inguinal canal shortly after birth, and high frequently it remains opened which opens the possibility of having hernia.
A hiatal hernia means when part of your stomach slips up through the diaphragm into the chest. The diaphragm is a plain of muscle that helps you with breathing.it separates the organs in your abdomen from your chest.
This type of hernia usually develops over age of 50.
Hiatal hernia doesn’t mean automatically reflux disease.If it casuses reflux then we should perform a hiatal hernia repair along with fundoplication which is basic procedure of anti reflux treatment.
Umbilical hernias mean protruded area bulge in umbilical ring which may or may not contains bowels or other fatty tissue from abdominal cavity. It may cause pain, discomfort, occasionally strangulation.
There are two types acquired and congenital. Congenital will develop after birth and most of these cases will solved by nature and disappear in first couple of years. Acquired or adult type works as a real hernia and grows year by year. Occasionally causes cosmetic problem only but sometimes pain is the leading symptom of patient.
Incisional hernias can occur after you have abdominal surgery. Your intestines may push through the incision scar or the surrounding, weakened tissue. If patient has had surgery in past, and his doctor find a bulge in incision line in subcutaneous tissue
What is the possible cause of a hernia?
Hernias are caused by a muscle weakness which might be congenital weakness on a certain area of human body, or caused by previous surgery.
Common causes of muscle weakness include:
- Damage from previous surgery or injury
- age(every year we loose 1-2 % from our muscle pool)
- chronic coughing(chr obstructive diseases like COPD)
- failure of the abdominal wall (congenital defect)
Other aggravating factors which brings out a hernia :
- being pregnant (puts pressure on your abdomen)
- being constipated(causes you to strain when having a bowel movement)
- heavy weight lifting(sportmen)
- fluid in the abdomen
- weight gain
When should I visit my doctor?
The most common sign of a hernia is a protrusion or lump in an area. In the case of an inguinal hernia, you may notice a lump on either side of your groin. In standing position and during heavy lifting, coughing or straining bulge can be much more prominent and touchable. Other important symptom is the pain or just mild discomfort in groin or in belly button. A bulge is typically the only symptom of an umbilical hernia.
If you notice a painful lump on your abdomen or in your groin, or pain which develops in an existing hernia, you should visit your doctor as soon as possible.
Diagnostic protocol of hernia
When your doctor sees you at first will examine you thoroughly and check coug impulse also. Most of the hernias can be diagnosed correctly by physical examination. If surgeon has any doubt of the nature of hernia or strangulation then will require either a ultrasound scan or CT scan.
Surgery is the gold standard of treatment of hernias
An existing symptomatic hernia is absolute indication for surgery. Basically we should prefer now days laparoscopic surgery if patient is fit for surgery and there isn’t any contraindications(like cardiac condition, lung problems, deterioration, severe COPD, cancerous condition).laparoscopic hernia repair have pretty shorter recovery period, guarantees smaller post operative pain, lesser recurrence rates.
Open surgery requires a longer recovery process. You may be unable to move around normally for up to six weeks. Open surgery is recommended for those who are not fit for keyhole surgery or patient has had previously extensive big abdominal surgeries.
Laparoscopic surgery is appropriate type of surgery even for enormous big scrotal hernia repairs in hand of experienced laparoscopic surgeon.