A hernia is a medical condition where an organ protrudes through a weak area on the tissue or muscle holding it in place. Hernias in the abdominal area make up the majority of cases and they can appear near the groin area, belly button, and on the upper thigh. Generally, hernias are not life-threatening and present as a bulge and discomfort or pain. Hernia can only be repaired with surgery, and, if left untreated, it can become larger over time.
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Types of Hernia
Hernias can be either external or internal. In the external type, the internal organ pushes outward and is visible under the skin. In an internal hernia, the organ pushes through a tissue deep inside your body and is invisible.
This condition is more prevalent in men. The inguinal canal refers to an opening which allows the testicles and the spermatic cord to descend to the scrotum as the fetus develops. Normally, a person has two inguinal canals located on either side of the abdomen. After this, the inguinal canal is supposed to close up tightly. When this does not happen, a small part of the bowel may slide through the opening and get into the scrotum, thus the inguinal hernia.
This is when part of your internal organs protrude through a weak area on your abdominal wall due to past surgery.
This type of hernia affects the femoral canal, a tube-shaped opening near the groin area. It happens when part of the bowel or fatty tissue slide through the femoral canal forming a bulge. Women are more susceptible to suffer from femoral hernias due to the weakened abdominal tissues during pregnancy.
Also referred to as a hiatus hernia, this condition occurs when part of the upper stomach protrudes through the chest cavity or the diaphragm. This type is further divided into two types: the sliding and rolling or paraesophageal hiatal hernia. In the former, the top of the stomach protrudes through the hiatus or hole in the diaphragm while in the latter, part of the stomach protrudes through a hole next to the esophagus.
This hernia occurs when tissue lining near the umbilical cord is weak and an internal organ bulges outward. Although this type is most common in infants, adults can also develop it.
This type is located in the upper abdomen. Just like other types of hernias, this is corrected through hernia repair surgery which is often postponed until the child becomes a toddler.
Signs and Symptoms
A hernia can be caused or triggered by factors such as heavy lifting, overexertion, extra weight or obesity, smoking, pregnancy, an enlarged prostate, and any action that increases the pressure in the stomach such as a chronic cough or constipation.
A hernia can go unnoticed for quite a long time and only a small percentage of patients experience acute pain. Most types are only visible when standing and could completely disappear once an individual lies down. Other types of hernia may be visible only when individuals perform strenuous activities, laugh, sneeze, cough, or bend. The most typical symptom of hernia is a soft bulge that might not be painful, but tenderness around the area or some tension may be experienced.
As the hernia gets bigger, the discomfort and pain may increase. If individuals do not get immediate medical treatment, they may be unable to function normally due to the discomfort. Other signs and symptoms that one should look out for include:
- A bulge or inflammation in the groin or scrotum
- Discomfort or pain when urinating or moving your bowels
- A discomfort that gets worse when you are lifting something or bending
Diagnosing a Hernia
When diagnosing a hernia, the doctor normally takes the patient’s medical history and performs a physical exam. In some instances, the doctor could recommend some imaging tests such as a CT scan, an MRI or an ultrasound to help rule out other conditions. However, most hernias do not require any imaging tests.
How is Hernia Treated?
While a hernia can go untreated for as long as it does not cause significant discomfort and pain, it will not go away on its own. Surgery is required to repair all hernias.
Some of the surgical repair options the doctor may recommend are:
Open repair surgery
This type of surgical procedure requires general anesthesia administered to a patient. The doctor then makes one large incision where the hernia is located and sets the protruding tissue back in place. The weakened tissues or muscle wall is then stitched together. In nearly all instances, a mesh may be implanted for additional support. This surgery also prevents the hernia from recurring.
Laparoscopic Repair Surgery
Rather than a large incision, the doctor makes small incisions in the abdominal area through which surgical instruments (laparoscope) are inserted to repair the hernia. Laparoscopic repair surgery is a minimally invasive procedure that has shorter recovery time and fewer complications.
Robotic Repair Surgery
This surgery is also performed using a laparoscopic device. Rather than handling the instruments, the doctor controls them from a console. Recovery time for robotic surgery is also shorter and has fewer complications.
Each surgery option has its pros and cons. The doctor will decide which surgery is the best treatment.
Can a hernia become an emergency?
Hernia can become a medical emergency if the esophagus (in a hiatal hernia) or the intestines become trapped, thus cutting off the blood supply. If this happens, a condition known as strangulation sets in. The tissue can become necrotic or die. This is a life-threatening situation which demands that the affected area be immediately removed through surgery.
Signs that a hernia is an emergency include:
- Intense aches, redness, or swelling on the affected area
- A bulge that suddenly becomes larger
- Nausea and vomiting
- Bloating or constipation
- A burning sensation around the hernia
- Increased heart rate
A strangulated hernia must be attended to immediately. In most cases that involve such, the diagnosis is performed in the emergency room due to their fatal nature. Open surgery is the preferred treatment option for such hernias. The repair surgery for a strangulated hernia is normally a two-step procedure. The hernia surgeon starts off by reducing it. He applies pressure on the hernia to ease the trapped tissue back into its place. He then removes any damaged tissue.
Hernia Surgery Recovery
The recovery time differs from one person to another but largely depend on the type of hernia and the treatment option used. Patients who go through minimally invasive procedures are able to go home within the same day of the surgery. Individuals who undergo open repair surgery or other procedures such as abdominal tissue reconstruction may need to stay in the hospital for a few days.
The pain and discomfort after repair surgery are normally treated with a combination of prescription and over-the-counter medications. The hernia repair surgeon will also recommend a follow-up schedule to make sure that there are no post-surgery infections that slow down recovery time.
Can hernias be prevented?
It is not always possible to prevent a hernia. Some types are hereditary, and thus cannot be avoided. You may reduce your chances of getting certain types of hernias by:
- Losing weight if you are overweight
- Limiting or avoiding tobacco and alcohol consumption
- Using appropriate lifting techniques to avoid strains
Hernia Surgery with Dr. Clay Albrecht
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