Hernia and its Symptoms
When a defect or weakness occurs in the abdominal wall, the contents of the abdomen( Fat/ bowel) protrude out through the defect. This is called a Hernia. It can be felt under the skin as a lump.
Most commonly a hernia presents as a gradually increasing swelling which is usually painless. Often the swelling disappears on lying down and appears or increases on standing. The swelling is usually noted in the groin as it is the most common site of a hernia. Hernia can occur in any part of the abdomen. It can also occur through the |scar of previous abdominal surgery or around the umbilicus.
A Reducible Hernia is usually painless and can be pushed back in but comes out on standing or coughing.
Sometime the swelling becomes painful when it increases in size or when it doesn’t disappear. In certain patients this could even be the first presentation. This presentation is worrisome and needs urgent attention and is known as an Incarcerated Hernia.
In certain situations it may get aggravated and the blood flow to the hernial contents is affected leading to a Strangulated Hernia. This is a surgical emergency and delay in seeking surgical opinion may have serious implications for the patient.
Diagnosing a Hernia
The Surgeons Hand and his Clinical Acumen are the most reliable instruments of diagnosing a hernia. Typically a Surgeon would listen to your problem and then examine you. The patient maybe examined in a lying down and in standing position as well and may even be asked to cough. At the end of the examination the Surgeon would be able to diagnose your hernia.
In certain situations (e.g Obesity, multiple previous surgery, athletes etc) it may be difficult to diagnose a hernia by clinical method. In such situations CT/MRI Scans, Ultrasound Scan or further invasive methods might be necessary to diagnose a hernia. Each investigation has its own limitation and a Hernia Surgeon would be able select and utilise the test to diagnose a hernia.
In hernia surgery there is no “One size fits all” concept. It is a customised tailor- made approach to plan the surgery individually for each patient. Hence sometimes scans may be ordered to plan your surgery.
Types of Hernia
Hernia is often named depending on the cause of hernia or its location site or after a surgeon who has described it.
Groin Hernia: presents in the groin, usually of three types.
- Inguinal: commonest
- Femoral: uncommon
- Obturator: rare
Inguinal: most common may affect upto 3% of the population. It is more common in males than females. It appears as a bulge in the groin above the groin crease, which may go down into the scrotum in males and labia in the females. Inguinal Hernia is further classified as
- Depending on location: Direct or Indirect
- Depending on Extent: Bubonocele, Incomplete, or Complete
- Depending on Content: Omentocele, Enterocele
Femoral: very uncommon. Between the sexes, more often seen in women. It is seen as a bulge in the groin below the groin crease, quite often this may not be appreciated it. Often it presents acutely with pain and discomfort or with incarceration or strangulation. It is Umbilical- It is seen around the belly button, usually more common in females than males. Especially after pregnancy.
Epigastric: in the upper abdomen above the umbilicus.
Lumbar: in the lumbar region or the flanks
Incisional: It occurs through the scar of any previous abdomen. When can a hernia occur.
Hernia can occur in any age right from very early childhood to old age. It can occur in male or females.
Mechanism of Hernia Formation
Any weakness or excessive strain in the abdominal wall can cause a hernia to occur.
It can be because of:
– Congenital weakness ( present since birth)
– Weakness due to old age
– Excessive strain due to lifting weights or indulging in very strenuous physical activity.
– After any abdominal surgery
– After pregnancy
– Excessive weight gain or obesity.
FAQs
Surgery is the only treatment which can correct a hernia. During the surgery the defect in the abdominal wall in closed and usually reinforced with a mesh implant. It can be performed by traditional open methods or by laparoscopy.
Allows to get back to routine activities. Takes care of the swelling and discomfort. Avoids complications of having a hernia.
Surgery is the only known treatment for hernia.
Usually most often hernia swelling reduces on its own on lying down and comes back on standing. Sometimes it no longer reduces or the swelling increases or maybe painful. It is then the contents of the hernia (bowel or fat) may strangulate or may even lead to gangrene which can be a life threatening complication.
Hernia surgery depends a lot on the site , size of defect and type of hernia. Also on patient factors e.g obesity, smoking, other pre-existing medical conditions. Generally it can be done by traditional open approach or by Laparoscopy(keyhole surgery).
Mesh is like a net. It is usually made of Polypropylene or Polyester, though other materials are also there. Mesh adds strength to hernia repair. In hernia repair in an adult patient, mesh is almost always needed. Mesh is not needed in children.
Yes, there are many different types of mesh depending on the material, mesh construction or mesh coating. As the mesh will be in your body for your lifetime Your surgeon will discuss the mesh and help you choose the one appropriate for your hernia and be comfortable for you.
It depends on the type of hernia. Usually inguinal hernia surgery takes 30-40minutes. Complex hernia or incisional hernia may even take 3-5hrs.
Usually most patients after surgery would be able to go home the same day or the next day. Some patients with incisional or atypical hernia may take 3-4 days to go home.
3-4 days after a groin hernia surgery should be fine. Some patients may return earlier or later as well. Incisional or recurrent hernia may take a longer time.
Usually a person would be able to do day to day routine actives on his own on the day of surgery.
For upto six months after surgery the operated area continues to gain strength. Hence lifting weight during that period should be avoided to decrease the chance of it coming back.
Hernia surgery as such is very safe. Sometimes there can be a swelling at the operative site, or there can be infection, bleeding, or prolonged wound discharge.