Any person who notices a swelling which appears on straining like coughing, exercising especially in the groin or anywhere on the abdomen should report to a doctor. It might be hernia. Incidence of hernias tends to rise with advancing age. But certain lifestyle choices, like smoking and sedentary habits too are reasons. A team of doctors led by Sunil Chumber, head of Surgical Discipline Department, AIIMS Delhi discusses threadbare with The HEALTH PIONEER about the common ailment, its complication and treatment
Three patients, different ages and symptoms but, on investigation found to be suffering with the same ailment ie hernia.
Hernia—a protrusion of an organ or tissue from an abnormal opening in the muscle or tissue that holds it in place---can be seen in all age-groups and genders. In children, congenital hernias are common, inguinal hernias are seen more often in men, while umbilical and femoral hernias are seen more commonly in women.
Dr Sunil Chumber said that the incidence of inguinal hernias in the general population is estimated to be around 27 per 1,000 males and 3 per 1,000 females.
It is often due to weakened abdominal muscles caused by factors such as chronic coughing, heavy lifting, obesity or pregnancy. Post-surgery, incisional hernias can develop near to the incision site and these are more after open surgery compared to laparoscopic surgery. The incidence of hernias tends to rise with advancing age, as the musculature and connective tissue naturally weaken over time. Moreover, certain lifestyle choices like smoking, poor nutrition, and sedentary habits too can contribute to hernia formation.
Dr Prasanna Ramana said, that hernias can manifest in different anatomical regions, including the groin followed by abdomen, umbilical and diaphragm, and rarely the upper thigh just below the groin.
The incidence of hernias is influenced by various factors, including age, gender, heavy work or exercise, obesity and genetic predisposition. Abdominal hernia can occur after prior surgery. Inguinal hernias are the most common type of hernia, accounting for approximately 75% of all hernias, said Dr Piyush Ranjan
While some hernias may remain asymptomatic and require no immediate intervention, others can result in discomfort, pain, and potentially severe complications if left untreated.
Hernias can become complicated when they cause intestinal obstruction or strangulation, which will need emergency surgery.
Dr Sunil Chumber and Dr Ajay Mohan talked about symptoms and cause of hernia.
The symptoms of a hernia can vary depending on the type and location of the hernia. Common symptoms include:
Bulge or Swelling: One of the most noticeable symptoms of a hernia is a bulge or lump in the affected area. It might be more noticeable when you cough, strain, or stand up.
Pain or Discomfort: Hernia may cause mild to severe pain, especially when you lift heavy objects, cough, or bend over.
Feeling of Pressure: Some people with hernias may experience a sensation of pressure or fullness at the site of the hernia.
Heartburn or Indigestion: In some cases, a hiatal hernia (a type of hernia involving the stomach) can cause symptoms like heartburn, acid reflux, or difficulty swallowing.
Nausea and Vomiting: In rare cases, a hernia can lead to a blockage in the intestines, resulting in nausea and vomiting.
What Causes Hernia?
Hernias are often caused by a combination of factors, including:
Weak Muscles: The most common cause of hernias is weakened muscles in the abdominal or groin region. When the muscles are weak, they are less able to support the organs properly.
Chronic Straining and Heavy Lifting: Engaging in activities that involve heavy lifting, prolonged coughing, or straining during bowel movements can increase the pressure inside the abdomen, making it more likely for a hernia to develop.
Age: As we age, our muscles tend to weaken naturally, which can make us more susceptible to hernias.
Pregnancy: During pregnancy, the abdominal muscles stretch to accommodate the growing fetus, which can create a vulnerability to hernias.
Obesity: Being overweight or obese can put extra pressure on the abdominal muscles, increasing the risk of hernias.
Chronic Constipation: Straining during bowel movements due to chronic constipation can contribute to the development of hernias.
Types of hernias
Hernias can be classified into several ty\pes based on their locations, explained Dr Devender Singh . Some of them are:
Inguinal (groin) hernias: These hernias appear as a bulge in the groin and the scrotum which may increase on coughing or straining. It may cause discomfort and pain.
Femoral (thigh) hernias: This type of hernia is more common in females and appears as a bulge at the upper inner part of the thigh.
Ventral hernias: These types of hernias occur due to a weak abdominal wall. They may occur in the upper abdomen above the umbilicus (epigastric), at the umbilicus (umbilical) or in the flank region.
Incisional hernias: These types of hernias occur over the scars of previous surgery due to the weakness at the scar site.
Hiatal hernias: These hernias may result in heartburn, chest pain or sour taste in the mouth.
Complications of Hernia
Dr. Gagan Soni and Dr Kamal Kataria warned that while most hernias are reducible, which means that the herniated contents can be manipulated back into the abdominal cavity, some cannot be pushed back to their original location. This can lead to the following complications:
Obstruction: A hernia becomes obstructed when a part of the intestine gets stuck in the defect (hernia ring). Symptoms of an obstructed hernia may include: Nausea, Vomiting, abdominal pain.
Strangulation: A hernia becomes strangulated when blood flow to the obstructed (trapped) section of intestine or other tissue is cut off.
Symptoms of a strangulated hernia may include: Nausea, Vomiting, Fever, severe abdominal pain, colour change of the overlying skin and inability to pass stool or gas.
Investigations in Hernia involve a combination of medical history evaluation, physical examination, and diagnostic tests. The purpose of these investigations is to confirm the presence of a hernia, determine its type and severity, and assess the need for surgical intervention. Some common investigations conducted for hernias:
Ultrasound: It is commonly used to diagnose hernias as it can accurately identify the location, size, and type of hernia.
CT scan or MRI: These can help in identifying complicated or recurrent hernias and provide more information about surrounding tissues and organs.
Treatment of Hernia
Dr Devender Singh and Dr Richa Garg emphasised that not all hernias of the abdominal wall require urgent treatment. Patients may require surgery for symptom alleviation or aesthetic reasons. Surgeons should, however, advocate surgery when complications are likely, particularly intestinal obstruction and strangulation, which are more prevalent in narrow-necked hernias. Because of the risk of symptoms and consequences, it is often suggested to repair femoral hernias, symptomatic or irreducible hernias, and hernias in younger adult patients.
Asymptomatic inguinal hernias in the elderly can frequently be handled with a "watchful waiting" strategy, with surgery considered if symptoms emerge. The use of trusses or hernia belts to manage hernias is not very beneficial.
Large incisional hernias, particularly recurring ones, provide considerable surgical problems, and the risks and benefits of surgery should be carefully assessed, especially in obese and elderly patients.
Urgent surgery should be offered to patients presenting with acute pain in a hernia, especially if it is irreducible. The higher likelihood of similar episodes and the higher risk of complications warrant surgical intervention at the earliest opportunity.
(to be continued...)