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Hernia develops when an internal organ such as the bowel squeezes through a weak spot in a surrounding muscle or the connective tissue covering it (fascia). Most hernias are not life threatening, – sometimes they do not cause troublesome symptoms – but they cannot heal on their own. In some cases, surgery is essential to prevent complications.
Hernias are usually easy to diagnose, doctors can usually spot them by looking and feeling for a bulge on the abdomen or groin. Treatment in most cases is corrective surgery, either via an open or keyhole operation.
Hernias are often classified based on their location ont he body. In most cases the affected area is the inguina (inner groin).
Inguinal hernia is the most common type of hernia in adults. It is more common in men, but it may also occur in women. In case of inguinal hernia, the abdominal organs – most commonly the small bowel (small intestine) – and the omentum (the apron that covers the abdominal cavity) protrude through the hernia, creating a visible lump which may cause discomfort and pain.
Femoral hernia is relatively rare, making up only 3% of all hernias. While femoral hernia can occur in both men and women, it is most likely to occur in women due to a wider hipbone. Femoral hernias are more common in adults than in children. Those that do occur in children are more likely to be associated with a connective tissue disorder or with conditions that increase intra-abdominal pressure. Once this type of hernias are diagnosed, early treatment is strongly recommended because there is a high risk of complications.
Umbilical hernia occurs in or around the belly-button. This area is inherently weaker than the rest of the abdominal wall. As a result, the fascial layer is susceptible wearing away, leaving behind in a hole (hernia) in the abdominal wall.
An epigastric hernia occurs when a weak spot in the abdominal muscle allows the tissues of the abdomen to protrude through the muscle. An epigastric hernia is similar to an umbilical hernia, except for its location. While umbilical hernias form around the belly button, epigastric hernias can be found between the belly button and the chest.
In most cases hernia can be diagnosed based on the symptoms they cause. Occasionally imaging tests are used to confirm the diagnosis or to rule out other possible causes.
The most common symptoms include:
Risk factors are varied, they include smoking, chronic obstructive pulmonary disease, obesity, pregnancy, an enlarged prostate, chronic constipation, cystic fibrosis, physical exertion, a previous open appendectomy, lifting heavy items, peritoneal dialysis, and undescended testicles among others. There is a genetic component too, some types of hernia tend to run in some families.
If your hernia is growing or causing pain, your physician may decide that surgery is your best option. Hernia repair is used to prevent complications like bowel obstruction or strangulation of the hernia. Most abdominal hernias can be repaired surgically.
There are various ways to treat hernia In open hernia surgery a mesh is used to repair the weak spot. The surgery is quick but involves longer recovery and you may not be able to return to your normal daily activities for up to six weeks.
In laparoscopic or keyhole surgery a tiny camera and miniaturized surgical instruments are used to repair the hernia through a few tiny incisions. Laparoscopic surgery causes much less damage to the surrounding tissue, there is a lower risk of infections and the small wounds heal faster. However, there is a higher incidence of postoperative complications such as incisional hernia.
Surgical techniques used in hernia repair have developed a lot in the past few years. Nowadays, most people who undergo hernia surgery are able to return to normal activities just a few weeks, sometimes even a few days after surgery.
Surgical complications include pain lasting more than three months, infections, damage to nearby nerves and blood vessels, and hernia recurrence.
It is important to recognize the early signs of hernia as an untreated hernia will not go away on its own. It can also put pressure on nearby tissues, leading to swelling and pain in the surrounding area. In such cases surgery is optional.
For a hernia without symptoms, the usual course of action is to watch and wait, but this can be risky for certain types of hernia, such as femoral hernias. Within 2 years of a femoral hernia being diagnosed, 40 percent result in bowel strangulation. Strangulation occurs when blood flow to the trapped section of the intestines is reduced. This can cause the intestinal tissue to become infected or die. A strangulated hernia is a life-threatening condition and requires immediate medical attention.
When you return home after surgery, follow your surgeon’s instructions regarding when you can return to your normal daily activities. The amount of pain and/or discomfort you experience depends on the location of the hernia, the type of repair, and your personal pain tolerance level. Generally, walking and climbing stairs may be difficult for a day or two.
A post-operative follow-up is required 7-10 days after the surgery. At this appointment your doctor will remove your stitches. He will also check how your recovery is progressing.