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Hernia

What is a hernia?

A hernia (or “rupture”) occurs where there is a weakness in the wall of the abdomen. As a result, some of the contents within the abdomen can then bulge (push through) under the skin. Normally, the front of the abdomen has several layers comprising skin, then fat, then muscles, which all keep the intestines (guts) and internal tissues in place. If, for any reason, there is a weak point in the muscles, then part of the intestines can push through. You can then feel a soft lump or swelling under the skin.

What are the types of hernia?

Different types of hernia can occur. The most common types are listed here:

Inguinal hernia

This occurs when some tissue pushes through the lower abdomen in the groin. This is the most common type of hernia, accounting for more than three out of every four hernias. They usually occur in men. They can occur in both sides of the body. These hernias often occur after heavy lifting, during which you may experience a sharp pain in the groin and notice the appearance of a swelling.

Femoral hernia

This also occurs when some tissue pushes through in the groin, a little lower down than where an inguinal hernia occurs. They occur more commonly in women. They tend to be smaller than inguinal hernias.

Incisional hernia

This occurs when tissue pushes through a previous scar or wound. They are more common if you have had a scar in the past that has not healed well. For example, if the wound had an infection after the operation. They usually occur within two years of having an operation.

Umbilical and paraumbilical hernias

These occur when some tissue pushes through the abdomen near to the umbilicus (belly button). Umbilical hernias are present from birth and, if they need treatment, then they are usually repaired in childhood. In most cases of umbilical hernia, the hernia goes back in and the muscles re-seal on their own before the baby is one year old. They are usually only treated if they are large, as small ones cause no problems and do not need repairing.

Paraumbilical hernias occur in adults and appear above the umbilicus. Although they are usually small, they usually need repairing because there is a risk of intestines contained within them becoming strangulated (see below).

Who gets hernias?

Hernias can occur in anyone. Men are more likely to have inguinal hernias, as they have a small tunnel in the tissues of their groins which occurred when they were developing as a baby. This tunnel allowed the testes to come down from the abdomen into the scrotum. Intestinal tissue can also pass into this tunnel, forming an inguinal hernia.

Hernias in adults may arise as a result of the strain which raises the pressure in the abdomen causing a weakness or tear in the abdominal wall. This can be caused by:

  • Persistent coughing.
  • Being overweight or pregnant.
  • Lifting, carrying or pushing heavy loads.
  • Straining on the toilet.

What are the symptoms?

Sometimes a hernia is noticed after a strain – for example, after lifting a heavy object. Sometimes one may develop for no good reason and you may simply notice a small lump that has develop, usually in the groin area. Usually, at first, the lump can be pushed back, but may pop out after straining again. Coughing is a common strain that brings them out. The swelling often disappears when you lie down.

Hernias are not usually painful, but many people feel an ache over a hernia which worsens after doing any activity. In time, they might become bigger as the gap in their muscle or ligament tissue becomes larger. Sometimes, in men, they track down into the scrotum.

Why do they need treatment?

Although having a hernia is not usually a serious condition, treatment to fix it is usually advised for two reasons:

  • It may gradually become bigger and more uncomfortable.
  • There is a small chance it might strangulate. A hernia strangulates when too much intestine (bowel) has come through the gap in the muscle or ligament and then it becomes squeezed. This can cut off the blood supply to the portion of intestine in the hernia. This can lead to severe pain and some damage to the part of the intestines in the hernia. A strangulated hernia is uncommon and is usually dealt with by emergency surgery. However, it is preferable to have the hernia fixed by routine rather than by emergency surgery.

The risk of strangulation is greater with a femoral hernia than an inguinal hernia. The risk is also greater with smaller hernias.

How are hernias repaired?

A hernia can be fixed by a small operation. Wearing a truss (support) was used in the past but is now not recommended.

A hernia repair is one of the most common operations performed by surgeons. It is very common for people to have their hernia repaired as a day case so you do not need to stay overnight in hospital. A hernia can either be repaired under a local or a general anaesthetic. This will depend on the actual type of operation needed.

The type of operation will depend on the type of hernia that you have. A brief overview is given below. There are now various different ways of repairing a hernia which will depend on many factors. For example, the type of hernia, the size of the hernia, your general health. Your surgeon will be able to discuss the type of operation with you in more detail.

Inguinal hernia repair

This is usually done by a “key-hole” operation as the recovery is quicker compared to having an open operation. The operation is performed through three tiny cuts, the largest of which is only around 1.5 cm in size.

It is more common that inguinal hernias be repaired by using a mesh. This is a thin sheet of material which is usually stitched or glued over the hole of the hernia. This has been shown to be stronger and more effective than sewing the edges of the hole together for inguinal hernias. With time, the mesh safely becomes incorporated into the muscle layer, which results in a very strong, permanent repair.

Femoral hernia repair

As the hole through which a femoral hernia has to pass is very tight, there is a significant chance that any bowel that passes into it will become strangulated. This means that a femoral repair should be repaired early. Like inguinal hernias, femoral hernias are usually repaired using a mesh.

Incisional hernia repair

Incisional hernias vary enormously in size which means that treatment may differ depending on the size of the incisional hernia. Again, a mesh is usually used, especially for larger hernias.

Umbilical and paraumbilical hernia repair

Most umbilical hernias do not need repairing. Smaller hernias are usually repaired by an operation which simply closes the defect with stitches. However, umbilical and parumbilical hernias over 2 cm in length are usually repaired by using a mesh.

Newer techniques mean that people tend to be off work for much shorter periods than in the past. Even workers in heavy work can often be back in two weeks. The operation is usually very successful. However, hernias can recur in a small number of people, when a further operation may be advised.

References

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