Hernia

What is a Hernia?

A Hernia is an out-pouching of intra-abdominal contents through a defect, or hole in the muscle. The abdominal muscles and bones of the pelvis prevent abdominal contents from drooping out under normal circumstances. The skin and fat below the skin do not provide any strength and stretch if there is a hernia present. Hernias can occur anywhere in the abdomen, but most commonly occur at weak points where a small tear can start, and enlarge over time. The common weak points are:

Inguinal
This is the most common spot in men, the weak point is where the spermatic cord passes toward the testicle.

Femoral
Here the weak point is where the blood vessels to the thigh and leg pass through at the bottom of the pelvis.

Umbilical
Hernias around the belly button are common and often present as an ‘outie’ type umbilicus.

Incisional
Scar tissue after previous surgery is weaker than the surrounding muscle and can tear to form a Hernia.

Epigastric
Some people get Hernias in the region between the belly button and the breast bone.


Predisposing factors

It is not always possible to identify the time when a Hernia started, although sometimes that is the case. Hernias are often associated with either weak muscles or raised abdominal pressure (or both). Frequent features are:

  • A history of heavy lifting

  • Male Sex

  • Obesity

  • Chronic cough, constipation or urinary retention

  • Previous surgery


Symptoms of Hernia

There are frequently no symptoms of Hernia. When present, the common symptoms are:

  • A lump that comes and goes and is more prominent on standing or straining

  • Pain, discomfort or ‘dragging’ sensation at the site

  • Incarceration or strangulation (see below)


Complications of Hernias

Hernias do not repair themselves. Over time Hernias tend to get bigger as the defect in the muscle stretches to allow more abdominal contents to slip in and out. As time goes on there is a risk that the Hernia will develop a complication. 

Incarceration
Occurs with a long term (chronic) hernia where the contents come out and stay out and are unable to be pushed back in. This often causes discomfort or mild to moderate pain but not severe pain.

Strangulation
This is where in the short term the contents come out and can not be pushed back in, and where the defect causes such pressure on the blood vessels that the contents are starved of blood supply. This causes swelling, and severe pain. This is an emergency and warrants prompt attention at hospital. Unless it is dealt with promptly, the contents of the Hernia will die which can lead to bowel loss and further complications.


Who needs a hernia repair?

Patients with Hernias, who are fit enough to undergo surgery, should have Hernias repaired before complications occur. Patients with strangulated Hernias require urgent repair.


What tests are done?

Most commonly Hernias are diagnosed clinically by your doctor. Sometimes ultrasound and or CT scans can help rule out other causes of symptoms and diagnose the Hernia. Tests to ensure safety of anaesthesia are performed according to age group and risk factors


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