UNDERSTANDING HERNIA

Hernia is a common surgical condition everyone would have heard about atleast once.As a Surgeon,hernia surgery is one among the most frequently performed surgeries in my clinical practice.



So what is hernia?

In simple words,a hernia happens when an internal organ pushes through a weak spot in muscle or tissue.Since it is a defect in the muscle,the ONLY treatment for hernia is surgical correction.Depending upon the clinical presentation the treatment can be elective or surgical.

What are the types of hernia?

There are many types of hernia,the commonest are as listed below:

  1. Inguinal Hernia By far the most common type of hernia,here,the intestine or fatty tissue protrudes out into the groin, above the inner thigh.

  2. Femoral Hernia Here,the fatty tissue or intestine bulges out at the upper inner thigh below the location for an inguinal hernia

  3. Umbilical Hernia In umbilical hernia,the bulge occurs at the level of the belly button or just adjacent to it(paraumbilical hernia).

  4. Incisional Hernia The herniation occurs at the site of scar of a previous operation as it is a relatively weak spot.

  5. Hiatus Hernia Here part of the stomach protrudes into the chest cavity through an opening in the diaphragm,the horizontal sheet of muscle separating the two. There are other uncommon types of hernia which are beyond the scope of general awareness.



What causes a hernia?

As discussed earlier,the root cause for hernia is the loss of strength of the muscles.The risk factors predisposing to the development of hernia are:

  • Increased pressure within the abdomen as in chronic cough,chronic straining etc.

  • Strenuous physical activities such as habitual weight-lifting.

  • Chronic constipation

  • Chronic straining at urination as in untreated Benign Prostatic Hyperplasia(BPH) in men when the prostate gland enlargement occurs with aging.

  • Smoking which by itself can weaken the muscle but can also lead to chronic cough.

  • Obesity

  • Previous surgeries

  • Pregnancy

It is always important to find out the underlying cause and to treat it first before going for the surgical correction of hernia unless it is an emergency.



Symptoms

  1. Swelling or bulge at the site of hernia-which might completely disappear on lying down if in initial stages.This is the most common symptom.

  2. Pain or occasional discomfort.

  3. Heartburn or difficulty in swallowing food in hiatus hernia.

Complications of hernia

Though the risk of complications are comparatively less in hernias,if they do occur,there must be no delay in the management of hernia.What are the complications and what are the warning signs?

  • Intestinal obstruction

  • Strangulation (loss of blood supply to the trapped intestine) The warning signs in both these cases would be continuous abdominal pain associated with constipation,vomiting and in some cases,fever.

How is hernia diagnosed?

Hernia is a clinical diagnosis and hence,the best diagnostic tool is clinical examination by a surgeon or even a primary physician.Your surgeon might order an imaging for better clarification prior to planning of intervention as well as to rule out underlying causes such as an obstructing prostate gland.


What is the treatment?

As discussed earlier,surgery is the only treatment option for hernia.Both open and laparoscopic (key-hole surgery) options are available with both having equal efficacy.The selection of the method depends on the type of hernia,stage of hernia,associated factors and surgeon’s expertise.Mesh surgeries(strengthening of muscle by ‘net’) are the gold standard now. Adhere to the post-operative instructions of your surgeon meticulously.


Some common questions I have been asked as a surgeon!

  1. When should I get my hernia operated? The ideal time to operate a hernia is when it is still in the uncomplicated state.In other words,it is always better for the hernia surgery to be planned when the patient hasn’t yet developed complications pertaining to it.Any surgery,when done as an emergency is associated with more morbidity compared to when done electively where adequate steps for anticipated complications can be taken care of.

  2. Which is better?open or laparoscopic surgery? Results are comparable in both methods.Open surgery is however associated with a larger wound,therefore more chances of wound related complications and post-operative care.Your surgeon would discuss with you the pros and cons of each as well as limitations if any.

  3. Can I get hernia again after surgery? Yes,you can. It depends on the elective/emergency setting as well as the status of predisposing factors.You can develop hernia at the same site or an alternate site.

  4. Aren’t there any medications or alternatives to surgery? No. If anyone has told you hernia can be treated medically- beware of quackery! Muscle weakness can only be corrected surgically.

  5. How can I prevent hernia? Make sure that the following instructions are taken care of:

  • Maintain an ideal body weight.

  • Use correct form while lifting heavy weights if you can’t avoid it altogether.

  • High-fibre diets to check constipation.

  • Stop smoking.

  • Consult a Urologist if you experience any urinary symptoms to rule out prostatic enlargement and risk for hernia later.

Do not hesitate to pay a visit to your surgeon if you notice any abnormal swellings on your abdomen-it could be a hernia!


Have any queries?Ask away!


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