Hernia is an abnormal protrusion of internal organs through an abnormal opening in the wall of the abdomen. It’s a combination of increased pressure within the body and weakness in the body wall that damages the abdominal wall leading to protrusion through the thin membrane and stomach swelling.
The abnormal protrusion of internal organs is mainly portions of intestines or abdominal fatty tissue. It will form a swelling which will increase the size with coughing, lifting weight and while passing stool and urine. In lying down position the stomach swelling goes inside except in strangulated and irreducible hernia.
Small hernias may not cause a serious problem, but large hernias can lead to heartburn and chest pain. The affected organs may suffer shortage of blood supply. When this occurs, a surgical assistance may be needed.
Causes of a hernia
Some of the common causes leading to hernia:
1. Weakness in the body wall
- Congenital weakness.
- Acquired weakness due to injuries, wear out of muscles, suppurating lesions in the wall and presence of weak natural openings, obesity, lack of exercise, repeated pregnancy.
- Surgical operation with improper suturing or sepsis of operated site.
2. Increased pressure inside the body
- Chronic constipation
- Recurrent cough
- Weight lifting
- Stricture of urethra
- Straining during a bowel movement or urination
- Lung disease
- Fluid retention in abdominal cavity
- Pressure on abdomen during pregnancy
Symptoms of a hernia
The symptoms of a hernia depend mainly on the site of hernia you are affected by. In the early stages, a slight lump that doesn’t hurt when touched may be noticed. As the disease progresses, it becomes painful and keeps swallowing. The lump increases in size when you cough or sneeze. In most cases, it can be pushed back, but it will bulge again in a few minutes otherwise, you may be suffering a strangulated or irreducible hernia. Other common symptoms of a hernia include:
- Heartburn, worse when bending over or lying down
- Chest pain
- Soreness of the groin or pain in the groin by bending
- A painless lump
- Stomach swelling or tender protrusion
- Difficulty in swallowing
- Blockage of the esophagus
Sites of a hernia
Some sites of hernia are as follow:
- Inguinal hernia Here the stomach contents protrude through the inguinal canal - passage in the lower abdominal wall just above the inguinal ligament which can be seen on either side. Inguinal hernia is common in males. At the beginning, the stomach swelling occurs only while straining and disappears while lying down. Later the large portion of intestine may stick out and hardly go back again.
- Femoral hernia Femoral hernia occurs when the abdominal contents pass through the femoral canal which is seen just below the junction between the thigh and lower abdominal wall (Inside the femoral triangle).The contents pass downwards and comes out through saphenous opening in the thigh and forms a swelling under the skin. Femoral hernia commonly occurs in females.
- Umbilical hernia Umbilical hernia is common in children and can be present at birth. The umbilicus is the weaker part of the abdomen. The contents of the abdomen may protrude as a bulb like stomach swelling while crying and defecating.
- Incisional hernia Incisional hernia is seen in operated areas. This type of hernia is due to improper suturing or sepsis during operation that causes incompletely healed surgical wound or weakening of the operated area.
- Epigastric hernia Here the hernia occurs in the epigastrium – at the midline of the stomach, between the breastbone and the navel. It is a rare type hernia. Due to the presence of hard bony covering the chest wall, it is normally not affected.
- Lumbar hernia Lumbar hernia is a hernia that occurs in the lumbar area on either side of the lumbar spine (in the lumbar triangle). Hernia in the lower back (lumbar) area is also rare due to spine, back muscles and tough ligaments.
- Obturator hernia This is also a rare type of hernia. Here the contents pass through obturator foramen in the pelvic bone.
- Indirect inguinal hernia This is an inguinal hernia that is an outcome of the failure of embryonic closure of the internal inguinal ring after the testicle has got through it.
- Direct inguinal hernia A direct inguinal hernia is a type of inguinal hernia that protrudes through a weakened area in the transversalis facia near the medial inguinal fossa.
- Spigelian hernia This is a hernia that protrudes through the spigeilan fascia.
- Hiatal hernia Hiatal hernia occurs when a part of the stomach protrudes above the diaphragm.
- Herniated disc A disc that, due to use, injury or disease, bulges outside its normal area, causing leg and low back pain ruptured disc and limiting function.
Complications of a hernia
If the hernia opening is narrow the abdominal contents may not go back easily and later cause blockage of blood flow to the herniated tissues. This will cut the blood supply and cause death of protruded intestine. In this case you must visit your doctor immediately because it can get worse as time passes.
This type of hernia can also present vomiting symptoms and the strangulated area is always painful. Strangulated hernia may need surgery, but hernia surgery is an easy operation that succeeds in almost all cases so there’s no need to fear and delay it.
You may also suffer from asymptomatic reducible hernia. The signs and symptoms of this hernia are a little different.
First of all, pain can appear before the affected area begins to swallow and the lump is discovered. Besides the original lump you may discover another lump in the groin or in the abdominal wall. The herniation’s size may vary depending on your position - It is bigger when you stand and smaller when you lie down.
Irreducible hernia, just as its name suggests, can not be pushed back. This usually means that an old hernia is transforming, and complications can appear. It can easily lead to strangulation of the tissue. It also has some other different symptoms like vomiting.
This occurs when the whole portion of the intestine is protruded in to the hernial sac. The narrow hernial opening will block the passage of bowels.
Infection and peritonitis
If there is strangulation with death of a portion of intestine there will be spread of infection to the stomach resulting in peritonitis – inflammatory disease of the peritoneum.
In conclusion, symptoms of a hernia may include stomach swelling, chest pain, heartburn, painless lump and difficulty in swallowing. In addition, hernia can occur anywhere in the body. However the most common site of occurrence is the abdominal wall (may lead to abdominal swelling). Two reasons for this are:
- Compared to other parts the abdominal wall is weak due to the presence of some natural openings.
- There are some areas wherein the abdominal muscles are weaker and thin.