Hernias

Usually a hernia is a sac formed by the lining of the abdominal cavity (peritoneum). The sac through a hole or weak area in the fascia, the strong layer around the abdominal muscle wall.

The types of hernias are based on where they occur:

Femoral hernia appears as a bulge in the upper thigh. This type is more common in women than in men.
Hiatal hernia occurs in the upper stomach.
Incisional hernia: can occur through a scar if you have had abdominal surgery in the past.
Inguinal hernia appears as a bulge in the groin. This type is more common in men than in women. The protrusion may descend into the scrotum.
Umbilical hernia appears as a bulge around the navel. Occurs when the muscle around the navel does not close completely.

Causes, incidence, and risk factors

There is usually no obvious cause for the appearance of a hernia, although sometimes occur with heavy lifting. Hernias may be present at birth, but it is possible that the bulge is not noticeable until later in life. Some patients may have a family history of hernias.

Hernias can be seen in infants and children. This can happen when the lining around the abdominal organs does not close properly before birth. About 5 out of 100 children have inguinal hernias (more boys than girls). Some children do not have symptoms until adulthood.

Any activity or medical problem that increases pressure in the tissue and muscles of the abdominal wall may lead to a hernia, including:

Chronic constipation, straining to have bowel movements
Chronic cough
Cystic fibrosis
Enlarged prostate, straining to urinate
Overweight
Heavy lifting
Malnutrition
Smoking
Exertion
Cryptorchidism

Symptoms

Most times there are no symptoms. However, sometimes there may be discomfort or pain. The discomfort may be worse when you stand, strain or lift heavy objects.

Although a hernia may cause only mild discomfort, you can get deeper and strangled. This means that the fabric is stuck inside the hole and the blood supply has been suspended. If this happens, emergency surgery is needed.

Exams and Tests

A doctor can confirm the presence of a hernia during a physical exam . The mass may increase in size when coughing, bending, lifting, or make an effort.

It is possible that the hernia ( bulge ) may not be obvious in infants and children, except when they are crying or coughing. In some cases , you may need an ultrasound to look for one.

Treatment

Surgery is the only treatment that can repair a hernia permanently. However, sometimes you can monitor smaller hernias with no symptoms. Surgery may have more risk for patients with serious health problems .

The surgery usually be used for hernias that are getting larger or are painful. In operation, the weakened tissue of the abdominal wall ( fascia ) and closes any hole is ensured. Currently, most hernias close fabric patch to seal the holes .

An umbilical hernia that fails to heal itself when your child is 5 years old can be repaired.

Sometimes emergency surgery is needed. The bag containing the bowel or other tissue may become stuck in the hole in the abdominal wall. If it can not be reintroduced through the hole , this can lead to a strangulated loop of intestine . Without treatment, this portion of the intestine dies because it loses its blood supply.

Instead of open surgery , some hernias can be repaired using a laparoscope ( camera). The advantages of using a camera include small surgical cuts , faster recovery and less pain after the procedure.

For information on hernia surgery , see also:

Femoral hernia repair
Repair of inguinal hernia
Repair of umbilical hernia

Expectations ( prognosis)

Generally the prognosis is good if the hernia is treated. Recurrence is rare ( 1 to 3 %).

Complications

In rare cases, inguinal hernia repair can damage structures involved in the functioning of the testicles of a man.

Another risk of hernia surgery is nerve damage , which can lead to numbness in the groin area .

The biggest risk of hernia surgery is another hernia, which may occur years later.

Call your doctor right away if :

You have a painful hernia and the contents can not be pushed back into the abdomen using gentle pressure.
Develop nausea , vomiting or fever along with a painful hernia.
It has a hernia that becomes red , purple, dark or discolored
Call your doctor if :

You have pain , swelling or a lump in the groin.
It has a bulge or swelling in the groin or the navel or is related to a previous surgical incision.

Prevention

Use proper lifting techniques.
Lose weight if overweight .
Relieve or avoid constipation by eating plenty of fiber, drinking lots of fluid , going to the bathroom as soon as you feel the urge , and exercising regularly.
Men should seek medical advice if they strain with urination, as this can be a symptom of an enlarged prostate.

Alternative Names

Inguinal hernia hernia in the groin ; Rupture ; Strangulation ; Incarceration

References
Turnage RH, Richardson KA, Li BD, McDonald JC. Abdominal wall, umbilicus, peritoneum, mesenteries, omentum, and retroperitoneum. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier;2008:chap 43.