Hernia: Types, Causes, Symptoms, and Repair Surgery

What is a Hernia?

A hernia is a protrusion of a body organ through a weak area or a natural orifice through which it does not pass ordinarily. Usually, the term hernia means abdominal wall hernia. It occurs due to a weakness in the abdominal wall, but could also be congenital (by birth) or acquired. Swelling or a bulge is noticed when the patient strains or stands. Some hernias cause pain and some do not cause any pain. The first signs may be a bulge, along with discomfort or pain.

What are the Types of Hernia?

There are several types of hernias, each classified based on its location in the body. The most common types of hernias include:

1. Inguinal Hernia: This is the most common type of hernia and occurs in the groyne. It can be further divided into direct and indirect inguinal hernias. Inguinal hernias are more common in men.
2. Femoral Hernia: Similar to an inguinal hernia, a femoral hernia also occurs in the groyne, but it is more common in women and tends to be lower in the groyne near the upper thigh.
3. Umbilical Hernia: This type of hernia occurs at the belly button or navel. It is more common in infants but can also develop in adults.
4. Incisional Hernia: An incisional hernia occurs at the site of a previous abdominal surgery. It can develop when the surgical incision doesn't heal properly or weakens over time.
5. Hiatal Hernia: Hiatal hernias are different from the others, as they occur in the upper abdomen at the diaphragm and can allow a portion of the stomach to bulge into the chest cavity. These are often associated with gastroesophageal reflux disease (GERD).
6. Epigastric Hernia: These hernias occur in the upper abdominal area between the breastbone and the navel. They typically involve fatty tissue or, in some cases, a portion of the intestine.
7. Spigelian Hernia: Spigelian hernias are rare and occur along the side of the abdominal wall, typically below the navel.
8. Parastomal Hernia: These hernias develop around a stoma, which is an opening created during colostomy or ileostomy surgery. The hernia occurs near the stoma, where a section of the intestine is brought to the surface of the abdomen.
9. Obturator Hernia: This is a rare type of hernia that occurs in the pelvic region, where a portion of the intestine can get trapped in the obturator canal.

It's important to note that hernias can vary in severity, and not all hernias require immediate treatment. However, surgical repair is often recommended to prevent complications and alleviate symptoms.

What are the Causes of Hernia?

Hernias occur when there is a weakness or opening in the muscles or connective tissues that normally hold internal organs in place. These weaknesses can be caused or exacerbated by a variety of factors. Common causes of hernias include:

• Congenital Weakness: Some individuals are born with a congenital predisposition to hernias, which means they have a natural weakness in their abdominal or groyne muscles that can lead to hernia development later in life.
• Ageing: As people age, their muscles and connective tissues naturally weaken. This age-related muscle weakening can contribute to hernia formation, particularly in the abdominal wall.
• Chronic Coughing: Conditions such as chronic obstructive pulmonary disease (COPD), persistent coughing, or frequent bouts of sneezing can increase intra-abdominal pressure, potentially leading to a hernia.
• Straining During Bowel Movements: Frequent and forceful straining during bowel movements, often due to chronic constipation, can increase the risk of developing hernias, particularly in the abdominal and pelvic areas.
• Pregnancy and Childbirth: The strain of pregnancy and the physical stresses of childbirth can lead to hernias, particularly in the abdominal and groyne regions.
• Obesity: Excess body weight and obesity can increase pressure on the abdominal muscles, increasing the risk of hernias.
• Lifting Heavy Objects: Lifting heavy objects with improper form or straining while lifting can cause a sudden increase in intra-abdominal pressure, potentially leading to a hernia.
• Strenuous Physical Activity: Engaging in strenuous physical activities or sports without proper conditioning and technique can increase the risk of hernia formation, especially in the groyne area.
• Prior Abdominal Surgery: Surgical incisions in the abdominal area can create weak points where hernias can develop, especially if the incision does not heal properly or if there is significant stress on the area.
• Genetics: A family history of hernias can increase an individual's risk of developing one.
• Smoking: Smoking can impair connective tissue and contribute to the weakening of abdominal muscles, potentially increasing the risk of hernias.

Note: While these factors can increase the likelihood of or cause hernias, not everyone with these risk factors will develop a hernia. Hernias can sometimes occur without an obvious cause.

Signs and Symptoms of Hernia

The symptoms of a hernia can vary depending on the type of hernia and its location. Common symptoms of hernias include:

• Bulge or Lump: A visible and often palpable lump or swelling at the site of the hernia is one of the most noticeable symptoms. The lump may become more pronounced when you cough, stand, or strain and may disappear when lying down.
• Pain or Discomfort: Hernias can cause varying degrees of pain or discomfort, which may be sharp, aching, or a feeling of pressure. The pain is typically felt at the site of the hernia, but it can radiate to the surrounding area.
• Weakness or Heaviness: Some people describe a general sense of weakness or heaviness in the affected area.
• Burning or Gurgling Sensations: Some individuals experience burning or gurgling sensations near the hernia site.
• Reflux or Difficulty Swallowing: Hiatal hernias, which occur in the upper abdomen, can cause symptoms like heartburn, acid reflux, or difficulty swallowing.
• Nausea and Vomiting: In some cases, hernias may lead to nausea and vomiting, especially if the hernia becomes incarcerated (trapped) and obstructs the normal flow of the intestine.

If you or someone you know has been experiencing persistent or severe symptoms that may be related to a hernia, it's advisable to seek medical evaluation and diagnosis as soon as possible, as untreated hernias can lead to complications.

Complications of Hernia

Hernias, if left untreated, can lead to various complications that may require more extensive medical intervention. Some common complications of hernias include:

Strangulation

This is a severe and potentially life-threatening complication. It occurs when the blood supply to the herniated tissue becomes compromised, leading to tissue damage and necrosis (tissue death). It is a medical emergency that requires immediate surgical intervention.

Obstruction

Hernias, particularly those in the abdominal area, can obstruct the normal flow of the intestine, which can lead to symptoms such as severe abdominal pain, nausea, vomiting, and the inability to pass gas or have bowel movements. This too is a medical emergency that may require surgery to relieve the blockage.

Incarceration

An incarcerated hernia is one in which the herniated tissue is trapped within the hernia sac and cannot be pushed back into the abdominal cavity. This can cause pain, discomfort, and a visible bulge. While not as urgent as strangulation, incarceration often requires surgical repair to prevent further complications.

Infection

In some cases, hernias can become infected. This is more likely to occur in incisional hernias or hernias with open wounds. Infections can cause redness, swelling, pain, and fever. Antibiotics and surgical intervention may be required to manage the infection.

Chronic Pain

Some individuals may experience chronic pain at the site of the hernia or at the surgical site after hernia repair. This is known as post-herniorrhaphy pain syndrome (PHPS) and can persist for an extended period.

Urinary Retention

Inguinal hernias can sometimes affect the nerves responsible for bladder control, leading to difficulty in urinating.

When is Hernia Surgery Required?

Hernia causes pain and discomfort & can cause dangerous complications such as intestinal obstruction, strangulation (hampering of blood supply), and gangrene (tissue death) which are life-threatening conditions. It never gets cured itself.

The hernia repair surgery is essentially done to:

• Replace the protruded organ back to the abdominal cavity.
• Repair the weak area of the abdominal wall through which protrusion occurs.

Surgical Techniques for Hernia Repair 

Usually, the hernia operation is performed by either of the two following techniques

• Open Tension-free Hernia Repair: A prosthesis such as polypropylene mesh is introduced from outside to cover the defect. An open operation may be done under local anaesthesia.
• Laparoscopic Hernia Repair: A prosthesis such as polypropylene mesh is used to cover the defect through the abdominal cavity. Laparoscopic hernia repair is under general anaesthesia. Nowadays local anaesthesia is long-acting, so the effect lasts for 4 to 6 hours. The patient walks out of the operation theatre and is soon discharged.

Also, Read - How Does Robotic Surgery Benefit Hernia Patients?

Pain Management and Post-operative Care

Recovery after hernia surgery involves careful pain management and post-operative care to promote healing and reduce the risk of complications. Here's what you can expect and how to manage your recovery effectively:

Pain Management

• Local Anaesthetics: In some cases, your surgeon may use local anaesthetics to numb the surgical area during and immediately after the operation. This can provide pain relief in the early stages of recovery.
• Medication: Your surgeon will prescribe pain medication to help manage discomfort. These may include over-the-counter pain relievers or, in some cases, stronger prescription medications. Take these as directed and don't wait until pain becomes severe to take your medication.
• Ice Packs: Applying ice packs to the surgical site can help reduce swelling and alleviate pain. Be sure to use a cloth or towel as a barrier between the ice pack and your skin to prevent frostbite.

Rest and Recovery

• Avoid Strenuous Activities: It's essential to avoid heavy lifting and strenuous activities for several weeks after surgery. Follow your surgeon's recommendations regarding when you can gradually resume physical activities.
• Supportive Clothing: Wearing an abdominal binder or supportive undergarments can provide extra support to the surgical area, reduce discomfort, and help you move more comfortably.

Wound Care

• Keep the Incision Area Clean: It's crucial to keep the incision area clean and dry. Gently wash it with mild soap and water, and pat it dry. Avoid scrubbing or using harsh chemicals.
• Inspect for Signs of Infection: Regularly check the incision for signs of infection, such as redness, swelling, increased pain, warmth, or discharge. Contact your surgeon if you notice any of these symptoms.

Diet and Nutrition

• Balanced Diet: Maintain a balanced diet with adequate protein and fibre to support healing and prevent constipation. Constipation can strain the surgical site and increase discomfort.
• Hydration: Drink plenty of water to stay well-hydrated, which can aid in the healing process.

Medication Management

• Adhere to Medication Schedule: If you were prescribed antibiotics or other medications, make sure to take them exactly as instructed by your surgeon.
• Pain Medication Side Effects: Be aware of potential side effects of pain medications, such as drowsiness or constipation. Inform your healthcare provider if you experience any adverse effects.

Follow-Up Appointments

It's crucial to attend all scheduled follow-up appointments with your surgeon. These visits allow your surgeon to monitor your progress and address any concerns.

Identification of Complications

Keep an eye out for potential complications, such as infection, severe pain, high fever, or increased swelling, and promptly contact your surgeon if you experience these symptoms.

Recovery times can vary based on the type of hernia, surgical technique, and individual factors. It's essential to follow your surgeon's specific post-operative care instructions and to be patient with the healing process. 

Final Words

Hernias are a common medical condition that can be effectively treated by experienced general surgeons. With early diagnosis, appropriate treatment, and diligent post-operative care, individuals can expect a smooth recovery and a return to their regular activities. If you or someone you know has reasons to suspect a hernia or have any concerns about your health, it's essential to consult with a medical professional, to get a thorough evaluation and personalised guidance. Your health and well-being are of utmost importance, and seeking timely medical attention is a vital step towards a healthier, hernia-free future.