A hernia is a protrusion of an organ through the weakest part of the muscles or connective tissue of the abdominal wall. Hernias are provoked by a combination of factors – increased intra-abdominal pressure and the weakness of the abdominal wall muscles or fascia. Therefore, the main risk factors associated with hernias are obesity, pregnancy, chronic cough or constipation, connective tissue disorders, as well as older age, smoking, family history of hernia and physical exertion.
The most common types of hernia include inguinal, femoral, incisional and umbilical hernias.
Inguinal hernias occur in the groin and are divided into two groups: indirect and direct hernias. Indirect inguinal hernia protrudes through the internal inguinal ring to the inguinal canal and follows the course of the spermatic cord. Direct hernias bulge straight through the defect of the lower abdominal wall muscles. Inguinal hernias are more common among men.
Femoral hernia occurs just below the inguinal ligament, with the protrusion of the abdominal contents into the femoral canal. This type of hernia affects more women than men.
Incisional hernia develops at the surgical incision site made for a previous abdominal surgery. It is more likely to occur if the wound has not healed well (e.g. there was a surgical site infection).
Umbilical hernia involves a protrusion of the abdominal contents through the navel. It often occurs in obese or pregnant women or new-borns.
Overall, abdominal wall hernias have a variety of clinical presentations depending upon their location. Generally, there are no symptoms except a painless bulge varying in size. However, hernias may cause discomfort or increased pain when standing up or stretching.
Whatever type of hernia a person has, it is recommended to consider a proper and timely treatment. It is suggested to treat hernias to prevent obstruction of the herniated intestine or strangulation of the protruded tissue. There are two ways to treat hernias. First is a non-invasive treatment where special devices and medications designed to keep the protruded tissue within the abdominal cavity are used. This type of treatment is rarely recommended by experienced doctors because of the high rate of failure.
The second and more sustainable way to treat hernia is an invasive one – a surgery. The way the surgery is carried out may be an open surgery where the abdominal cavity is cut open or it may be a laparoscopic – this is a less invasive method where the surgeon makes a couple of incisions in the abdominal wall and performs the procedure using special instruments. The principle of either way of surgery type is the same – to restore the integrity of the abdominal wall and to reduce the mass of the protruded tissue. To do so, the mass of the hernia is pushed into the abdominal cavity and the weak part of the abdominal wall muscles is either mended with sutures or covered up with special mesh prosthesis without using the tension. The latter is said to be a longer lasting way to surgically treat the hernia.