Overview

A hernia develops when an organ or tissue pushes through a weakened area in an adjacent muscle or connective tissue. Hernias are caused by a combination of pressure and an opening or weakness. The muscle weakness can be present at birth or it can develop later in life. Almost anything that can increase the pressure in the abdomen can cause a hernia. Some of these causes include:

• Lifting heavy objects without stabilizing the abdominal muscles
• Persistent coughing or sneezing
• Diarrhea or constipation
• Obesity
• Smoking
• Poor nutrition
• Pregnancy

Types of Hernias

Hernias are classified by anatomical location. The most common types of hernias are:

Inguinal (inner groin) hernias- Inguinal hernias are the most common type of hernia. They are located in the lower abdomen, near the pubic area. About two-thirds of adult hernias fall into this category. These hernias occur when the bowel or abdominal tissues protrude into the inguinal canal in the groin. Most inguinal hernias occur in men because of a natural weakness in this area.

Femoral hernias- Femoral hernias appear just below the groin crease. Usually occurring in women, femoral hernias often develop because of pregnancy or childbirth. A weakness in the lower groin allows an intestinal sac to drop into the femoral canal, the space near the femoral artery. Women who are overweight are also prone to this type of hernia, but men can also develop a femoral hernia. This type of hernia has a high risk of strangulation (cutting off blood supply), so immediate repair is strongly suggested.

Incisional hernia- After abdominal surgery, sometimes the intestine may push through the scar in the abdominal wall and result in an incisional hernia. These hernias may occur weeks, months or even years after the surgical procedure. It is important to see your doctor right away if you think you may have an incisional hernia because it can become worse and be quite difficult to repair. Although incisional hernias are not as common as groin hernias, they occur more often in elderly or overweight individuals. These two groups of people tend to be more inactive after abdominal surgery and are more prone to incisional hernias.

Umbilical (navel) hernias- Umbilical hernias are common in newborns because of the natural weakness due to the blood vessels around the umbilical cord. Sometimes, these hernias resolve themselves around the age of three or four. Men, women and children may develop an umbilical hernia because of coughing, pregnancy or excess weight. These factors may cause some of the intestine to protrude through the abdominal wall near the navel. Women who have had multiple children or are overweight are also prone to umbilical hernias.

Hiatal (upper stomach) hernias- Hiatal hernias are different than other types of hernias because they are located in the upper abdomen. Hiatal hernias occur when the upper stomach pushes through an opening in the diaphragm through which the esophagus passes. This can cause acid reflux from the stomach, which can lead to heartburn and erosion of the esophagus. Hiatal hernias may require surgery and often a longer hospital stay.

Signs and Symptoms of a Hernia

Because there are many types of hernias, there are a variety of symptoms you may experience. Symptoms may be gradual or sudden and can be painless or quite painful. Some warning signs and symptoms of a hernia could include:

• Pain when lifting, coughing or straining
• A bulge in the abdomen, groin or scrotum that is visible when you cough but disappears when you lie down
• The sensation that something has ruptured
• Pressure, weakness, burning or pain in the abdomen

Methods of Hernia Repair

• Using tension repair, the surgeon makes an incision at the hernia site and manipulates the protruding tissue into its proper position. Stitches place tension on each side of the defect in order to keep it closed.
• Tension-free repair is the most common hernia repair technique. Instead of sewing the two sides of the incision together, the surgeon will use a piece of mesh to connect the hernia defect.
• Laparoscopic tension-free repair uses small incisions and an endoscope to place tissues in proper position. It is known as posterior hernia repair because the procedure is done behind the abdominal wall. The surgeon uses a piece of mesh to support the weakened area.

Call your doctor if you have signs or symptoms of a hernia. A thorough examination is necessary to identify and properly treat a hernia. Although hernias are common, some require prompt treatment, so make an appointment today with your physician.