Hernia

What is a hernia?

A hernia occurs when an organ like the intestine bulges out through a gap, or a weakened spot in the muscle or tissue that is meant to contain it.

Generally, you’ll find hernias in the abdomen or groin area, and they appear as a bulge or lump. The most effective treatment of hernias is surgical repair – and it is one of the most common operations in Australia, with about 40,000 Australians having hernias repaired each year.

Some people are born with a weak abdominal wall, making them more susceptible to hernias. Others develop later in life.

There are different types of hernias. The most common include:

• Inguinal – occur in the groin area, where the tissue of the bowel or other abdominal tissue pushes through an area of the groin. These account for up to 90% of all hernias. Most commonly affecting middle-aged men.
• Hiatus – within the body where your oesophagus passes through the diaphragm, so you won’t be able to see a hiatus hernia. Often causing symptoms such as heartburn and difficulty swallowing.
  
• Femoral – These occur on the thigh where the leg joins to the body. They occur as a result of intestines forcing their way through the weak muscles of the femoral canal, which means they are a serious hernia requiring urgent surgery. More common in women.
• Umbilical – occur when a section of intestine pushes through the muscle near the navel. These are more common in newborns and women who are overweight or who have had multiple pregnancies.
• Incisional – occurring after abdominal surgery, this is where the intestines push through the site of surgery.

A hernia can be at risk of becoming strangulated – which means it cannot be gently pushed back through the abdominal wall. Another term for this is non-reducible hernia. When this happens, there is reduced blood flow to the trapped tissue. If left untreated, this can lead to serious complications to the tissue, including it getting damaged or dying (gangrene).

Symptoms of hernia

Generally, a hernia can be seen or felt on your body as a lump. Other symptoms of hernias include:

• Pain when exercising or when lifting heavy objects
• An uncomfortable feeling in the gut, especially when bending over
• Changes in your bowel habits
• The lump gets bigger when on standing up and on straining
• The lump gets smaller when you lie down

If you have a hernia, , and you experience any of the below symptoms, you should see a doctor straight away, as these suggest the hernia has become strangulated. Surgery is needed to remove the hernia and reduce your risk of gangrene

• Nausea
• Vomiting
• Severe pain.

Causes and treatment of hernia

A hernia can be caused by different things, but is typically a combination of muscle weakness and excessive strain. There are mechanical causes such as heavy lifting, bouts of coughing, a sharp blow to the abdomen, or poor posture. Other physical causes include obesity, constipation (and the resultant straining), pregnancy and smoking.

For the majority of hernias (reducible and non-reducible), surgery is the only treatment option. The good news is that many hernias – particularly inguinal hernias – can be fixed with laparoscopic surgery, which is also known as ‘minimally invasive’ surgery. In this type of surgery, the surgeon will make a few small incisions, then they insert a tiny camera and tools and, directed to the area around the hernia. The defect is then repaired by pushing back the herniated tissue and repairing the weakened muscle. If you have a laparoscopy, you should expect to be able to return to work in a week or two.

Some hernias require a more complicated procedure, in which the surgeon needs to cut a larger opening in the abdomen to reach the affected area. In some cases, a synthetic material (mesh) is placed over the weak muscle area to strengthen against future occurrences of hernia.

If you think you may have a hernia, or have some of the warning signs that make you a likely candidate for one, it’s a good idea to get it checked out by your GP. Untreated hernias may cause complications that are easily avoided with surgical correction.

Further information and sources

• Health Direct Australia
• Better Health Channel
• UpToDate