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Saturday, September 26, 2020

Types of Hernia: Causes, Symptoms and Treatment

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A hernia is one of the most common problems that has been seen to affect both males and females. A hernia is said to occur when a piece of tissue or an organ passes through a tiny opening in the muscle or tissue that holds the organ in place.

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Usually, in the body, around most of the organs, there is a surrounding tissue or muscle that holds it in place. Hence, if the organ passes through the spaces that have been created by the surrounding tissue, a hernia is said to occur.

Mostly, a hernia occurs in the abdomen (which is the part of your body that is between the chest and the hips). Most times, the intestines mostly caught in the spaces created by the surrounding muscles or tissues.

Although the abdomen is the most common area where a hernia occurs, a hernia can occur in other places such as the groin, and the upper thigh. Most hernias aren’t exactly life-threatening at the initial stage, but they can’t resolve themselves without treatment.

Most hernias require surgery before they can be resolved. If they are left untreated, then a problem or a complication may arise and, as such, cause life-threatening conditions. There are different kinds of hernias.

The types of hernias are so named based on where they are found. They include:

1. Epigastric Hernia

An epigastric hernia is a type of hernia that mostly occurs in the epigastric portion of the abdomen. The abdomen is divided into four parts and nine regions anatomically. One of these anatomical regions is known as the Epigastric region.

In case you are wondering, the epigastric region is that part of the abdomen that is found just below the ribcage and above the navel(popularly known as the belly button). Once a person has an epigastric hernia, you will feel pains just around this region.

Whenever there is pressure on your belly button or your abdominal wall, you will feel severe pains. If you experience intense pains when you laugh, cough, bend down to do any bowel movement, or perform relatively any activity that can cause an increase in pressure in your abdominal wall, then you probably have an epigastric hernia.

Another symptom you will experience when you have epigastric hernia is tenderness, and sometimes, inflammation may occur in this region.

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2. Ventral Hernia

A ventral hernia is a type of hernia that is said to occur when an organ passes through an opening that is created by the muscles that are found within the abdomen. Some people often mistake ventral hernia with an epigastric hernia, but they aren’t the same.

While epigastric hernia occurs only in the epigastric region of the abdomen, the ventral hernia can occur in any part of the abdomen. Recall that there are nine anatomical regions of the abdomen, and if a hernia occurs in any of these regions, it will lead to what is known as a ventral hernia.

Often the pain caused by ventral hernia reduces when you lay down, but as soon as you stand up or sit up, you may begin to feel the aches around your abdomen again. According to research, most ventral hernias can be acquired during one’s lifetime, although a small fraction of ventral hernias is often seen to occur from birth.

In this kind of hernia, certain factors can contribute to one developing this condition. Among these factors are some which are very common and they include; obesity, pregnancy, and strenuous activities

Also, a ventral hernia can occur through an incision that was made during a surgical operation. Whenever a hernia goes through a site of incision, it is often referred to as an incisional hernia.

Incisional hernia can also be as a result of scarring or the weakness in the muscles that surround the site of the incision. When the muscles are weak, healing might take forever. During this period, it is possible for one of the organs to go through this incision resulting in an incisional hernia.

3. Femoral Hernia

A femoral hernia is one of the most common surgical hernias that are seen by doctors. A femoral hernia often occurs just around the thigh region. When a mass of tissue or an organ decides to push through a part of the inner thigh or groin region, it causes the development of a femoral hernia.

In a human body, there are some places that look like pouches, and this is absolutely normal. One of such sites is known as the femoral canal. The femoral canal has a ring-like structure at the entrance, which is referred to as the femoral ring.

When a mass of tissue enters the femoral ring, which is present just at the upper thigh, it can lead to the formation of a femoral hernia. Upon touch, a femoral hernia often feels like a small or medium-sized lump.

A femoral hernia is one of the most common forms of hernia. According to research, almost about 4-5% of all hernias that have been brought to the operating room are femoral hernias; however, when compared with inguinal hernias, they are more commonly seen than femoral hernias,

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Also, a recent study shows that women mostly experience femoral hernia more than men.

4. Inguinal Hernia

This is the most common type of hernia that is often operated on in the hospital. An inguinal hernia occurs when a small portion of the intestine passes through a weak portion of the lower part of the abdominal wall.

Inguinal hernia gets its name from the particular space it passes, which in this case, is the inguinal canal. The inguinal canal is a unique passage. Usually, when males at born, your spermatic cord alongside your testes is found in the abdomen (that is the portion of your body that is located between your chest region and your hips).

However, when the male child is born, the testes alongside the spermatic cord descends from the abdomen into the scrotal sac through the inguinal canal. This is one of the reasons amongst others why the inguinal canal is a very important passage.

Women are not left out. There is an important ligament that is found in the inguinal canal. This ligament helps to hold the uterus in position, and hence, the inguinal canal is a very important passage in women as well.

However, sometimes, the intestines can decide to pass through the inguinal canal resulting in the development of an inguinal hernia. Because this passage is commonly used in men (which is for the descent of the spermatic cord as well as the testes), inguinal hernia happens to be more common in men than in women.

The inguinal canal is typically meant to close immediately after the descent of the spermatic cord and testes (which is immediately after birth). However, in some cases, there are exceptions.

The inguinal canal may not close up or doesn’t close up properly, leaving behind a weakened portion. It is through this area that the intestines tend to pass through, leading to the formation of a hernia.

According to a study paper from the National Institute of Diabetes, Digestive and Kidney diseases, inguinal hernias mostly occur on the right side of the body(although in some cases, the left side too might be affected).

Also, in this study, it was concluded that a total of 27%-30% of males experience inguinal hernia while only 3%-5% of women experience inguinal hernia throughout their lifetime.

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In some cases, it may be difficult to distinguish between a femoral hernia and an inguinal hernia, as both occur in the groin area. However, when men experience inguinal hernia, in addition to the bulge in their grown, they will most likely have another lump within their scrotum.

5. Umbilical Hernia

An umbilical hernia is almost like a ventral hernia. However, in this case, the intestines pass through the weak area around the umbilicus, which is popularly known as the navel. An umbilical hernia is most common in children, especially in newborns.

According to a research carried out by the American College of Surgeons, about 10% of all hernias that occur around the belly are umbilical hernias. Once you or your kids have an umbilical hernia, you will notice a small(slightly larger than normal) kind of a bulge that can be seen around the navel.

Usually, you will feel slight pains around that area; however, whenever you cough, laugh deeply or strain during a bowel movement, the pains you feel will be increased. Typically, an umbilical hernia tends to resolve itself as your child grows older, and his abdominal muscles begin to gain mass and weight.

Mostly, Children who were born with Umbilical Hernia will have their hernias resolved before they attain the age of two years. However, in situations where the child becomes five years old and still has an umbilical hernia, the child will have to undergo a surgical procedure to help resolve the issue.

Although the most substantial amount of umbilical hernia is seen in children, adults likewise, can develop this condition. However, in adults, the causes are slightly different. An abdominal hernia is said to occur in adults when the intestines enter a weak part of the abdominal muscles.

The weakness of the abdominal muscle is caused by conditions such as pregnancy, ascites (which means excess fluid in the abdomen), or obesity.

6. Hiatal Hernia

A hiatal hernia is said to occur when a small portion of the fundus of the stomach pushes through a weak point around the diaphragm. The diaphragm is a muscle that separates the abdomen from the thorax and the lungs.

People who have hiatal hernia have always been seen to have issues with acid reflux. Hiatal hernia, just like other hernias, can either be developed as a person ages or can be as a result of an inborn complication.

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A hiatal hernia can occur anywhere around the diaphragm. Based on the place where the hiatal hernia is located, there are four types (type I-IV) of hiatal hernia. The majority of the Hiatal hernias that occur in patients are Type I.

In type I hernias, the position of the stomach remains the same; however, the part that connects the esophagus and the stomach sometimes slides up above the diaphragm. Once that part slides over the diaphragm, type I hiatal hernia occurs.

What causes hernia in general?

Most hernias are usually caused by a number of factors. However, severe muscle weakness, as well as intense strain, have been seen to be the major culprits. Generally, a hernia can develop quickly or over time based on its cause.

Although muscle weaknesses and strain are the widely known factors of hernia, there are certain factors that can contribute to its development.

They include:

  1. Congenital disabilities: When there is a congenital malformation that occurs during the baby’s developmental process(especially during the last trimester), and it is seen during birth, it can lead to the weakening of the baby’s muscles and as such cause hernia to occur.
  2. Aging: Usually, as one age, your muscles begin to weaken and lose its elasticity. Once that occurs, it can cause an opening within the muscle fibers and, therefore, can result in the formation of a hernia.
  3. Any damage to the internal muscles or organs or an untreated injury which may occur during surgery can lead to the formation of a hernia.
  4. Chronic coughing or Chronic Obstructive Pulmonary Disorder (COPD) can result in a tear in the diaphragm leading to hiatal hernia.
  5. Strenuous exercises done over some time, as well as lifting heavy objects, can result in a hernia.
  6. Those who are pregnant, especially those who are expecting more than one, are at an increased risk and may develop a hernia.
  7. Intense constipation, which causes you to keep straining during a bowel movement, will, over time, result in the formation of hernia.
  8. Being overweight or obese causes excess strain on your muscles and may result in muscle weakness leading to hernia.
  9. The excess fluid within the abdomen, generally known as Ascites, will cause a hernia to occur.

Symptoms

One of the most common symptoms that doctors lookout in patients who have hernias is the presence of a lump or bulge in the affected area. Most hernias sometimes may “disappear” when you are lying down. However, whenever you sit or are in an upright position, the bulge becomes visible.

Also, you can feel the bulge as well as its associated pain whenever you are laughing, coughing, bending down, or standing up. These are the general symptoms of a hernia. However, certain hernias have different symptoms, as well. For example, hiatal hernia, you can develop specific symptoms in addition to the general symptoms.

Some of these specific symptoms include heartburn, severe chest burns, and pains, as well as difficulty in swallowing. In some cases, you may not experience any symptoms if you have a hernia.

However, during a routine exam, maybe for a completely unrelated problem, your doctor may discover that you have a hernia.

Risk factors

Certain factors can increase your chances of developing hernias. These factors are known as risk factors, and they include:

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1. Genetics

If any member of your family has had a hernia in the past, there is every tendency that you may most likely develop a hernia as well.

2. Age

Usually, as you grow older, your muscles tend to become weaker. Hence, the older you are, the more your chances of developing certain conditions such as a hernia.

3. Pregnancy

Being pregnant causes your abdominal muscles to stretch in order to accommodate the presence of the growing baby. Hence, when you are pregnant with one child, you have a risk of developing a hernia.

If you are having multiple pregnancies(as in the case of twins or triplets), then your chances of developing a hernia further increases.

4. Being obese or overweight

Being overweight or obese causes your muscles to stretch and as well as causes fat deposits, which can cause your muscles to get weak.

Other risk factors may include chronic constipation, chronic cough which is often as a result of the continuous increase in the abdominal pressure, certain diseases such as cystic fibrosis, smoking which causes weakness in the connective tissues present in the lungs and the diaphragm, premature births, as well as babies who have a low weight.

Diagnosis

The first thing your doctor will do to help you diagnose if you have a hernia is to carry out a physical examination.

During this examination, your doctor may feel the presence of a lump or a bulge in a particular area, which will help determine what kind of hernia it is.

After the physical examination and your physician suspects a hernia, he may ask you to take some imaging tests. Such tests may include:

1. Abdominal Ultrasound

Abdominal Ultrasound uses sound waves at a high-frequency to create images of the internal structures of the body.

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2. CT Scan

Computed Tomography(CT) Scan uses both x-ray scans as well as computer technology to help produce a scan.

3. MRI scan

This type of scan makes use of a combination of both radio waves and strong magnets to help produce imaging of the internal structures of the body.

Generally, these three scans can help your doctor determine if you have a hernia and where the hernia is. If your doctor still suspects hiatal hernia, he or she will ask you to go for the following tests.

1. Gastrografin or Barium X-ray

This type of x-rays gives complete imaging of your digestive tract. For this type of x-ray to be done, you will be required to drink a liquid that contains diatrizoate meglumine and gastrografin(diatrizoate sodium) or liquid barium.

After taking this, then you will be required to go for an x-ray, which will, therefore, produce clear images of your internal organs.

2. Endoscopy

This procedure involves the use of a small camera that is attached to a tube(endoscope). This tube is then inserted down your throat into your esophagus and then into your stomach.

Doing this will give a full image and help your physician know where the problem is coming from.

Treatment

The only way by which a hernia is treated is by surgical procedures. However, in some cases, your physician may decide that you don’t need surgery after looking at the size of your hernia as well as how severe your symptoms are.

In the event that your doctor feels you don’t need surgery, he may keep you under observation to check if there are no further complications that can arise from this. This period is always known as the watchful period.

In some cases, your doctor may decide that you need a “Truss.” According to research, wearing a truss may help in relieving the symptoms the patient is feeling. Truss helps to keep the hernia in place.

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However, it is important to know that your doctor must determine if the truss fits well before allowing you to wear it. In a case where you have hiatal hernia, your doctor may advise you to use some over-the-counter drugs such as antacids, H-2 receptor blockers as well as proton-pump-inhibitors can help reduce your stomach acid reflux, relieve your symptoms and improve your discomfort.

In conclusion, having a hernia is one of the most common surgical problems doctors encounter. If you have a hernia, the first sign you need to look out for is the presence of a lump. Once you notice that you have a bulge in any area of your body, it is best you go to your doctor to help you figure out what it is and the best way to reduce the swelling.

It is also important to note that over-the-counter drugs will only help you reduce the pain but it can’t resolve the lump or what is causing it. All these drugs will do for you is to help you reduce the pain and possibly the inflammation associated with hernia.

However, they can’t help you treat the hernia you have. The only possible form of treatment is through surgery.

If you delay treatment, it can lead to certain complications which can be life threatening such as strangulation of your intestines and possible death of the organ due to the lack of blood flow, incarceration of your intestine which can lead to bowel obstruction and possible sepsis and so on.

References;

  • Everything you want to know about hernia; Healthline
  • Understanding Hernia- The basics; WebMD
  • What to know about 6 hernia types; Healthline
Types of Hernia
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Disclaimer: This article is purely informative & educational in nature and should not be construed as medical advice. Please use the content only in consultation with an appropriate certified medical or healthcare professional.

Deborah Akinola
Wirter, poet and public speaker
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