A hernia is a bulge or protrusion that occurs when an organ pushes through a weakness or hole in the muscle wall of the abdominal cavity.
Hernias can be congenital or acquired. Congenital hernias develop prior to birth, causing the individual to be born with an existing hernia. Acquired hernias develop during infancy, childhood or adulthood, as a result of a weakening in the muscle wall.
Common hernia locations include:
- Groin – inguinal hernias develop in the groin, just above the leg crease. They are the most common hernia and appear most often in men. They result from the intestine or bladder protruding through an opening in the abdomen or inguinal canal. Femoral hernias also occur in the groin but the bulge is located below the leg crease.Femoral hernias are more common in women, particularly those that are obese or pregnant
- Umbilical – located near the belly button, umbilical hernias develop when a portion of the small intestine protrudes through a weakening in the abdominal wall.Umbilical hernias that occur in babies are the only hernias that can resolve on their own. However, those that don’t disappear within the first year of life, require surgical repair
- Incisional – this type of hernia is due to abdominal wall weakening as a result of prior surgery. Incisional hernias develop at the site of the incision during or after healing has taken place
- Hiatal – this type of hernia is due to a weakening in the diaphragm – the muscle that separates the chest cavity from the abdominal cavity. Hiatal hernias cause gastric reflux, a back-up of stomach juices into the esophagus
Hernias develop as a result of muscle wall weakness. While such weakness is usually not evident, it increases the likelihood of herniation. Risk factors for hernias include the following:
- Increased pressure due to pregnancy or rapid weight gain
- Heavy lifting
- Chronic coughing or sneezing
- Cystic fibrosis
- Ascites – an accumulation of fluid in the abdomen
- Straining at the toilet due to chronic constipation
Symptoms vary depending on the type and location of the hernia but may include:
- A soft bulge or swelling in a particular area that may or may not be painful. Hernias in babies can sometimes only be felt when crying
- Pain or soreness that may become worse with lifting, coughing, standing or straining
- Heartburn caused by acid reflux can be a symptom of a hiatal hernia
Many hernias are diagnosed through physical examination. If your physician identifies a bulge, you may be asked to cough, stand or push to observe whether or not the swelling increases.
Special imaging tests such as CT or ultrasound may also be ordered to better evaluate the condition.
Hiatal hernias are not outwardly visible and require barium x-rays – films performed after the patient drinks a liquid barium preparation that makes it possible to evaluate the digestive system function. Endoscopy, a test where a small tube with a camera is passed through the mouth and into the esophagus and stomach, is also helpful in diagnosing hiatal hernias.
Depending on the size, location and symptoms of the hernia, treatment options range from watchful waiting to surgical repair. Most femoral hernias require surgery due a high risk of bowel strangulation.
Hernia repair can be done through an open surgical procedure where a larger incision is made to close the hole in the muscle wall or through a less invasive laparoscopic technique performed through a small incision using a miniature camera and microscopic instruments.