HEALTH: What is a hernia?

Here’s the latest in VAC’s excellent series of health information features, The Things We Should Talk About…

This time the subject is hernias.

A hernia occurs when an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall. A hernia usually develops between your chest and hips. In many cases, it causes no or very few symptoms, although you may notice a swelling or lump in your tummy (abdomen) or groin. The lump can often be pushed back in or disappears when you lie down. Coughing or straining may make the lump appear.

Some of the more common types of hernia are described below.

Inguinal hernias
Inguinal hernias occur when fatty tissue or a part of your bowel pokes through into your groin at the top of your inner thigh. This is the most common type of hernia and it mainly affects men. It’s often associated with ageing and repeated strain on the abdomen.

Femoral hernias
Femoral hernias also occur when fatty tissue or a part of your bowel pokes through into your groin at the top of your inner thigh. They’re much less common than inguinal hernias and tend to affect more women than men. Like inguinal hernias, femoral hernias are also associated with ageing and repeated strain on the abdomen.

Umbilical hernias
Umbilical hernias occur when fatty tissue or a part of your bowel pokes through your abdomen near your belly button (navel). This type of hernia can occur in babies if the opening in the abdomen through which the umbilical cord passes doesn’t seal properly after birth. Adults can also be affected, possibly as a result of repeated strain on the abdomen.

Hiatus hernias
Hiatus hernias occur when part of the stomach pushes up into your chest by squeezing through an opening in the diaphragm (the thin sheet of muscle that separates the chest from the abdomen). This type of hernia may not have any noticeable symptoms, although it can cause heartburn in some people. It’s not exactly clear what causes hiatus hernias, but it may be the result of the diaphragm becoming weak with age or pressure on the abdomen.

When to seek medical advice

See your GP if you think you have a hernia. They may refer you to hospital for surgical treatment, if necessary. You should go the accident and emergency (A&E) department of your nearest hospital immediately if you have a hernia and you develop any of the following symptoms:

 – sudden, severe pain
– vomiting
– difficulty passing stools (constipation) or wind
– the hernia becomes firm or tender, or can’t be pushed back in

These symptoms could mean that either:

 – the blood supply to a section of organ or tissue trapped in the hernia has become cut off (strangulation)
– a piece of bowel has entered the hernia and become blocked (obstruction)

A strangulated hernia and obstructed bowel are medical emergencies and need to be treated as soon as possible.

Assessing a hernia

Your GP will usually be able to identify a hernia by examining the affected area. In some cases, they may refer you to a nearby hospital for an ultrasound scan to confirm the diagnosis or assess the extent of the problem. This is a painless scan where high-frequency sound waves are used to create an image of part of the inside of the body. Once a diagnosis has been confirmed, your GP or hospital doctor will determine whether surgery to repair the hernia is necessary. Although most hernias won’t get better without surgery, they won’t necessarily get worse. In some cases, the risks of surgery outweigh the potential benefits.

Surgery for a hernia

There are two main ways surgery for hernias can be carried out:

open surgery – where one cut is made to allow the surgeon to push the lump back into the abdomen

keyhole (laparoscopic) surgery – this is a less invasive, but more difficult, technique where several smaller cuts are made, allowing the surgeon to use various special instruments to repair the hernia

Most people are able to go home the same day or the day after surgery and make a full recovery within a few weeks. If your doctor recommends having surgery, it’s important to be aware of the potential risks, as well as the possibility of the hernia recurring. Make sure you discuss the benefits and risks of the procedure with your surgeon in detail before having the operation.

More info: NHS Choices Hernia Info

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