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What is a hernia?

A hernia is a tear or weakness in the muscle or tissue covering our body cavities that allows part of the underlying internal organ to bulge through. Hernias commonly occur in the groin area and are called inguinal hernias. These are mostly found in men. Femoral hernias seen in the upper inner thigh are much less common and are mostly found in women. The abdomen is another frequent location for a hernia. If hernias occur in the midline of the abdomen, they are called ventral hernias. If they occur at the site of a previous surgical scar, they are called incisional hernias. Umbilical or para-umbilical hernias occur around the belly button. In the abdomen it is usually the intestines or omentum (fatty tissue) that protrude. Sometimes the hernia can be seen outside, depending on its location and size. Internal hernias are not visible and are usually diagnosed during evaluation of specific symptoms. For instance, in a hiatus hernia, part of the upper stomach bulges into the chest through an opening in the diaphragm muscle. This causes acid to leak from the stomach into the esophagus or food pipe causing heartburn, indigestion, and acidity. Certain activities can worsen the hernia, like straining, coughing, bending over or lifting heavy objects. Hernias become common as age advances but they can occur in all ages, even in the new-born. Rarely hernias also occur as serious birth defects.

What are the symptoms of a hernia?

There may or may not be symptoms, depending on the type of hernia. One common sign of a hernia is the visible bulge in the affected area. Other reported symptoms include pressure, pain, abdominal distension, vomiting and difficulty in passing urine or motion. Hernias can cause the protruding organs to become infected, blocked, or strangled which then become an emergency. What causes a hernia? Some people are born with weak muscles or tissue that isn’t fully developed. However, most people get hernias as their bodies age and their muscles weaken. When this is combined with an increased pressure within the body cavity, it leads to protrusion of the internal organs. Certain movements and habits can cause or worsen a hernia.

These include:

* Picking up heavy objects (especially lifting them in the wrong way a and with weak muscles)

* Overuse of the same muscle and straining movement (such as long-standing coughing, sneezing, diarrhea, or constipation)

* Being overweight or having poor nutrition

* Use of tobacco and drugs

* Large or repeated cuts from surgeries causing weakness (incisional hernia)

How is a hernia diagnosed?

A surgeon can usually detect a hernia during a physical exam. Further tests may be ordered to assess the severity, type and to determine the cause. An ultrasound scan or computed tomography (CT) scan are frequently used. Occasionally, other tests like endoscopy may be needed.

Can a hernia be prevented?

It is not always possible to prevent hernias. Some are caused by genetics that cannot be changed. Some are birth defects. However many factors that lead to a higher chance of hernia later in life can be modified. The chance of getting some types of hernias can be reduced by:

* Eating smaller meals

* Losing weight if obese
Avoiding alcohol and tobacco

* Avoiding lifting weights or using proper techniques to prevent strains

* Leading an active lifestyle

Hernia treatment

Treatment options depend on the type of hernia and the general state of health. This may also include making changes to diet, activities and habits. Medicines may help to lessen the symptoms but cannot cure hernias. Surgery is essential to repair most hernias. Early surgery can prevent the severity and complications. There are two types of surgical repair. Laparoscopic (keyhole) surgery is less invasive using small cuts in the affected area to repair the hernia by viewing through a camera and using special instruments. Open repair surgery requires a larger cut to make the repair. In most hernia surgeries, especially in adults, a reinforcing net like material called mesh is used. The purpose of this prosthetic mesh is to act as a support for the weakened muscle or tissue to enable it to strengthen over time.

Living with a hernia

Most hernias can be easily diagnosed, treated and cured by appropriate surgery. However, it is rarely possible for hernias to come back or recur or lead to life-threatening complications. In most cases, a timely diagnosis and surgical repair with mesh can help reduce this chance. A proper diet and lifestyle with regular exercise to strengthen the muscles can prevent many hernias.

Dr Shafy Ali Khan S L MBBS, DNB, MRCS, FMAS
Consultant, Dept of General and Minimal Access Surgery

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