A hernia is an abnormal protrusion of internal organs through an abnormal opening in the wall of the cavity. A combination of increased pressure inside the body with weakness in the wall is responsible for this condition.

In this condition, internal organs or parts of organs are protruded out forming a swelling which will increase the size with coughing and lifting weight, and while passing stool and urine. In lying down position the swelling goes inside except in strangulated and irreducible hernia.


Symptoms

In many cases, a hernia is no more than a painless swelling that presents no problems and needs no immediate medical attention. A hernia may, however, be the cause of discomfort and pain, with symptoms often becoming worse when standing, straining, or lifting heavy items. Most people who notice increasing swelling or soreness eventually see a doctor.

In some cases, a hernia needs immediate surgery, for instance, when part of the gut becomes obstructed or strangulated by an inguinal hernia, immediate medical attention should be sought if an inguinal hernia produces acute abdominal complaints such as pain, nausea, and vomiting. The bulge cannot be pushed back into the abdomen.

The swelling, in these cases, is typically firm and tender and cannot be pushed back up into the abdomen. A hiatal hernia can produce symptoms of acid reflux, such as heartburn, which is caused by stomach acid getting into the esophagus.


Causes of Hernia

  • Congenital weakness.
  • Acquired weakness due to injuries, wasting of muscles, suppurative lesions in the wall and presence of weak natural openings, obesity, lack of exercise, repeated pregnancy.
  • Surgical operation with improper suturing or sepsis of operated site.
  • Chronic constipation.
  • Recurrent cough.
  • Weight lifting.
  • Stricture of the urethra.


Common sites in the body for hernia

A hernia can occur anywhere in the body. However, there are some common sites for a hernia. Due to the presence of hard bony covering the chest wall is normally not affected. Hernia in the lower back is also rare due to the spine, back muscles, tough ligaments, and sheets.

The common site for hernia is an abdominal wall. Compared to other parts the abdominal wall is weak due to the presence of some natural orifices. There are some areas wherein the abdominal muscles are weaker and thin and all these factors make a chance for herniation. The common sites for hernia are:

Inguinal hernia – Here the abdominal contents protrude through the inguinal canal (passage in the lower abdominal wall just above the inguinal ligament. It is seen on either side).This type is common in males. Initially, the swelling comes only while straining and goes back while lying down. Later the large portion of the intestine may come out which may not go back easily.

Femoral hernia – This type of hernia is more in females. Here the abdominal contents pass through the femoral canal which is seen just below the junction between the thigh and lower abdominal wall(Inside the femoral triangle). The contents pass downwards and come out through the saphenous opening in the thigh and form a swelling under the skin.

Umbilical hernia – This is common in children. The umbilicus is the weaker part of the abdomen. The contents of the abdomen may protrude as a bulb-like swelling while crying and defecating.

Incisional hernia – These hernias are seen in operated sites. It can occur near or along with surgical scars in the abdomen. Although they don’t usually cause any serious problems, they can be unpleasant. The treatment options for incisional hernias are open surgery or minimally invasive surgery. Minimally invasive surgery is also called “keyhole surgery,” or “laparoscopic” surgery if it is performed on the abdomen.

Incisional hernias may occur months or years after an abdominal operation. You can usually only see a small lump or swelling near the site of the scar at first. The lump appears when you cough or strain, and then goes away again. Over time, though, it might get bigger and start hurting.

Epigastric hernia – Epigastric hernia is a type of hernia in the epigastric region of the abdominal wall. It’s above the belly button and just below the sternum of your rib cage. This type of hernia is a somewhat common condition in both adults and children. About 2 to 3 percent of all abdominal hernias are epigastric hernias.

Lumbar hernia – Here the hernia appears in the lumbar area on either side of the lumbar spine(in the lumbar triangle).This is a rare type.

Obturator hernia – obturator hernia is a rare type of hernia of the pelvic floor in which pelvic or abdominal contents protrudes through the obturator foramen. Because of differences in anatomy, it is much more common in women, especially multiparous and older women who have recently lost a lot of weight.


Complications Of Hernia

Strangulation – If the hernial orifice is narrow the abdominal contents may not go back easily, and later the blood flow to the herniated tissues may be blocked due to constriction. This can cause the death of protruded intestine.

Intestinal obstruction This occurs when the whole portion of the intestine is protruded into the hernial sac. The narrow hernial orifice will block the passage of bowels.

Infection and peritonitis – If there is strangulation with the death of a portion of intestine there will be spread of infection to the abdomen resulting in peritonitis.


Management Tips for Hernia

Although a hernia will not repair itself with rest, if the symptoms are tolerable and the bulge can be pushed back (reduced), one may choose to simply avoid activities that aggravate it in the initial stages following these steps:

1. Using hernia belt: Special types of hernia belts are available for each type of hernia. This will prevent the protrusion and will reduce pain.

2. Avoid physical activities immediately after meals: Because it may trigger your symptoms. Don’t lie down, bend over, or get active directly after a meal. Avoiding these activities can prevent further damage and injury to the affected area.

3. Relieve your discomfort by taking painkillers: Get an over-the-counter painkiller to help you cope with your pain. You can use acetaminophen (Tylenol) or NSAIDs like ibuprofen (Motrin, Advil) or naproxen (Aleve). If these don’t work, ask your doctor about a prescription painkiller. It’s best to talk to your doctor before using painkillers because they aren’t right for everyone.

4. Quit and avoid smoking: Smoking can cause further deterioration of not only your muscles but also other tissues in your body. If you’re not doing it for your heart, lungs, hair, skin, and nails, do it to improve your current condition.

5. Treat sickness on time: Constipation, recurrent cough, urinary obstruction, etc. can all put a strain on your intestines and abdominal cavity. so do your best to treat them on time when they occur.

6. Lose weight to strengthen the abdominal wall: Being overweight increases the pressure in the abdominal cavity and causes the intestine to protrude through, therefore causing a hernia. Having a healthy diet (that includes small meals often) and doing exercises appropriate to your level can help you achieve this goal.

Before changing your diet and workout routine drastically, consult your doctor. He or she will give you the proper guidelines to lose weight without compromising your health.

7. Regular abdominal exercises: To increase the muscle tone. Specific and suitable abdominal exercise includes Yoga exercise, walking exercise for at least 15 minutes, pool exercise, pillow squeezes mini crunches, inclined cycling, and leg lifting. These exercises can be very friendly on your abdominal walls and strengthen the body part in which hernia occurs.

8. Add vegetables and fruits to diets: Take plenty of leafy vegetables, fruits and fibrous diet for easy bowel movements.

9. Avoid foods that upset your stomach: In the case of Hiatal hernias, avoid eating spicy foods, aerated drinks or anything that can upset the gastric contents of your stomach. 

10. Eat the right quantity of food: Large or heavy meals are not recommended as this can lead to backflow of stomach contents, especially in cases of Hiatal hernias. The acid moves back into the esophagus because a part of the stomach protrudes up through the diaphragm into the chest.

11. Avoid lifting heavy objects: Lifting heavy objects mount much pressure on your muscles and abdomen. Thus it’s imperative you avoid any heavy lifting or, if you absolutely must, consider proper body mechanics. That is, always remember to lift objects using your knees and not your back. You can bend low, using your knees before picking up an object. Carry objects near your torso in order to distribute their weight. This way you can use up all the muscles without putting too much strain on a specific muscle group.

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