What is a hernia?

A hernia is a defect in the strength layer of the abdomen (called fascia) that can produce a bulge or pain.

This can happen in areas of natural weakness, such as the belly button or the groin, or in areas of incisions from previous surgeries.

 

Risk factors for a hernia:

  • Older age: as we age the muscles become weaker
  • Obesity: increased weight places pressure on the abdominal muscles
  • Sudden twists, pulls or strains
  • Chronic straining
  • Family history
  • Connective tissue disorders
  • Pregnancy – 1/2000 women will develop a hernia during pregnancy
  • Large abdominal incisions
  • Post-operative infections in surgical incisions
  • Smoking
  • Diabetes
  • Lung disease such as COPD

 

Ventral or umbilical hernias

A ventral hernia is a bulge through the opening in the muscles of the abdomen through which abdominal tissue or intestines may bulge through.  An umbilical hernia is a type of ventral hernia that happens at the belly button. A hernia is reducible if the abdominal tissue or intestine can be pushed back into the opening. When intestine or abdominal tissue fills the hernia and it cannot be pushed back, this is called incarcerated. A hernia is strangulated if the intestine is trapped in the hernia pouch and the blood supply to the intestine is decreased. This is a surgical emergency.

 

Incisional hernia

An incisional hernia can develop at the area of a prior surgical incision. Five of 1000 patients with prior laparoscopic incisions will develop a hernia, and up to 150/ 1000 patients with an open abdominal incision. Most appear within 5 years after their operation.

An incisional hernia is reducible if the abdominal tissue or intestine can be pushed back into the opening. When intestine or abdominal tissue fills the hernia and it cannot be pushed back, this is called incarcerated. A hernia is strangulated if the intestine is trapped in the hernia pouch and the blood supply to the intestine is decreased. This is a surgical emergency.

 

Symptoms of hernias:

The most common symptoms of hernias:

  • A bulge in the groin, scrotum, abdomen or belly button area that often increases in size with coughing or straining
  • Mild pain at the hernia site
  • Numbness or irritation due to pressure on the nerves around the hernia
  • Sharp abdominal pain, nausea and vomiting can mean that the intestine has slipped through the hernia sac and is stuck or strangulated. This is a surgical emergency and immediate treatment is needed.

References:

American College of Surgeons