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 Gastrology

June 2010
The Chronicles of Hernia
Dr Devendra Singh
 
Hernia is caused by a combination of pressure and an opening in the muscle/connective tissue: the pressure pushes an organ or tissue through the opening or weak spot, causing it to bulge out. It usually occurs due to a weakness in the muscular structure of the wall of the abdomen.

Battle of the Bulge
  • Activities that raise the pressure inside the abdomen, like lifting a heavy weight, straining to have a bowel movement, sneezing or even coughing, makes the hernia more noticeable.
  • The intra-abdominal pressure could be raised for a longer duration through conditions like chronic cough, pregnancy, accumulation of fluid in the abdomen, and malignancies inside the abdomen. These go on to develop the hernia.
  • All that bulges against the abdominal wall is not hernia though: lymph nodes and some tumours of the abdominal wall could also be guilty. Consult your doctor to get this battle of the bulge diagnosed properly.
6 Types of Hernia
Hernias are commonly located at the sites prone to medical weakness either because of some muscle weakness one is born with, or due to acquired conditions. Depending on the organs involved in causing the disorder, there can be many different types of hernia.
  1. The commonest site is the groin, and a hernia there is called inguinal hernia. The intestine or the bladder could protrude through the abdominal wall or into the inguinal canal in the groin. This occurs more in men.
  2. Femoral hernia meanwhile, occurs more in women. You can notice the bulge in the upper part of the thigh, just below the groin, where the femoral artery and vein pass.
  3. A hernia affecting newborns too, called umbilical hernia, where part of the small intestine passes through the abdominal wall near the navel. This can also affect women who have had many children, or women who are obese.
  4. The elderly and the overweight, inactive after abdominal surgery need to watch out for incisional hernia, where the intestine pushes at the site of previous abdominal surgery.
  5.  Sports hernia is characterised by chronic groin pain in athletes and a dilated superficial ring of the inguinal canal.
  6. Another unusual but common type is hiatus hernia, in which there is no exterior bulge. A portion of stomach protrudes upward into the chest, through an opening in the diaphragm.
Treatment
  • Surgery is the only definitive treatment for hernia, though all hernias do not warrant immediate surgery. The ones which are large and become irreducible need immediate attention and the patient should see a surgeon at the earliest.
  • With lesser cutting and equal precision, the quick laparoscopic surgery has practically replaced conventional hernia surgical techniques over the last few decades.
  • All hernia surgeries involve identifying the normal anatomical structures and closing the defect. Closure is done by direct suturing of the anatomical structures together. This puts strain on the repaired area though – and could lead to recurrence of hernia at the same site after some time. To effectively minimise such a risk, a wire mesh is fitted at the site of the hernia.
  • The contributing factors, which played a role in the hernia development, should be managed simultaneously, to combat recurrence.
  • Never wear tight belts or tight apparel over the hernia without the surgeon’s clearance. This could reduce blood circulation to the herniated part, and become dangerous.
Is Hernia Dangerous?
Hernia can be life threatening. If the neck of the herniated sac is obstructed, blood supply to the distal part would be cut short. This would result in gangrene of the herniated part, which is a surgical emergency.
Dr.Devendra Singh is Sr.Consultant – Gastroenterology at Apollo Hospitals, Bilaspur


    
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