Hernia is a protrusion of an abdominal organ or its part through the wall of the cavity that normally contains it. Hernias affect individuals of any age; men more often than women.
The abdominal cavity is wrapped in muscles that protect it and maintain its shape. In the cavity wall, there are spots where the cavity wall is weakened. These are also the locations where hernias most often occur – exertion or prolonged overloading may cause penetration of the organ through this weakened place. Within the abdominal wall there are also recesses and folds of intestine supporting apparatus formed by connective tissue where hernia can also develop.
Development and Symptoms of Hernia
The inner wall of the abdominal cavity is lined by fibrous membrane called the peritoneum. Hernia originates by protrusion of this membrane; the resulting cavity contains the whole abdominal organ or its major part. Hernia occurs mostly in places with weakened abdominal wall. From the outside, hernia appears as a lump protruding above the surface of the abdomen. Usually, it can be easily palpated. The hernia is generally accompanied by feeling of tension in the place, sometimes pain. At the beginning it can be pushed back to the abdominal cavity; later its reposition is no more possible.
Classification of Hernias
Hernia is a relatively common disease; several different types of the disease are recognized. Each hernia consists of three components - hernial gate (location where the content of the abdominal cavity penetrates), hernial sac (the wrapping that covers penetrated abdominal organ, usually skin, subcutaneous tissue, muscles and peritoneum wall) and hernial content (abdominal organ that has protruded).
Hernias can be divided into groups according to several aspects. The basic classification differentiates internal and external hernias. Internal hernias are those in which a portion of the abdominal organs gets into a fold within the abdominal cavity. These folds are either natural formed in the intestine supporting apparatus, or are formed by fibrous adhesions after surgeries or infections in the abdominal cavity. External hernias are protrusions of an abdominal organ or its part through the wall of the abdominal cavity outside of the body.
Different classification divides hernias in congenital and acquired. Congenital hernia develops before birth and can be diagnosed already shortly after birth. It is more common in premature babies. Acquired hernia affects people later in life and it is the result of weakened abdominal wall and overloading of the abdominal muscles. Therefore, it is sometimes called exertional hernias. Hernias occur more often in places of least resistance, either due to anatomical structure, or due to aging, local surgery or trauma.
Classification of External Hernias
External hernias can moreover be classified by localization.
Inguinal hernia occurs in the inguinal canal, a structure through which in women the uterine ligament leads and in men vas deferens with blood vessels and nerves. It is the most common type of hernia; up to 85% of the patients are men. Sometimes, the inguinal canal widens and one or more of the abdominal organs squeezes in, most often it is part of the small intestine. Later, a lump may be palpated in that area, painful at times. Protruded organ can even descend into the scrotum or in the labia majora in women.
Umbilical hernias affect mostly infants, since the region of the navel is another naturally weakened spot in the abdominal wall. Manifestations in this location are the same as in the previous type.
Femoral hernia occurs in a place under the inguinal ligament through which the blood vessels and nerves supplying the lower limbs gets by. Again, this is naturally weakened place in the abdominal wall. This hernia type accounts for 10% of all hernias.
Incisional hernia occurs after surgeries in the abdominal cavity. Scar is formed by connective tissue which is elastic and therefore may spread out and enable penetration of organs or adipose tissue.
Diagnosis of Hernias
Diagnostics of hernias is not too demanding. The basic method is inspection and palpation by a physician, including a try to push the hernia back into the abdominal cavity. Abdominal sonography can also be useful in visualising the hernia.
Treatment of Hernia
Hernias can be treated conservatively or by surgery.
Conservative Treatment of Hernia
Conservative treatment generally means that patients are treated without surgery. In the case of hernia, conservative treatment means trying to push the hernia back into the abdominal cavity. Afterwards, so-called hernia support belts are recommended. Such treatment, however, will never solve the underlying problem and therefore it is not widely used.
Surgical Treatment of Hernia
Surgical treatment is the only causal treatment for hernias. During surgery, the hernial sac is examined and in case it is intact, it is repositioned into the abdominal cavity. The place of its penetration is than fixed by suture; special mesh is often used to strengthen the place to prevent hernia from reoccurring. If the hernial sac is damaged, it is necessary to remove the damaged part immediately. After surgery, the patient must follow certain rules to prevent recurrence – avoid lifting heavy objects, reducing the pressure at the area by pressing hands against it when coughing, sneezing, or during defecation.
Risk Factors and Complications of Hernia
Risk factors for acquired hernias are scars after operations. Furthermore, it is a long-term overloading of the abdominal wall, especially by lifting too heavy objects. A hernia can occur also in pregnancy due to increased intraabdominal pressure when the fetus grows and in obesity. Hernias do not have serious consequences if the hernia is not incarcerated. In case of incarceration, the content of the hernial sac is undersupplied with blood and the tissue dies very quickly. The patient is afterwards threatened by inflammation of the peritoneum, co-called peritonitis, which can be followed by sepsis. Sepsis is a systemic inflammatory disease characterized by increased heart and respiratory rate, low blood pressure, fever and changes in the blood count. It is a very serious condition that can lead to death of the patient.
Prevention of Hernia
Prevention of hernia as such does not exist. However, it is recommended not to lift too heavy objects, maintain optimal body weight and strengthen abdominal muscles. Already 10 kg overweight can significantly increase the risk of a hernia. Equally, increased risk of hernias is connected with sudden weight loss, probably due to loss of important muscle substances (proteins).