HERNIA
DEFINITION
Hernia is a general term for a bulge or protrusion of an organ through a part of the body in which it is usually contained.
DESCRIPTION
There are many different kinds of hernias. The most familiar are those that occur in the abdomen. In this type of hernia, a part of the intestines protrudes (sticks out) through the wall of the abdomen. An abdominal hernia can occur in different areas. The name given to the hernia depends on the location in which it occurs. Some examples of abdominal hernias are the following:
- An inguinal (pronounced IN-gwin-null) hernia appears in the groin. It may come and go depending on various factors, such as the amount of physical activity. Inguinal hernias account for 80 percent of all hernias. They are more common in men.
- Femoral (pronounced FEH-muh-rull) hernias are similar to inguinal hernias, but they occur lower in the body. They are more common in women, and commonly occur during pregnancy.
- A ventral hernia is also called an incisional hernia. The name reflects the fact that it often occurs at the location of an old surgical scar (incision). A ventral hernia is caused by the stretching of scar tissue. It occurs most commonly in pregnant women and people who are obese (excessively over-weight, see obesity entry).
- An umbilical hernia occurs at the navel. Umbilical hernias are common among infants. They occur when the naval area does not close up properly after birth. Some umbilical hernias clear up by themselves within the first year.
- A hiatal (pronounced hi-ATE-ul) hernia is different from other abdominal hernias. It cannot be seen from outside the body. In a hiatal hernia, the stomach bulges upward into the diaphragm. The diaphragm is a muscle that separates the chest from the abdomen. Hiatal hernias are more common in women than in men.
CAUSES
Most hernias develop at weak spots in the abdominal wall. The weakness may be present at birth, or it may develop later in life for a variety of reasons. Any unusual pressure on the abdomen can cause a hernia to develop. Some examples of the causes of hernias are:
- Heavy lifting
- Unusually severe coughing
- Pregnancy
- Obesity or sudden and excessive weight loss
- Aging
- Previous surgical procedures
SYMPTOMS
A person can sometimes feel a hernia as it develops. There may be tenderness or a slight burning sensation in the area where the hernia is developing. Sometimes a person can push the hernia back into place. In other cases, the hernia may just disappear by itself. In still other cases, the hernia cannot be pushed back into place easily.
About half of the people with hiatal hernias have no symptoms. Those who do have symptoms are likely to experience heartburn. Heartburn is caused when stomach acid is pushed back into the esophagus (pronounced ee-SAH-fuh-guss). The esophagus is the tube that leads from the windpipe to the stomach. Heartburn may also be accompanied by chest pain. These symptoms are worse when a person is lying down.
DIAGNOSIS
Hernias are fairly easy to diagnose. A doctor can usually feel the hernia simply by touching it. The doctor may ask the patient to cough. The extra pressure caused by coughing will make the hernia stick out even more, making it even easier to feel.
A hiatal hernia is more difficult to diagnose. The first clue often comes from symptoms described by the patient, such as heartburn and chest pain after eating. A barium swallow can also be used to diagnose a hiatal hernia. A barium swallow is a procedure in which a patient swallows a chalky white substance containing barium. An X ray is then taken of the patient's digestive system. A hiatal hernia shows up as a protrusion into the diaphragm.
Hiatal hernias can also be diagnosed by endoscopy (pronounced en-DOS-kuh-pee). Endoscopy is a procedure in which a small tube is inserted through the mouth, then into the esophagus and stomach to allow the doctor to see the hernia. A hiatal hernia can actually be seen by this method.
TREATMENT
Once an abdominal hernia occurs, it tends to increase in size. Some patients with an abdominal hernia decide not to seek treatment right away. They may try to keep the hernia under control with a truss. A truss is a support garment worn like a belt. It helps keep the hernia from protruding. People with hernias must avoid strenuous activity, such as heavy lifting or straining themselves.
Constant pain, nausea, and vomiting are signs that the hernia has become worse. The patient may notice that the hernia can no longer be pushed back into place. In such cases, medical help should be sought. Surgery will probably be necessary.
The surgical treatment for hernia is relatively simple. The hernia is pushed back into the abdominal cavity. The muscle lying on top of the hernia is then sewed back into place. If necessary, additional support may be added to keep the hernia in place.
If a hernia is not treated, severe complications can result. Part of the intestine can become trapped outside the muscles of the abdomen. A blockage in the intestine may develop. In the worst cases, this blockage can cut off the blood supply to the intestine. Part of the intestine may actually die.
A hiatal hernia is treated differently. Surgery is recommended only as a last resort. Instead, changes in the patient's lifestyle are recommended. Some of these changes are:
- Avoiding lying down after meals
- Avoiding spicy or acidic foods, alcohol, and tobacco
- Eating small, frequent, bland meals
- Eating a high-fiber diet
Several medications can also help relieve the symptoms of a hiatal hernia. For example, antacids are used to neutralize stomach acid and decrease heartburn. Drugs are also available to reduce the amount of stomach acid produced. A third option is a group of drugs that makes the muscles around the esophagus work more efficiently. The stomach empties faster and there is less chance of heartburn.
Alternative Treatment
Alternative practitioners often recommend changes similar to those listed above. In the case of a hiatal hernia, they may also suggest the use of visceral manipulation. Visceral manipulation is a method for returning the stomach to its proper position. Natural products are sometimes recommended for hiatal hernias too. For example, the natural product called deglycyrrhizinated licorice is thought to help reduce the effects of stomach acid.
PROGNOSIS
Abdominal hernias usually do not reoccur in children. They do reappear, however, in about 10 percent of adults. Surgery is considered the only cure. The prognosis will be excellent if the patient does not seek medical help too late.
Hiatal hernias are treated successfully with medication and changes in diet about 85 percent of the time. The prognosis remains good even if surgery is required to repair the hernia.
PREVENTION
Some hernias can be prevented by following some simple rules, such as:
- Maintain a reasonable weight.
- Avoid heavy lifting.
- Follow a program of moderate exercise.
FOR MORE INFORMATION
Books
Delvin, David. Coping with a Hernia. Sterling, VA: Capital Books Inc., 1998.