Hernia: Protrusion or projection of an organ or a part of an organ through the well of the cavity that normally contains it is called hernia.
Different sites of hernia:
[A] External hernia:
- Inguinal hernia.
- Femoral hernia.
- Umbilical hernia.
- Paraumbilical hernia.
- Epigastric hernia.
- Incisional hernia.
- Obturator hernia.
- Lumber hernia.
- Gluteal hernia.
- Sciatic hernia.
- Perineal hernia.
[B] Internal hernia:
- Hiatus hernia.
- Tentorial hernia and
- Lung hernia
Differences between direct & indirect inguinal hernia:
|Age of onset||Usually in elderly person||Any age common in infants, children and young adults.|
|Sex||Relatively rare in female||Commonly male but female may suffer.|
|Entrance||Through the floor of the Hasselbach’s triangle.||Through the deep inguinal ring.|
|Exit||Rarely through the superficial inguinal ring.||May be through the superficial inguinal ring.|
|Extent||Usually incomplete||Incomplete/ Complete|
|Relation to inferior epigastric vessels||It lies lateral to the neck. Expception: Saddle bag or pantaloon type, which has both lateral & medial components.||It lies close to the medial side of the neck of sac.|
|Shape||Globular and broad base above.||Piriform with narrow end above and broad base below.|
|Reducibility||Reduces spontaneously||Gradually reduce|
|Deep ring occlusion test||Negative||Positive|
|Obstruction & strangulaiton||Rare||Common|
|Invaginaiton test||Impulse is felt on the pulp of the finger.||Impulse is felt on the tip of the finger.|
Common Hernia Types
Inguinal hernias are the most common type of hernia. They make up about 70 percent of all hernias, according to the British Hernia Centre (BHC). These hernias occur when the intestines push through a weak spot or tear in the lower abdominal wall, often in the inguinal canal.
The inguinal canal is found in your groin. In men, it is the area where the spermatic cord passes from the abdomen to the scrotum. This cord holds up the testicles. In women, the inguinal canal contains a ligament that helps hold the uterus in place.
This type of hernia is more common in men than in women. This is because a man’s testicles descend through the inguinal canal shortly after birth, and the canal is supposed to close almost completely behind them. Sometimes, the canal does not close properly and leaves a weakened area prone to hernias.
A hiatal hernia occurs when part of your stomach protrudes up through the diaphragm into your chest. The diaphragm is a sheet of muscle that helps you breathe by contracting and drawing air into the lungs. It separates the organs in your abdomen from those in your chest.
This type of hernia is most common in patients over 50 years old. If a child has the condition, it’s typically caused by a congenital (birth) defect. Hiatal hernias almost always cause gastroesophageal reflux, which is when the stomach contents leak backward into the esophagus, causing a burning sensation.
Umbilical hernias can occur in children and babies under 6 months old. This happens when their intestines bulge through their abdominal wall near their bellybutton. You may notice a bulge in or near your child’s bellybutton, especially when they’re crying.
An umbilical hernia is the only kind that often goes away on its own, typically by the time the child is 1 year old. If the hernia has not gone away by this point, surgery may be used to correct it.
Incisional hernias can occur after you’ve had abdominal surgery. Your intestines may push through the incision scar or the surrounding, weakened tissue.
What Causes a Hernia?
Hernias are caused by a combination of muscle weakness and strain. Depending on its cause, a hernia can develop quickly or over a long period of time.
Common causes of muscle weakness include:
- failure of the abdominal wall to close properly in the womb, which is a congenital defect
- chronic coughing
- damage from injury or surgery
- Factors that strain your body and may cause a hernia, especially if your muscles are weak, include:
- being pregnant, which puts pressure on your abdomen)
- being constipated, which causes you to strain when having a bowel movement
- heavy weight lifting
- fluid in the abdomen, or ascites
- suddenly gaining weight
- persistent coughing or sneezing
The most common symptom of a hernia is a bulge or lump in the affected area. In the case of an inguinal hernia, you may notice a lump on either side of your pubic bone where your groin and thigh meet. You’re more likely to feel your hernia through touch when you’re standing up.
If your baby has a hernia, you may only be able to feel the bulge when he or she is crying. A bulge is typically the only symptom of an umbilical hernia.
Other common symptoms of an inguinal hernia include:
- pain or discomfort in the affected area (usually the lower abdomen), especially when bending over, coughing, or lifting
- weakness, pressure, or a feeling of heaviness in the abdomen
- a burning, gurgling, or aching sensation at the site of the bulge
- Other symptoms of a hiatal hernia include:
- acid reflux, which is when stomach acid moves backward into the esophagus causing a burning sensation
- chest pain
- difficulty swallowing
- In some cases, hernias have no symptoms. You may not know you have a hernia unless it shows up during a routine physical or a medical exam for an unrelated problem.
Preventing a Hernia
You can’t always prevent the muscle weakness that allows a hernia to occur. However, you can reduce the amount of strain you place on your body. This may help you avoid a hernia or keep an existing hernia from getting worse. Prevention tips include:
- not smoking
- seeing your doctor when you’re sick to avoid developing a persistent cough
- maintaining a healthy body weight
- avoiding straining during bowel movements or urination
- lifting objects with your knees and not your back
- avoiding lifting weights that are too heavy for you