Hernia Definition, Reason, Symptoms, Treatment & Prevention
Understanding
A Hernia is a lump in the body that occurs when the inside of the body presses on a weak part of the muscle or tissue around it. Hernias, or commonly known as hernias, usually appear in the area between the chest and hips.
Most cases of hernias are asymptomatic, or only minimal if they are present. The most common complaint is a lump in the stomach or groin. These lumps can be pressed or disappear when lying down. Coughing or straining can make these lumps appear.
There are several types of hernias that often occur, namely:
- Inguinal hernia
In an inguinal hernia, the intestine or bladder protrudes through the abdominal wall in the groin. More than 90% of hernias originate in this area. Men are more at risk of experiencing an inguinal hernia because there are parts that naturally tend to be weak.
- Femoral hernia
This hernia occurs when the intestine enters the channel through which the thigh blood vessels pass. Its position is slightly lower than the inguinal hernia. The lump that forms is smaller than an inguinal hernia. Femoral hernias are more common in women, especially women who are pregnant or obese.
- Umbilical hernia
In an umbilical hernia, part of the intestine penetrates the muscular wall of the stomach around the belly button. This condition usually occurs in newborns. In most cases, this hernia disappears before the baby is 1 year old. A new operation will be carried out if this lump persists until the age of over 5 years or the lump is very large.
- Incisional hernia
In an incisional hernia, the intestine penetrates the muscular wall of the stomach at the site of a previous operation. This type of hernia often occurs if the surgical wound does not heal completely, for example, if you have had an infection after surgery. Incisional hernias usually occur within 2 years after surgery and are often found in elderly or overweight people.
- Epigastric hernia
An epigastric hernia occurs when fatty tissue protrudes through the abdominal wall, which is located between the navel and the bottom of the breastbone. This type of hernia is more common in men than women.
- Hiatal hernia
A hiatal hernia is somewhat different from other types of hernias. In this type of hernia, the upper part of the stomach protrudes through the hiatus, an opening in the diaphragm.
Symptom
Most hernias enlarge over a long time. However, an umbilical hernia has its own characteristics. Most cases of umbilical hernia appear before the baby is 6 months old and will disappear by itself before the baby is 1 year old. Larger umbilical hernias may also disappear before age 3 or 4.
Symptoms of inguinal, femoral, umbilical, incisional, and epigastric hernias are almost the same, namely:
- There is a lump under the skin of the abdomen or groin that comes and goes. The lump will disappear when lying down and will appear when abdominal pressure increases due to coughing or straining.
- There may be pain when the lump is pressed.
- Discomfort in the stomach which is sometimes accompanied by constipation or blood in the stool.
- Discomfort in the abdomen or groin when lifting heavy objects, bending, straining or standing for a long time.
Symptoms of a hiatal hernia occur due to stomach acid rising into the esophagus, causing a burning feeling in the chest or heartburn.
In advanced stages, an incarcerated hernia may occur, in which the intestine protruding into the hernia sac cannot re-enter the abdominal cavity. If left unchecked, the trapped intestine can experience strangulation, in which blood flow to the trapped intestinal tissue is cut off. Trapped intestinal tissue will die and cause great pain. This condition requires immediate surgery.
Reason
Hernias occur due to pressure and holes or weakness in the muscles. This pressure will push the tissue through the hole or weak point. Muscle weakness may be present at birth, although it is more common later in life. Because of this, anything that increases pressure in the abdomen can cause a hernia, including:
- Lifting heavy objects
- Diarrhea or constipation
- Persistent cough or sneezing
In addition, being overweight, pregnant, undernourished, and smoking can weaken muscles so that a hernia is more likely to occur.
Diagnosis
Determining the presence of a hernia is not difficult. Generally, patients are aware of lumps in areas that are prone to hernias. This will be confirmed by the doctor through a physical examination.
The doctor will ask the patient to strain or cough while standing. This will make the lump easier to see or feel. If a lump cannot be found during a physical examination, the doctor will recommend further examinations in the form of a CT scan or abdominal ultrasound.
Treatment
Specific hernia treatment is surgery. However, not all hernias require surgery. Surgery is recommended for hernias that cause symptoms and are bothersome or getting bigger. The operation is generally performed by a general surgeon or digestive surgeon.
The success rate for hernia surgery is more than 95%, especially when using a laparoscopic technique. However, there is still a possibility that the hernia will recur. Therefore, before deciding to have surgery, first discuss with your doctor all the benefits and risks that come with it.
The surgical technique used depends on the type, size, and location of the hernia. The following are a selection of surgical techniques that are commonly performed:
- Suturing the weak part
- Using a mesh (mesh) to fix weaknesses
- Laparoscopic technique with a minimal skin incision
Hernias that experience incarceration or strangulation require immediate treatment. Usually, the doctor will try to massage the hernia back into the abdominal cavity. If it doesn’t work, surgery should be done immediately.
Umbilical hernias in infants are usually not operated on unless they persist until the age of 5 years, are very large, and cause symptoms or experience strangulation. This hernia may require surgery if the hole through which the hernia passes is more than 2 cm in diameter.
Hiatal hernias that do not cause symptoms of acid reflux do not need to be treated. If there are symptoms, drugs can be prescribed to reduce stomach acid. A new operation will be performed if the hiatal hernia is large and causes persistent symptoms, or if the hernia is trapped in the chest cavity.
Postoperative recovery
After surgery, patients can generally go home the same day or the day after surgery. The average patient can return to normal activities within three days. More strenuous physical activity such as new sports can be done within 2 weeks after surgery.
When to see a doctor?
If there is a lump that matches the characteristics of a hernia, immediately consult a doctor. The doctor will examine and if necessary will refer to the hospital for surgery.
If you have a hernia and one of the following symptoms, immediately go to the nearest hospital Emergency Unit (ER):
- Severe and sudden pain in the hernia
- Nausea and vomiting
- Difficulty defecating or passing wind
- The hernia becomes hard, painful to the touch, or cannot be pushed into the abdominal cavity