Hernia: types, symptoms, when it is an emergency and repair, a review

A hernia is a lump or bulge that appears when something inside the body pushes through a weak spot. Many hernias are not dangerous at first, but some can become emergencies. This article explains the types, symptoms, treatment and warning signs, using information from the NHS, NIDDK and MedlinePlus.

1. Introduction

The NHS explains that a hernia happens when part of an internal organ, such as the bowel, pushes through a weak area or gap in the muscle that holds organs in place. Most develop in the abdomen (belly) or groin. Some cause a lump you can see, while others are inside and cannot be seen ^[1]. MedlinePlus says most hernias are in the abdomen and they affect men, women and children ^[3].

The NHS and MedlinePlus list types of hernia including ^{[1, 3]}:

• Inguinal hernia, in the groin, where the leg meets the belly. MedlinePlus says this is the most common type (the NHS also lists lumbar and stoma hernias)
• Femoral hernia, in the upper thigh near the groin
• Umbilical hernia, under or near the belly button
• Hiatus (hiatal) hernia, where the upper stomach moves up into the chest through a small opening in the diaphragm, the muscle used for breathing
• Incisional hernia, through the scar of an earlier operation

2. Causes and risk factors

MedlinePlus says hernias come from a mix of muscle weakness and strain, and heavy lifting might contribute. Some people are born with weaker belly muscles ^[3]. NIDDK describes two kinds of inguinal hernia. Indirect hernias are linked to an opening in the belly wall that is present before birth and normally closes but sometimes stays open, so a hernia may not show until years later. Direct hernias come from a weak area in the groin wall that develops later in life, mainly in men ^[2].

NIDDK lists these risk factors for inguinal hernia: older age, male sex (men are 8 to 10 times more likely than women), a previous prostate operation, family history, a lower body mass index and connective tissue disorders. Researchers are also studying chronic cough, long-term constipation, heavy lifting and long hours on the feet ^[2]. The same source estimates that about 27 percent of men and 3 percent of women will develop an inguinal hernia in their lifetime ^[2].

3. Signs and symptoms

The NHS describes these symptoms ^[1]:

• A bulge or lump that may get bigger when you cough, sneeze or cry and smaller when you lie down
• Tight, stretched skin over the lump
• A heavy or dragging feeling in the leg, with groin hernias
• Heartburn or acid reflux, with a hiatus hernia
• Pain, which is usually found with smaller hernias, although a large hernia may not hurt

NIDDK adds that groin hernias can cause discomfort, heaviness or burning, which often get worse with straining, lifting, coughing or standing for a long time and improve with rest. A bulge in the scrotum can occur in males ^[2].

4. Diagnosis

A doctor takes a history and examines you, and may ask you to stand, cough or strain so that the bulge can be seen or felt ^[2]. If the diagnosis is unclear, an ultrasound, CT or MRI scan can help, and scans can also look for complications ^[2]. The NHS says a GP may refer you for tests or treatment ^[1].

5. Treatment

The NHS says some hernias improve on their own, while others need surgery. The right treatment depends on the type, the cause and whether it is new or has come back. Weight loss may be advised for people who are overweight, and medicines may help the indigestion of a hiatus hernia ^[1]. MedlinePlus says treatment is usually surgery to repair the weak area ^[3].

For inguinal hernia, NIDDK describes two kinds of repair ^[2]:

• Open repair, through a cut in the groin, using mesh or stitches alone. This is usually done with local anaesthetic and sedation, and sometimes with general anaesthetic or a spinal block.
• Laparoscopic (keyhole) repair, through several small cuts in the belly with mesh, usually under general anaesthetic. Recovery may be shorter than with open repair.

NIDDK also says men with few or no symptoms may safely delay surgery with regular check-ups, but about 70 percent of them develop symptoms or need surgery within 5 years ^[2]. Your surgeon will explain which choice suits you.

6. Recovery and risks of surgery

NIDDK says pain after groin hernia repair is usually mild and settles in about 2 weeks, and many people return to work and daily activities within 3 to 5 days. Possible problems include trouble passing urine, infection, a collection of blood or fluid at the site, long-lasting pain and the hernia coming back. Serious problems such as damage to blood vessels or organs are rare ^[2]. Call your doctor promptly for bleeding, drainage or redness at the wound, fever or chills, vomiting, worsening pain or swelling, or problems passing urine ^[2].

7. Prevention and self-care

The NHS says hernias cannot always be prevented, but you can lower the risk of some types by keeping a healthy weight, being active, stopping smoking and seeing a GP about a cough that does not go away. The page suggests 150 minutes of moderate or 75 minutes of vigorous activity each week ^[1].

8. When to see a doctor

See a GP if you think you have a hernia ^[1]. A hernia that is stuck (incarcerated) cannot be pushed back in. A strangulated hernia has its blood supply cut off, which can kill tissue, and NIDDK calls this life-threatening ^[2]. Seek help straight away for a bulge that suddenly grows or will not go back in, sudden or severe pain, redness over the hernia, fever, or signs of a blocked bowel such as belly pain, bloating, nausea and vomiting ^{[1, 2]}. The NHS also lists vomiting blood or "coffee grounds", constipation and sudden confusion ^[1].

In an emergency, call your local emergency number (112 in India, 911 in the United States).

9. Conclusion

A hernia is a weak spot in the muscle wall that lets tissue push through. Many are manageable, and repair surgery is the usual treatment when symptoms or complications appear. Learn the emergency signs of a stuck or strangulated hernia, and see a doctor early about any new lump.