Hernia

A hernia occurs when part of an organ (or other tissue) pushes through an opening or weak spot in the muscle or connective tissue.  If you’ve been diagnosed with a hernia or you’re experiencing related symptoms, it’s important to be checked by a specialist who can determine the best treatment plan for your specific condition.

The specialty trained general surgeons affiliated with Memorial Hermann are here for you, to provide specialized care, guidance and the treatment necessary to help you get back to a pain-free life.

There are various types of hernias that can occur in different parts of the body, each with specific causes, symptoms and treatments. The most common are listed below.

Inguinal Hernia

Occurring up to eight times more often in men than women, an inguinal hernia is the most common type of hernia, and occurs when the intestines push through a weak spot or tear in the lower abdominal wall near the groin.

In men, this is usually the result of a birth defect when, before birth, the testicles descend and leave an opening in the muscle wall, which normally closes before birth. If this opening does not close properly, a hole remains that can allow tissue to push through.

Inguinal Hernias Causes and Risk Factors

Some inguinal hernias have no apparent cause. Others may occur as a result of:

• Failure of the abdominal wall to close properly in the womb
• Increased abdominal pressure
• A weakness in the muscles of the abdominal wall
• Excessive strain from bowel movements or urination
• Strenuous activity
• Chronic coughing or sneezing
• Pregnancy

Other factors that can increase the risk of developing an inguinal hernia include:

• Ethnicity (Caucasians are at higher risk)
• Age (muscles weaken as you get older)
• Obesity
• Lifting heavy weights
• Family history of inguinal hernia
• Chronic cough
• Chronic constipation (straining during bowel movements)
• Pregnancy (can weaken the abdominal muscles and increase abdominal pressure)
• Prior hernia or hernia repair

Inguinal Hernias Symptoms

The most common symptoms of inguinal hernia include:

• An abnormal bulge or protrusion in the groin area
• Burning or sharp pain in the lower abdomen, especially when bending over, lifting objects or coughing

Diagnosing Inguinal Hernias

Inguinal hernias are usually diagnosed with a physical examination. A doctor will check for a bulge in the groin area and may ask you to stand, cough or flex your abdominal muscles. In certain cases, imaging tests such as an abdominal ultrasound, CT scan, or MRI may be required.

Potential Complications with Inguinal Hernias

An inguinal hernia may become incarcerated, meaning the contents of the hernia can get trapped in the abdominal wall. This can obstruct the bowel and potentially cause vomiting, nausea and pain and possibly affect bowel tissue. This condition can be life-threatening and requires immediate medical attention – and likely surgery.

If you notice your hernia bulge turns a dark color like red or purple, or if you develop nausea, vomiting or fever, seek immediate emergency care.

Femoral Hernia

Femoral hernias occur more often in women than men, and closer to the groin area than an inguinal hernia. Because of their location, femoral hernias are usually painful and can often lead to strangulation of tissue in the groin area, requiring immediate surgery.

Umbilical Hernia

Umbilical hernias are located around the navel. They most often occur in infants, but can also occur in adults, especially in pregnant or overweight patients. Umbilical hernias in infants can close by themselves; however, they do not self-correct in adults and typically require surgical repair. If left untreated, the herniated tissue can become trapped, resulting in a medical emergency.

Incisional/Ventral Hernia

Incisional or ventral hernias occur in the belly or abdomen as a result of prior abdominal surgery. They are more frequent in people who are older, overweight and have had multiple operations using the same incision. This type of hernia is quite painful and requires medical attention.

Epigastric Hernia

Epigastric hernias are lumps or bulges that occur in the upper part of the abdominal wall, between the navel and the breastbone. Epigastric hernias can occur in men, women and children.

Like umbilical hernias, epigastric hernias can be present in infants when they are born and will sometimes self-heal as the abdominal wall strengthens. Epigastric hernias in adults will not self-heal and require surgical repair. As with other types of hernias, if left untreated, epigastric hernias can result in the herniated tissue becoming trapped, requiring emergency surgery.

Hiatal Hernia

Unlike the hernias described above, which occur when the intestine protrudes through the abdominal wall, hiatal hernias occur when the stomach protrudes thorough the diaphragm into the chest. The exact cause of hiatal hernias is unknown. They are mostly caused by weakening of the muscles of the diaphragm around the esophagus. Other causes that increase the intra-abdominal pressure such as pregnancy will contribute to the formation of hiatal hernias.

Types of Hiatal Hernias

• Type I hiatal hernia is the most common type. It is also called a sliding hiatal hernia. This type accounts for about 95% of all cases. In this type of hernia, the gastroesophageal junction is herniated into the chest cavity.
• Type II hiatal hernia is also called a paraesophageal hiatal hernia, in which the stomach herniates through the diaphragmatic esophageal hiatus alongside the esophagus. In the type II or "pure" paraesophageal hernia, the gastroesophageal junction remains below the hiatus and the stomach rotates in front of the esophagus and herniates into the chest. If more than 30% of the stomach herniates into the chest, the condition is also called a giant paraesophageal hernia.
  "Pure" type II paraesophageal hernia seldom occurs. Paraesophageal hiatal hernias make up less than 5% of all cases, but account for most of the complications.hiatal hernia - Type 2.
• Type III hiatal hernias are combined hernias in which the gastroesophageal junction is herniated above the diaphragm and the stomach is herniated alongside the esophagus. The majority of paraesophageal hernias are type III.
• With type IV hiatal hernias other organs in addition to the stomach (colon, small intestine, and spleen) also herniate into the chest.

Symptoms of Hiatal Hernias

The most common symptoms associated with hiatal hernias are:

• Heartburn: Symptomatic patients with hiatal hernia present with reflux disease and complain of heartburn, mostly after eating or at night. About 80% of patients with a paraesophageal hiatal hernia (type II hiatal hernia) have heartburn and have an increased amount of acid detected on pH monitoring (studies that detect acid in the esophagus).
• Regurgitation: Foods can remain in the hiatal hernia and return back into the mouth. Type II and Type III hiatal hernia can result in mechanical obstruction of the lower part of the esophagus, causing regurgitation of the food into the mouth after eating. This can be associated with a bitter taste in the mouth in patients with reflux disease.
• Dysphagia (difficulty swallowing): Hiatal hernias can cause obstruction and delay in emptying of the lower part of the esophagus and the stomach, resulting in dysphagia.
• Chest pain: The chest pain commonly occurs postprandially (after eating) and is substernal (behind the breast bone) in location, giving rise to concern that the chest pain is cardiac in origin.
• Anemia: Anemia is the most common laboratory finding in patients with paraesophageal (type II) hiatal hernia, and results from damage and ulceration to the lining of the stomach due to compression of the stomach at the level of esophageal hiatus (see image below).
• Chronic cough: Chronic cough is caused by aspiration of acid particles in the airway. It is also known that the presence of acid in the esophagus can cause a reflex phenomenon in the airway and cause cough.

This can cause chronic or recurring heartburn, and can lead to erosion of the esophagus. Treatment options include surgery, diet changes and/or medication.

Hernias that become enlarged or painful usually require surgery. Depending on your condition, your surgeon may perform either a laparoscopic hernia repair or an open hernia repair.

Laparoscopic Surgery

Laparoscopic surgery (sometimes referred to as a keyhole surgery) is a minimally invasive procedure performed under general anesthesia. During laparoscopic surgery, a few small incisions are made and a tiny camera (laparoscope) is used to view inside your body while the hernia is repaired.

Laparoscopic hernia repair results in fewer complications, smaller scars and a shorter recovery time than open surgery.

Open Surgery

Depending on a number of factors, your surgeon may determine that open surgery is the best option. Open surgery uses suturing or the placement of a synthetic mesh over your hernia (in one of the layers of the abdominal wall) to successfully repair the condition.

Hernia Revision Surgery

While uncommon, some patients can develop another hernia at the original site of the repair. Whether this is caused by an infection at the surgical site, weakening of the tissue due to surgery or an improper hernia repair, revision surgery is necessary to repair this condition.

Symptoms of a hernia repair failure are similar to those of the original hernia: abnormal bulging, pain and a darkening of tissue.

You can help avoid the need for hernia revision surgery, if you maintain a healthy lifestyle, avoid excessive weight gain and prevent constipation by drinking plenty of water.

Don't let a hernia hold you back any longer. Take the first step towards relief and get a physician referral today.