What is an Abdominal Hernia?

In general, a hernia refers to a condition that arises when an organ pushes through a weak
area in the muscles or tissue that surround and contain it.

An abdominal hernia occurs when there is a tear in the inner lining of the abdominal wall
(the outer layer of muscle, fat and tissue that extends from the bottom of the ribs to the
top of the thighs), causing a bulge in the abdominal wall where the organs protrude. The
bulge can be either reducible, which means that by applying slight pressure to the area,
you can feel the organs being pushed back into the abdominal cavity and the hernia will
flatten and disappear, or non reducible, which means the fat or tissue cannot be pushed
back into the abdomen and the hernia will not flatten. Whether a hernia is reducible
depends on how far it protrudes through the abdominal wall and how tightly it is held by
the abdominal muscles.

Hernias are repaired surgically with a simple surgical procedure. Without corrective
surgery the condition may lead to a strangulation. This is where the organ or intestine that
is protruding through the abdominal wall may have its blood supply cut and die if it
becomes tightly trapped. Strangulation of an intestine causes extreme pain, can block
digestion and may even cause gangrene in that area of intestine. In this case, emergency
surgical repair is required.

Who is at risk of Abdominal Hernia?

A hernia can develop in anyone, from a newborn baby to a senior citizen. The following
may increase risk of developing a hernia by straining or increasing pressure on the
abdominal wall:

A chronic cough, such as smoker's cough

Obesity

Straining during bowel movements or while urinating

Pregnancy

Straining to lift heavy objects

Persistent sneezing, such as that caused by allergies

Types of Abdominal Hernias

The following are different types of abdominal hernia:

Inguinal Hernia
When a male's testicles descend into the scrotum, this causes a naturally weakened area
in the wall of the abdomen, called the internal ring. This weakened area makes men more
susceptible to a hernia at this location. An indirect inguinal hernia is the most common
type of inguinal hernia. It occurs at the internal ring in the groin area. The intestine drops
down into the internal ring and can extend down into the scrotum in men or to the outer
folds of the vagina in women. An indirect inguinal hernia can be the result of an inherited
weakness at the internal ring or one that occurs later in life. The latter is known as an
acquired hernia.

Indirect Inguinal Hernia

Less common than an indirect inguinal hernia, a direct inguinal hernia occurs near the
internal ring instead of within it. They are acquired hernias that usually occur after age 40
as a result of aging or injury.

Epigastric Hernia
This type of hernia occurs as a result of a weakness in the muscles of the upper-middle
abdomen, above the navel. Men are about three times more likely to have an epigastric
hernia than women, and the majority occur in people between 20 and 50 years of age.

Umbilical Hernia
Another natural area of weakness in the abdomen is the navel, which, like the internal
ring, is made up of tissue that is thinner than that in the rest of the abdomen. These
hernias can occur in babies, children and adults.

Femoral Hernia
A femoral hernia occurs in the area between the abdomen and the thigh, and appears as a
bulge on the upper thigh. This type of hernia is more common in women than men.

Incisional Hernia
A type of hernia called incisional can occur at the site of an incision from a previous
surgery. The fat or tissue pushes through a weakness created by the surgical scar. An
incisional hernia can occur months or years after the initial surgery.
What are the Warning Signs?

A hernia usually first becomes noticeable as a bulge somewhere in the abdomen or pelvic
area or in the scrotum for men. If the bulge is reducible, it may enlarge when the person
is standing and become smaller when he or she lies down. The changes in the hernia's
size are due to the increased pressure on the abdominal wall caused by gravity when we
stand. A hernia may cause sharp or dull pain that worsens when having a bowel
movement, during urination, or while lifting a heavy object. The pain might worsen as
the day progresses, especially with long periods of standing, because of gravitational
pressure. Nonprescription drugs such as aspirin and acetaminophen may relieve minor
discomfort. In the case of a strangulated hernia that contains intestine, the herniated
section of intestine might become blocked. This blockage may cause blood in the stool,
constipation, fever, severe pain, vomiting and even shock. If these symptoms are
experienced, emergency medical attention is needed. Even with suspected hernias that do
not cause these symptoms, it is best to schedule an appointment with a doctor to avoid
these complications. The doctor will probably want to perform a physical examination
and discuss the patient's symptoms and medical history to determine if a hernia has
developed.

How are Hernias Treated?

Laparoscopic Hernia Repair Surgery
Hernia repair surgery is an effective long lasting treatment for hernias. Successful surgery
will end discomfort, repair the hernia, and stop the hernia from progressing.

The surgical procedure for hernia repair is a Laparoscopic procedure in which a fiber
optic viewing tube and special instruments are used to repair the hernia without making a
large incision. This procedure requires less recovery time than traditional hernia repair
surgery. The surgery will result in three small incisions, one is usually located in the
naval and one on each side of the tummy just above the waistline. The surgery will result
in scars about 10 mm in length. These scars will fade in time.

No Treatment
A patient always has the option of not undergoing treatment, but the hernia may become
worse and there is a risk of intestinal strangulation.

What can be Expected from Hernia Repair Surgery?

In preparation for the surgery, blood tests, an electrocardiogram (EKG), and/or a chest X-
ray may be undertaken depending on the age and fitness of the patient. The patient may
be required to stop medications before surgery, including aspirin, because they thin the
blood and reduce the post operative healing capacity also some drugs may have
dangerous interactions with anesthetics or increase the risk of abnormal bleeding.

The patient may be requested to stay a few days after surgery so that they may be
carefully evaluated and returned home in good health. After hernia repair surgery, time
should be allowed for rest and recovery at home.

General Anesthesia
Normally General Anesthesia is used. It is a safe, common method of ensuring that no
pain is felt while the hernia is repaired. There are some risks involved with general
anesthesia, especially if the patient has significant medical problems, which can factor
into the choice of anesthetic. These risks will be discussed with the patient. If a general
anesthetic is chosen, the patient should not eat or drink anything after midnight of the
night preceding the surgery.

During surgery, the surgeon will make an incision at the hernia and either move the
contents within the protruding hernia back into the abdominal cavity or remove the
contents, especially if the protrusion includes strangulated intestines. In order to repair
the hernia, the surgeon will insert a synthetic mesh behind the weekend abdominal wall.
In time the synthetic mesh will grow into the weakened tissue forming a strong barrier
preventing reoccurrence of the condition. The repair should be permanent and not require
any further surgery.

After surgery, the patient may receive fluids and pain-relieving medication through an
intravenous (IV) tube for a few hours.

Recovery time will depend on the health of the patient and the type of surgical repair that
was performed. The patient should be able to walk after 24 hours however several days
rest is needed as there will be some discomfort, swelling, brusing and pain. After a few
days once the patient is back at home, they may try to slowly ease back into normal
activities. Light activities can usually be resumed in a few days.

How soon the patient can return to work depends on the type of job that he or she has. A
job that is very physically demanding may require more recovery time before returning
than a job that does not require putting strain on the body. It is recommended that no
strain be put on the body for 6 - 8 weeks after surgery. Light exercise, such as walking,
helps increase blood flow and promotes healing.

Lifting should be avoided, but if it is absolutely necessary, only manageable objects

should be attempted and lifting should be done with the legs, not the back. Activities such
as driving and sex can also strain the incision. The patient should ask when these
activities can be resumed. Pain medications may be prescribed for the first few days at
home. A patient should never drive while taking pain medications.

A doctor should be notified immediately if any of the following symptoms are

experienced after the surgery:

Fever

Difficulty Urinating

Excessive Bleeding

Redness in the Area of the Incision

Excessive Tenderness or Swelling

Severe or Increasing Pain

How can a Hernia Recurrence be Prevented?

After a hernia has been treated there are certain things that can be done to decrease the
risk of recurrence. The following suggestions can help reduce the risk of a hernia
recurring:

Maintaining a healthy weight

Exercising to tone the muscles of the abdomen

Receiving medical help for chronic constipation, allergies or a chronic cough

Eating high-fiber foods

Avoiding the risk factors mentioned earlier