Hernias

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Hernias

There are several types of hernia each with different symptoms. Depending on the type and location of your hernia, as well as your age, lifestyle and general state of health, you may be offered a range of different treatments.

It is vital with a hernia to not ignore the symptoms, as it is unlikely they will improve on their own, without treatment. These are the most common types of hernia.

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Groin (Inguinal) Hernia

An inguinal hernia occurs when the contents of the abdominal cavity  – such as part of the intestines, colon, bladder or fat – protrude through a weak area in the lower abdominal wall (groin).

The inguinal canal lies between the layers of the abdominal wall in the groin area, in men this is where the spermatic cord exits the abdomen to pass down into the scrotum, creating a weak area. An inguinal hernia s causes discomfort which usually limits physical activity and may lead to life threatening complications.

Symptoms include:

  • A bulge in your lower abdomen (groin) which becomes more pronounced when you stand up and goes away when you lie down
  • Burning and aching at the site of the bulge
  • Pain when coughing, bending or lifting
  • A heavy, dragging sensation in your groin accompanied by a feeling of weakness or pressure.

Complications can arise if:

  • A section of bowel becomes stuck in the inguinal canal (incarceration) causing nausea and vomiting
  • A section of bowel becomes trapped and its blood supply is cut off (strangulation). This requires emergency surgery.

Sometimes inguinal hernias develop without an apparent cause. Others can be due to:

  • Strenuous activity or straining to go to the toilet
  • Pregnancy
  • Chronic coughing or sneezing.

You are at risk:

  • If you are born with a weakness in your inguinal canal (lower abdominal wall)
  • As you age and muscles weaken
  • If you participate in strenuous activity
  • If you have a chronic cough
  • In men, at the point where the spermatic cord exits the abdomen (inguinal canal) to pass down into the scrotum. Men are eight times more likely to develop an inguinal hernia than women
  • In women at the same point, when the abdominal wall becomes weakened for example after pregnancy
  • If you are constipated and strain to pass stools
  • If you have an inherited soft tissue weakness.

Surgery is required  to repair the weakness in the abdominal wall.

The operation is performed open with an incision made directly over the hernia or laparascopically (keyhole) with 3 much smaller incisions in the lower abdomen. The repaired weakness is always reinforced with a mesh to significantly reduce the probability of the hernia reoccurring.

Keep a note of when your symptoms worsen – for example, after eating certain foods or at night. Wear loose fitting underwear and avoid repeated vigorous wiping. You can talk to your GP about how to prevent some of the symptoms.

Learn more about Hernia surgery

Groin Strain

A groin strain is an injury to the adductor muscles of the thigh (the inner thigh muscles). They are not usually serious although they may take a long time to recover from.

Symptoms can range from mild to severe and might include:

  • Pain – normally in the inner thigh but also from the hip to the knee
  • Weakness in the upper leg
  • Difficulty walking
  • Swelling and bruising.

Groin strains occur most commonly in athletes, for example when kicking, jumping or twisting to change direction while running or skating. They can also occur as a result of falling, lifting heavy objects or resistance training. You may hear a snapping sound when the injury occurs.

  • Athletes who play sport that involves kicking, jumping and turning suddenly while running (footballers, rugby players, skaters, martial arts practitioners)
  • Sports people returning to training after the offseason
  • Anyone with restriction motion in the hip joint
  • Anyone who has previously had a groin strain.

The best treatment for a groin strain is rest to allow the muscles to heal fully. Avoid anything that cause pain and resume activities gradually.

It is important to stretch and strengthen your adductor muscles and warm up properly before a training session. Continue some form of training throughout the year if possible and, if you take a break, build back up gradually. If you injure yourself allow your muscle to heal fully to prevent recurrent groin strain.

Umbilical Hernia

An umbilical hernia occurs when part of the bowel or fatty tissue protrudes through a weak area in the abdominal wall close to the belly button. They are not normally painful but when larger can lead to serious complications. In adults they are more common among women. In infants, the risk is the same for boys and girls.

The symptoms include:

  • A lump in the navel that tends to get smaller when lying down
  • It tends to be painless in children but adults may experience pain or discomfort.

An umbilical hernia in adults typically occurs when too much pressure is put on a weak section of the abdominal muscles.

  • Newborn babies born preterm and infants. Up to 75% of newborns weighing less than 1.5kgs at birth have an umbilical hernia
  • Children and adults who are obese
  • Anyone with a persistent cough
  • Anyone who lifts heavy objects
  • Women who have multiple pregnancies.

In infants hernias often close without treatment by the age of 12 months.

Surgery is usually  necessary if there are symptoms and in the larger hernias in adults to avoid the risk of complications, such as the intestine getting trapped in the hernia. Open surgery is usually performed  repairing the hernia is repaired with a mesh and the outer layer of the abdominal wall is stitched back together.

  • Losing weight to avoid putting too much pressure on the abdominal muscles
  • Avoid straining with constipation
  • Avoiding lifting heavy objects which can strain the muscles.

Find out about the consultants that will be looking after you, and their expertise in bowel and hernia diagnosis and treatment

Incisional Hernia

An incisional hernia develops at the site of a previously made incision in the abdominal wall causing a weak area, for example where there is a scar from a caesarean section or appendisectomy.

At the end of an abdominal surgical procedure the layers of the abdominal wall are closed with stitches. If the tissues are weak or are put under a lot of pressure they can fail to heal properly or can come apart with time.

If this happens, an incisional hernia can occur. Around 12-15% of abdominal surgery results in an incisional hernia. They can be very difficult to repair with a high incidence (50-60%) of recurrence.

Anyone who has had abdominal surgery is at risk. Factors such as your age, obesity, diabetes, smoking, the number of previous abdominal incisions and if an infection occurred in a healing wound  can increase your susceptibility.

The overall risk may be such that it is better not to operate on an incisional hernia, especially if it is large and the patient has a number of risk factors.

Incisional hernias require urgent surgery if the abdominal contents such as the intestine are trapped in the hernia weakness causing strangulation when the blood supply is cut off. Surgery to repair an incisional hernia is usually performed open with a mesh to reinforce the abdominal wall, this is usually a synthetic (woven nylon) mesh as it is strong but if there is a risk of infection a biologic mesh (animal collagen) may be recommended . It may be appropriate to consider repairing small incisional hernias laparascopically (keyhole surgery).

Larger incisional hernias present a surgical challenge and to facilitate the best outcome for the patient should be discussed in a specialist multidisciplinary forum to determine which patient factors should be modified, which surgical technique and mesh should be used to minimise risk.

If you have  abdominal surgery, you can take steps to prevent yourself from developing an incisional hernia:

  • Stop smoking and if you are obese lose weight before surgery
  • Keep the wound clean – developing a wound infection can increase your risk of hernia
  • In the first few weeks after surgery support the area if coughing or straining, a surgical support may be advisable. Avoid activities that could put pressure on the wound and do not overexert yourself
  • Treat constipation so you do not strain when you pass stools.

Para-stomal Hernia

Para-stomal hernias often develop at the site of a stoma They are not normally painful but they can be uncomfortable and inconvenient, making it difficult to attach a stoma appliance  properly, which can result in leakage. Rarely part of the intestine can become trapped or kinked within the hernia and may become strangulated. This is extremely painful and requires emergency surgery.

A stoma site creates an  opening in the abdominal wall, which increases in size over time , creating a para-stomal hernia.

Anyone who has a stoma is at risk.

Sometimes the risk of surgery means that it is better not to treat a para-stomal hernia, for example in someone who is elderly or frail.

If surgery is being considered a CT scan should be performed and discussed in a specialist multidisciplinary forum to determine which patient factors should be modified, which surgical technique and mesh should be used to minimise risk.

There are a range of surgical techniques which reflects the variety of para-stomal hernias and the high probability of recurrence after surgery.

Lose weight if you are obese.

Seek advice from a stoma nurse about a para-stomal support.

Learn more about Hernia surgery

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