The most common hernia is the inguinal hernia, which occurs in the groin, often as a result of lifting or straining. These hernias occur when a localised weakness in the abdominal wall allows the peritoneum (the lining of the abdomen) or some fatty tissue or a small length of intestine to protrude through a tear in the muscle wall. While an inguinal hernia can affect anyone, and occurs in 5% of the population, it is 25 times more likely to occur in men. Partly this is a reflection of male anatomy, and partly a reflection of the increased weight-bearing and heavy work done by men.
An inguinal hernia appears as a bulge in the lower abdominal wall near the groin. In it’s early stages the bulge will disappear when laying down, or when firmly pressed. The bulge will appear more prominent during coughing, straining or when standing up. Often there is discomfort or pain. Unless the hernia is surgically repaired, a piece of fatty tissue or a small piece of intestine can get caught inside the hernia, cutting off the blood supply and leading to strangulation and gangrene. A strangulated hernia is a medical emergency requiring surgery. For this reason patients with inguinal hernias are generally advised to have surgery after diagnosis.
Babies can develop a hernia known as an umbilical hernia. Occurring at the naval (bellybutton) these hernias are caused by an opening in the abdominal wall which usually closes at birth. At least half of these hernias will self-repair by the age of two years. Larger hernias may need surgery at 2-4 years of age.
Other abdominal hernias that occur less frequently are epigastric (from the upper central abdominal wall), femoral (just below the groin) and incisional (from a previous operation).
Prevention and treatment
1. Hiatus hernia
Hiatus hernia is a different type of hernia occurring internally in the chest area and affecting digestion. The oesophagus (which takes food from the mouth to the stomach) passes the diaphragm through the hiatus then passes into the stomach. It is the job of the hiatus to narrow the opening to the stomach, helping prevent food and acid from “refluxing” back up the oesophagus from the stomach. If the hiatus is weak it leads to reflux and “heart burn”. There are no outer signs of a hiatus hernia, and it is diagnosed through an x-ray or endoscopy. Treatment involves managing the symptoms although surgery can be undertaken laparoscopically these days.
2. Relief from hiatus hernia
Relief from hiatus hernia symptoms can be found with lifestyle and dietary management. Avoid eating and drinking for 2–3 hours before you lay down to sleep, and always have a light meal at dinner time. Avoid alcohol, coffee, spicy food and over eating. Elevate your bed head so that it is 3–4 inches higher than the foot of the bed, to limit reflux. Slippery Elm is a traditional naturopathic treatment for reflux, and can reduce symptoms of heartburn if taken regularly before eating. There are a variety of highly effective over-the-counter and prescribed medications to counter the effects of a hiatus hernia.
3. Pharmaceutical treatments for hiatus hernia
There are no drug treatments to actually “cure” a hiatus hernia, but a number of different medications can be used to offer relief from symptoms such as indigestion, pain and reflux. Antacids are used to neutralise the acid produced in the stomach, to help reduce heartburn. Other drugs called H2 blockers may be used to reduce the amount of acid produced in the stomach. There is also a drug that increases the tone of the muscle around the oesophagus and causes the stomach to empty more quickly, thus offering relief from hiatus hernia symptoms.
4. How to prevent an inguinal hernia
There is no surefire way to prevent a hernia – anyone can get one. However, maintaining a healthy weight and diet is important. Avoid constipation which can lead to straining. Regular abdominal strengthening exercises may help with inguinal hernia prevention. The chronic cough that often accompanies cigarette smoking may increase hernia risk or cause one to re-appear. Avoid lifting excessive weights, and always use correct lifting technique (straight back and bent knees) when lifting anything heavy.
Surgery is necessary to repair an inguinal or other abdominal hernia. Today’s surgical repair is effective and can be minimally invasive with the use of laparoscopic surgery, involving three tiny incisions each about the length of a thumbnail. Repair involves strengthening the weakened or torn muscle by sewing the muscle to a nearby ligament. A synthetic mesh is sewn into the weakened or torn area and then the body naturally forms scar tissue throughout the mesh, strengthening the area.
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