Went to the doctors yesterday, after having stomach cramps for a few days, so he gave me the usual prostate examination, checked my stomach (which I just thought was bloated) and he diagnosed an abdominal hernia.
So papers and forms were filled in, and I should be in surgery soon, at the Royal Blackburn hospital, Haslingden rd Blackburn, formerly Queens Park hospital.
So, what is a hernia ?
A hernia is an opening or weakness in the muscular structure of the wall of the abdomen. This defect causes a bulging of the abdominal wall. This bulging is usually more noticeable when the abdominal muscles are tightened, thereby increasing the pressure in the abdomen. Any activities that increase intra-abdominal pressure can worsen a hernia; examples of such activities are lifting, coughing, or even straining to have a bowel movement. Imagine a barrel with a hole in its side and a balloon that is blown up inside the barrel. Part of the inflated balloon would bulge out through the hole. The balloon going through the hole is like the tissues of the abdomen bulging through a hernia.
Types of hernia
Serious complications from a hernia result from the trapping of tissues in the hernia — a process called incarceration. Trapped or incarcerated tissues may have their blood supply cut off, leading to damage or death of the tissue. The treatment of an incarceration usually involves surgery.
Symptoms of a hernia include pain or discomfort and a localized swelling somewhere on the surface of the abdomen or in the groin area.
Epigastric, umbilical, incisional, lumbar, internal, and Spigelian hernias all occur at different sites over the abdomen in areas that are prone to anatomical or structural weakness. With the exception of internal hernias (within the abdomen), these hernias are commonly recognized as a lump or swelling and are often associated with pain or discomfort at the site. Internal hernias can be extremely difficult to diagnose until the intestine (bowel) has become trapped and obstructed because there is usually no external evidence of a lump.
A hernia repair requires surgery. There are several different procedures that can be used for fixing any specific type of hernia. In a standard repair, following appropriate anesthesia and sterilization of the surgical site, an incision is made over the area of the hernia and carried down carefully through the sequential tissue layers. The goal is to separate away all the normal tissue and define the margins of the hole or weakness.
Once this has been achieved, the hole is then closed, usually by some combination of suture and a plastic mesh. When a repair is done by suture alone, the edges of the defect are pulled together, much like sewing a hole together in a piece of cloth. One of the problems with this approach is that it can put excessive strain on the surrounding tissues through which the sutures are passed. Over time, with normal bodily exertion, this strain can lead to the tearing of these stressed tissues and the formation of another hernia. The frequency of such recurrent hernias, especially in the groin region, has led to the development of many different methods of suturing the deep tissue layers in an attempt to provide better results.
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A hernia happens when an internal part of the body, such as an organ, pushes through a weakness in the surrounding muscle or tissue wall.
A hiatus hernia occurs when part of your stomach pushes up into your chest (the stomach normally sits in your abdomen). It squeezes through an opening in the diaphragm, which is the large, thin sheet of muscle separating your chest from your abdomen.
The opening in your diaphragm is called the hiatus, and your oesophagus (the tube that carries food to your stomach) normally passes through this to reach your stomach.
What happens
At the base of the oesophagus is a ring-like muscle, called a sphincter, which closes the lower oesophagus. This muscle acts as a one-way valve, preventing stomach contents from flowing upwards into the oesophagus.
When part of your stomach pokes through the hiatus, it prevents the muscle from closing the lower end of the oesophagus.
A hiatus hernia can cause highly irritating stomach contents, such as acid, to move up into the oesophagus. This can cause heartburn and other problems, although in many cases a hiatus hernia causes no symptoms (see Symptoms, above).
If there are symptoms, antacid medicines and a change of lifestyle are the preferred treatments (see Treatment, above).
Who is affected?
Hiatus hernia can affect anyone, but it is more common in women and people who are over 50, overweight, pregnant or who smoke. It is estimated that a third of people over 50 have a hiatus hernia (see Causes, above).
There is a rare type of hiatus hernia that affects newborn babies.
Diagnosing Hernia
A hiatus hernia may be diagnosed using X-rays and diagnostic tests such as endoscopy (looking at the stomach via a fiberoptic tube), esophageal manometry (using a special instrument to measure your sphincter pressure), and tests to measure your esophageal acidity.
During a routine physical examination your doctor may discover an inguinal hernia. Your doctor will usually diagnose it by feeling the area of the internal inguinal ring, deep in the groin. If there’s a bulge in the area, then there’s a good possibility that it’s due to a hernia.
Treating and Preventing Hernia
General hernia prevention strategies include avoiding activities that cause abdominal strain (e.g., lifting heavy weights), and if you’re overweight, losing weight.
In 85% to 95% of hiatus hernia cases, treatment consists of relieving the accompanying heartburn with medication and modifying the diet. Losing weight is also recommended as a way to help relieve pressure. If you experience discomfort at night, it may help to sleep with the upper part of your body propped up on pillows or with the head of your bed raised. It is important not to eat for several hours before lying down, so that the stomach has time to empty. Standing straight rather than slouching is also a good idea. Surgery is uncommon and is reserved as a last resort for severe cases if medical and dietary management hasn’t helped.
If you have an inguinal or umbilical hernia, it is generally repaired by surgery that places the protruding mass back where it belongs and reinforces the weakened area by sewing the muscles together. This is a simple operation that is sometimes performed under local anesthetic.
It’s important to go for regular medical follow-up after surgery because of possible complications. Some surgeons recommend restricting exercise; however, most will encourage a speedy return to activities. Hospital stays of two or three days for surgery have been reduced in the last few years to a same-day discharge.
Laparoscopic hernia repair is done through a tiny incision and avoids the need for invasive open surgery. A television screen enables the surgeon to clearly see inside the person’s body. Studies have shown that this method of treatment promotes faster healing with less likelihood of recurrence.
Wearing a truss was sometimes used in the past to avoid surgery. It is no longer considered an acceptable form of treatment for hernias. In fact, it can even make your hernia worse by weakening tissues.
Paraesophageal hernias are generally treated with surgery.
Symptoms and Complications of Hernia
If you have a hiatus hernia, you usually don’t have any symptoms unless the sphincter muscles around the lower end of the esophagus become weak. When this occurs, the valve between the stomach and esophagus (gullet) won’t stay closed, and stomach acids will spill into the esophagus. As a result, you may experience heartburn, sharp pain, regurgitation, belching, and sometimes bleeding. At night, you may experience coughing, breathlessness, or a choking sensation.
Signs and symptoms of an inguinal (groin) hernia include discomfort while bending over or during lifting. You may feel a small egg-like lump in your groin that may become more prominent with certain activities such as coughing. It will usually not hurt at first and will disappear when you lie down. If the bulge persists and is accompanied by nausea and vomiting or abdominal pain, this can be a sign that the hernia has become obstructed or strangulated.
Although rare, an untreated hernia that strangulates may result in gangrene (death of tissue), which is a life-threatening condition and requires emergency surgical attention. Symptoms of strangulation include pain, swelling, discoloured bluish or red skin, vomiting, and an inability to urinate.
Children with strangulated inguinal hernias may have fever and vomiting and should be seen immediately by a doctor.
Inguinal hernias may not make themselves known until your abdominal wall is weakened after years of straining during bowel movements or from heavy coughing or lifting. Smokers are prone to such hernias. Physical exertion such as lifting may exacerbate a hernia by suddenly causing the weakened abdominal lining to give way.
Paraesophageal hernias usually have no symptoms, but if symptoms do occur, the most common are pain, indigestion, nausea, and retching.
There are several types of hernias:
* Hiatus or diaphragmatic hernias occur when a piece of your stomach protrudes into the diaphragm (the muscle that separates the chest region from the abdominal area) via the opening through which the esophagus (food tube) passes into the stomach. Approximately 10% of all Canadians and 30% of those over 60 years of age have hiatus hernias. Hernias may also occur in infancy because of a weakness in the abdominal wall. They occur in about 5% of full-term infants and up to 30% of premature babies.
* Inguinal or groin hernias occur when part of the abdominal contents (usually part of the intestine or a piece of bowel) protrudes into the groin area. They affect 3% to 8% of Canadians, and men are 10 times more likely than women to get them. They often occur after age 50 (on one side of the groin or both) and account for approximately 10% of all hospital admissions for surgery.
* Umbilical hernias are similar to inguinal hernias but are found in the area of the umbilicus (the navel or belly button area).
* Incisional hernias occur when a piece of intestine protrudes through a weakness in the abdominal wall in an area where surgery has been performed.
* Femoral hernias occur when a piece of intestine protrudes though the passage that is normally used by large blood vessels as they pass between the abdomen and leg.
* Paraesophageal hernias are very rare, but can be life threatening because in some cases they can cause the entire stomach to slip into the chest cavity.
Causes of Hernia
The cause of some hernias cannot be pinpointed, but many result from increased pressure within the abdomen, a weak spot in the abdominal wall, or a combination of the two.
In adults, hiatus hernias commonly develop in pregnant women and overweight people due to the increased pressure on the abdominal wall.
In men, an inguinal hernia will commonly develop in the groin, specifically in a region called the inguinal canal. This is where the spermatic cord and blood vessels to the testicles pass out of the abdominal cavity and into the scrotum. A weakness in the abdominal tissues at this point can allow a loop of bowel to pass out of the abdomen by following the path of the spermatic cord (indirect inguinal hernia) or between the opening into the inguinal canal and the pubic bone (direct inguinal hernia).
In women, inguinal hernias are rare, but can develop where the tissue that binds the uterus exits from the abdomen and joins with the tissue surrounding the vaginal opening.
Umbilical hernias may be present at birth. In adults, they may develop when there is a weakness in the tissue in the umbilical area combined with increased pressure on the abdominal wall.