This article is an over-view of hernias that occur in both males and females. But to explain the frequently used terminology and to clarity there is a difference between a hernia and a prolapse, a herniaoccurs when part of your “insides” bulges through an opening or weakness in the muscle or connective tissue that is supposed to keep organs in their proper place. Most hernias involve one of your abdominal organs pushing through one of the muscle walls of your abdominal cavity. Hernias can occur gradually as you get older with regular “wear and tear” during your lifetime causing the muscles to weaken or due a pre-existing opening in the muscles or connective tissue. They can also result from an injury, surgery or birth disorder. Common types of hernias include umbilical hernia, hiatal hernia, inguinal hernia, ventral hernia, incisional hernia, and femoral hernia.
A prolapse is specific – when a female pelvic organ (uterus, bladder or bowel) pushes down through the muscles of the pelvis and protrudes through the vagina or the anus. Another name for “prolapse” is called descensus or procidentia – meaning that the uterus has slipped from its usual position in the pelvis farther down into the vagina, causing the vaginal wall to bulge into or out of the vagina. A pelvic organ prolapseis aspecific“hernia” that only occurs in the female reproductive system. This condition is commonly described as a “falling” or “dropping” of the pelvic organs.
Overall, hernias are common, though some types are more common than others. Inguinal hernias affect around 25% of all men. Hiatal hernias affect around 20% of the population and 50% of those hernias affect those over age 50 years. Incisional hernias make up about 10% of hernias, and the other types of hernias make up the balance.
Common locations of a hernia are: (a) Inguinal hernia – the most common type, accounts for approximately 70% of all hernias. An inguinal hernia is a bulging of the contents of the bowel/abdomen through a weak area in the lower abdominal wall. They can occur at either of two inguinal canal passages through the lower abdominal wall, one on each side of the groin, that runs down into your inner thigh/groin area. (b) A femoral hernia – a less common type of groin hernia that occurs in the femoral canal, which runs underneath the inguinal canal – the inner upper part of the thigh/groin where fatty tissue may poke through. (c) A hiatal hernia – a common type of hernia that you acquire during your lifetime. It happens when there is an opening in your diaphragm (the muscle that separates the abdominal organs from entering into the chest cavity area) and your esophagus then passes through the ‘hole’ and/or the top of your stomach pushes up through this opening into your chest (the esophagus is the tube that transports food from your mouth to your stomach). The risk increases with age, obesity and smoking, (d) Incisional hernia – occurs when tissue protrudes through a former (surgical) incision in your abdominal wall that has weakened over time. It’s a common side effect of abdominal surgery. This occurs in up to 30% of patients who have had abdominal surgery. (e) Umbilical hernia – occurs when part of your intestine pokes through an opening in your abdominal wall near your “belly button.” Most umbilical hernias are congenital – present from birth, sort of waiting to happen at some time in your life, (f) Ventral hernia – occurs through the front wall of your abdomen. It includes umbilical hernias and incisional hernias. An “epigastric hernia” is also called a ventral hernia above the belly button. (g). Perineal hernia – occurs when organs or tissue push through an opening or weakness in your pelvic floor into your abdominal cavity. These hernias are relatively rare.
Not all hernias cause symptoms and different types (locations) of hernias may cause different symptoms. One telltale sign of a hernia is a visible lump or bulge that appears during certain activities or in certain physical positions and goes back in at other times. You may also feel pressure, a dull ache or pinching when the hernia comes out. It may come out when you’re straining, lifting, laughing or coughing. You may not feel it at all, or you may feel pressure, a dull ache or a sharp pain when the hernia comes through the opening. If you have frequent discomfort, you should see a healthcare provider right away. A hiatal hernia, in particular, may cause chronic acid flux – you may feel it as heartburn or indigestion, trouble swallowing, even chest pain.
For some hernias men and women may experience different symptoms – for men an inguinal/groin hernia can sometimes slip down into the scrotum increasing its size and causing pain. Femoral hernias occur more often in women and may cause invisible, unexplained groin pain. Women may not have a noticeable bulge, but that lack of a sign should not be dismissed/ignored but needs further investigation as this is a serious situation.
Hernias are caused by a combination of muscle weakness and strain. Depending on its cause, a hernia can develop quickly or over a long period of time. Some common causes of muscle weakness or strain that can lead to a hernia include: a congenital condition which occurs during development in the womb and is present from birth, aging, damage from an injury or surgery, strenuous exercise or lifting heavy weights, chronic coughing/COPD (chronic obstructive pulmonary disease), possibly especially having had multiple pregnancies, constipation which causes you to strain when having a bowel movement, being overweight/obese, or ascites – having cirrhosis of the liver with fluid buildup in the abdomen, cystic fibrosis, smoking leads to the weakening of connective tissue, or a personal or family history of hernias.
Some possible complications of a hernia not being identified/treated: (a) In most cases, complications begin when a hernia gets stuck and can’t move back in (incarceration/strangulation). An incarcerated hernia can become increasingly painful and serious. If it’s your bowel that’s stuck, your bowel may develop an obstruction that makes it unable to have a bowel movement or pass gas. If incarcerated tissue doesn’t have access to blood supply (strangulation), it can lead to tissue death (necrosis or gangrene). (b) Complications of diaphragmatic hernias are different. In general, organs that herniate through your diaphragm aren’t likely to get stuck. A hiatal hernia rarely causes complications, except for chronic acid reflux.
Hernia pain should not be ignored. It’s important to have a healthcare provider diagnose hernia pain, since many other conditions can be mistaken for a hernia. If your hernia changes color, goes numb, or causes symptoms like fever, nausea/vomiting, the bulge doesn’t reduce in size when you lie down and rest, you have worsening pain, difficulty having a bowel movement, bloating, or racing heart rate, seek medical help immediately.
A hernia is diagnosed by a visit with your doctor who does a physical exam and asks many questions about your symptoms, and possibly having an abdominal ultrasound or abdominal CT scan. If your doctor suspects a hiatal hernia, other tests may be ordered – an upper GI barium swallow x-ray and/or an endoscopy.
Once diagnosed you will work with your doctor as to its treatment. Most hernias are handled by repair surgery as they do not go away on their own.
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