A hernia is a medical term used to describe when an internal organ protrudes through body tissue and bulges under the skin. This happens due to muscle or wall weakness and can happen in many parts of the body, such as the bellybutton, abdomen, thigh, groin, or spine.
Inguinal hernias are one of the most common types of hernias. These occur when a portion of the intestine protrudes through the abdominal wall and becomes a visible small bump or swelling. They are usually located under the skin in the groin area.
When a hernia appears, it often needs to be treated. The treatment most commonly recommended for hernias is surgery with spinal anesthesia.
Hernia symptoms
Some of the symptoms that may indicate the presence of a hernia may include:
- Lump under the skin, in any region of the body;
- Swelling around the bump;
- Pain in the region, especially after exertion;
- Pain in the region when having a bowel movement or coughing.
In some cases, the hernia diagnosis can be made based on the symptoms and through local palpation in order to identify if there is any lump or bump under the skin. However, to confirm the diagnosis, the doctor may order an ultrasound.
If the herniated area swells, changes color, or the pain is severe, it is recommended that you go to the hospital immediately.
Most common types
A hernia is defined by its cause and where on the body it appears. The most common types of hernias include:
1. Inguinal hernia
An inguinal hernia is a bulge that appears in the groin and occurs when there is an opening or crack in the abdominal muscles. A portion of the intestine or another abdominal organ is able to bulge through this opening.
This type of hernia usually doesn't cause pain, but it can be seen as a small swelling in the groin. The bulge will either be persistently present or just appear with exertion. Inguinal hernias can happen in both men and women, but in men, the hernia can also affect the scrotum, causing pain or difficulty walking.
2. Herniated disc
Herniated discs affect the spine and occur in the intervertebral discs. These discs act as shock absorbers between the vertebrae of the spine but can become herniated due to many factors, like age-related degeneration, obesity, carrying excess weight or weakening of the abdominal muscles and of the back.
Symptoms of a herniated disc usually appear when the hernia is located in the lower back. Common symptoms include pain, tingling or numbness in the legs (which occurs because of nerve compression near the vertebra).
3. Hiatal hernia
A hiatal hernia, also called diaphragmatic hernia, occurs when a part of the stomach is able to bulge through the hiatus. The hiatus is a small opening in the diaphragm muscle, which is responsible for separating the chest from the abdomen.
When a hernia happens, a part of the stomach ends up going up through the hiatus and protrudes into the chest, causing symptoms that are similar to reflux (e.g. heartburn, belching, coughing and nausea).
4. Umbilical hernia
An umbilical hernia occurs when a portion of the intestines bulges through the abdominal muscle walls and into the bellybutton, causing a swelling in the navel region. This type of hernia is more common in babies or children and usually does not need specific treatment.
5. Femoral hernia
A femoral hernia happens when a portion of the intestine bulges through the abdominal muscle walls and protrudes into the upper thigh area. Symptoms associated with femoral hernias include abdominal pain, nausea, vomiting, or intestinal cramps.
6. Muscle hernia
Muscle hernias can appear in any muscle in the body, but are most common in the lower legs, between the knees and the ankle. This type of hernia is common in teenagers and young people who engage in intense physical activities.
7. Incisional hernia
An incisional hernia occurs inside the scar of an abdominal surgery, and can emerge months or years after the surgery. These usually do not cause any symptoms, just a small swelling or lump in the scar. However, the incisional hernia may enlarge over time, causing pain at the site. In these cases, surgery may be indicated.
Hernia causes
Hernias can have several causes, but the most common are:
- Lifting weights at the gym or at work;
- Carrying very heavy bags frequently;
- Excessive coughing;
- Intense physical effort;
- Excessive straining to pass stool;
- Having multiple pregnancies in a short period of time.
Hernias can appear at any age, but are more common in adults. In children, the most commonly occurring type of hernia is an umbilical hernia, which appears around 6 months of age and usually disappears on its own around 4 years of age.
Hernia symptoms
Some of the symptoms that may indicate the presence of a hernia may include:
- Lump under the skin, in any region of the body;
- Swelling around the bump;
- Pain in the region, especially after exertion;
- Pain in the region when having a bowel movement or coughing.
In some cases, the hernia diagnosis can be made based on the symptoms and through local palpation in order to identify if there is any lump or bump under the skin. However, to confirm the diagnosis, the doctor may order an ultrasound.
If the herniated area swells, changes color, or the pain is severe, it is recommended that you go to the hospital immediately.
Main treatments for hernias
Hernia treatments depend on the type of hernia. Some options include:
1. Surgery
Hernia surgery is the best treatment available, and consists of repositioning the organ back to its proper place, and, if necessary placing a protective mesh to prevent the hernia from coming back.
Surgery can be performed for the following types of hernias:
- Umbilical hernia in adults;
- Inguinal hernia;
- Femoral hernia;
- Muscle hernia;
- Incisional hernia;
- Herniated disc that does not improve with physical therapy.
For more severe cases of hiatal hernias that do not improve with medication, laparoscopic surgery can be performed.
It is ideal to have surgery as soon as the hernia is diagnosed to avoid complications, like organ strangulation (which occurs when the protruding organ has decreased blood flow and is at risk for dying).
2. Medication
Medication for hernias, particularly herniated discs, may include pain killers such as acetaminophen or prescription opioids for more severe pain.
Medications like omeprazole or esomeprazole can be prescribed for hiatal hernias that cause reflux-related symptoms like heartburn.
3. Watchful waiting
Watchful waiting is a conservative approach that is indicated for babies or children with umbilical hernias. This is recommended when specific treatment is not required and hernias are only assessed at follow-up appointments.
Treatment of muscle hernia also just require a more conservative approach, like rest or use of compression stockings prescribed by the doctor. In these cases, surgery is only indicated in cases of severe pain.
