Inguinal hernia is a condition where a part of the intestine protrudes out of the abdomen through a tear in the abdominal wall. Inguinal hernias most commonly develop in the area between the abdomen and thighs, in the area of inguinal ring. Inguinal hernias affect people of all ages and are more common in men compared to women.
Inguinal hernias are of two types:
- Indirect inguinal hernias – Indirect inguinal hernia often affects premature infants and is caused because of non-closure of inguinal canal and is a congenital disorder
- Direct inguinal hernias – Direct inguinal hernia is common in adult males and is caused because of degeneration of tissues in abdominal muscles
Inguinal hernias cause discomfort and sharp pain which may be worsened with increased activity and relieved on rest. Patients may also experience burning or gurgling sensation at the site of hernia.
Femoral hernia appears as a bulge in the upper thigh, is a loop of intestine, or another part of the abdominal contents, that has been forced out of the abdomen through a channel called the “femoral canal”(a tube-shaped passage at the top of the front of the thigh). It most commonly develops in women due to the wider pelvic region and also in older people.
Femoral hernias may be congenital or develop later in life. Certain factors such as chronic constipation, obesity, and stressful urination because of enlarged prostate may increase the risk of hernias. Patients with femoral hernias may have a bulge in upper thigh area and may have symptoms such as abdominal pain, nausea and vomiting, and discomfort on standing or lifting heavy objects.
Normally, the stomach is completely below the diaphragm. In individuals with hiatus hernia part of the stomach slides through the diaphragm, the muscular sheet that separates the lungs and chest from the abdomen, and protrudes into chest cavity. Hiatal hernia is more common and affects people of all ages.
Hiatal hernias are of two types:
- Sliding hiatal hernia – The top portion of stomach slides up and down through the diaphragm with increased pressure on abdominal cavity
- Fixed Hiatal hernia – The top portion of stomach moves up into the chest cavity and does not slide down into normal position
Obesity, chronic cough, chronic constipation, smoking, and hereditary factors increases the risk of developing hiatal hernias. Hiatal hernia may not cause any symptoms but patients may experience chest pain, heartburn, belching, and hiccups.
It occurs through a scar of any previous surgical incision made in the abdomen and usually develops after many years of surgery. Incisional hernias are small and only the peritoneum or tissue layer lining the abdominal cavity protrudes out. Incisional hernias are more common in obese individuals and in pregnant women. Risk is more in those who had multiple surgeries earlier and those who perform activities that impart more stress of abdomen.
Patients may experience pain and discomfort and there is always a risk of recurrence.
Umbilical hernia is a small bulge around the umbilicus (belly button). An umbilical hernia in an infant is caused by the incomplete closure of the muscles around the Umbilicus. Smaller umbilical hernias often require no treatment and get closed by the age of 2 however larger umbilical hernias may necessitate the surgical treatment. Umbilical hernias may also develop later in life during pregnancy. Conditions such as mucopolysaccharide storage diseases, Beckwith Wieldemann syndrome, and Down syndrome may increase the risk of umbilical hernias.
The bulge in umbilical hernia will be soft and bulges may appear when the baby cries or sits up.
Recurrent hernias as the name implies recur at the same site of earlier hernia. Recurrence is more common in obese individuals and those who had multiple surgeries earlier. Recurrence is more common with incisional hernias because the risk factors such as obesity may persist and cause recurrence.
Surgery is the best approach for recurrent hernias however the difficulty or complications increase on subsequent repairs. Recurrent hernias can be repaired with open surgery or laparoscopic surgeries and the chances on infections are minimal with laparoscopic approach. Certain preventive measures such as treating chronic cough before treating hernias, avoiding smoking, avoiding strain on abdomen during bowel movement, and avoiding lifting of heavy objects may help in preventing recurrence.