About Hernia

Hernias affect 15%–20% of the global population. In India, 1.5 to 2 million cases of inguinal hernia are reported, with men being far more susceptible than women. In fact, 90% of all inguinal hernia procedures are performed on men, while women account for 70% of femoral hernia surgeries. Men face a lifetime risk of 27% for inguinal hernias, compared to just 3% in women. Although femoral hernias are more frequent among women, inguinal hernias still occur five times more often in them. Umbilical hernias are more common in infants.

What Is a Hernia?

A hernia occurs when an internal organ or tissue pushes through a weak spot in the surrounding muscle or connective tissue. Common types include inguinal, femoral, umbilical, hiatal, and incisional hernias. They often result from factors like heavy lifting, obesity, pregnancy, chronic coughing, or previous surgeries. Hernias can be uncomfortable and are often visible as a bulge.

Types of Hernia

Hernias come in various forms. The most prevalent types include:

• Inguinal Hernia: The most frequently occurring hernia, making up 75% of all hernia cases according to Western data. Here, the intestine pushes through a weakened abdominal wall near the groin. This can be caused by ageing, heavy lifting, persistent coughing, prior surgeries, or injuries.
  • Direct Inguinal Hernia
  • Indirect Inguinal Hernia
• Hiatal Hernia: Occurs when part of the stomach pushes upward through the diaphragm’s opening.
• Umbilical Hernia: Appears near the navel when a section of the intestine bulges out. Often seen in infants and women with multiple pregnancies.
• Femoral Hernia: Typically affects the upper thigh, more commonly in overweight or pregnant women.
• Obturator Hernia: A rare pelvic floor hernia not visible externally. More frequent in women who’ve experienced significant weight loss or multiple pregnancies.
• Other Hernias:
  • Spigelian Hernia: Protrusion through abdominal wall layers.
  • Diastasis Recti: Abdominal muscle separation.
  • Incisional Hernia: Emerges at surgical incision sites.
  • Diaphragmatic Hernia: When abdominal organs push through the diaphragm.

Hernias can be either acquired (developing post-birth) or congenital (present at birth).

Signs & Symptoms of Hernia

Common symptoms include:

• Pain or discomfort when lifting or standing
• Visible bulge that becomes more noticeable when coughing or straining
• Pressure or weakness in the groin
• Nausea, vomiting, or constipation in strangulated cases
• Tenderness and swelling under the skin

Some hernia types (e.g., hiatal or diaphragmatic) may present with unique or less obvious symptoms.

Causes of Hernia

Several factors can contribute to hernia formation:

• Heavy physical activity or jobs involving lifting
• Long-term constipation or chronic coughing
• Excess body weight
• Multiple pregnancies
• Birth defects such as undescended testicles or premature delivery
• Poor nutrition and smoking
• Surgical history in the abdomen or groin

Risk Factors of Hernia

Risk of Hernia increases with:

• Age (muscles weaken over time)
• Male gender (especially for inguinal types)
• Genetic predisposition
• Obesity
• Persistent coughing or constipation
• Pregnancy
• Premature birth
• Previous abdominal surgeries
• Conditions like cystic fibrosis or liver cirrhosis
• Abdominal distension
• Prostatectomy history in men
• Long-term dialysis

Complications of Hernia

Untreated hernias can lead to:

• Strangulation: Cut-off blood flow causing tissue death
• Incarceration: Entrapped hernia content causing severe symptoms
• Bowel obstruction: Intestinal block leading to digestive issues
• Pain and enlargement: Swelling and downward pressure, especially in men
• Infections: From lack of blood supply

Diagnosis of Hernia

Diagnostic tools include:

• Physical exam and detailed patient history
• Blood work
• Imaging: Barium X-ray, USG, CT, MRI
• Endoscopy

Hernia Treatment Options

Depending on the hernia type and severity, treatment may include:

Non-Surgical Management:

• Observation for small, asymptomatic cases
• Weight control, diet changes, quitting smoking
• Medications

Surgical Intervention:

• Open Hernia Repair: Surgeon manually repositions the hernia through an incision, using stitches or mesh.
• Advanced Laparoscopic Repair: A minimally invasive method using small incisions and a laparoscope to place a mesh and reinforce the area. Techniques include:
  • TAPP (Transabdominal Preperitoneal)
  • IPOM (Intraperitoneal Onlay Mesh)
  • TEP (Total Extraperitoneal Procedure)

The choice of procedure depends on hernia type and individual health condition.