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Abdominal
Hernia
What is an Abdominal Hernia?
In general, a hernia refers to a condition that arises when
an organ pushes through a weak area in the muscles or tissue that surround and contain it.
An abdominal hernia occurs when there is a tear in the inner
lining of the abdominal wall (the outer layer of muscle, fat and tissue that extends from
the bottom of the ribs to the top of the thighs), causing a bulge in the abdominal wall
where the organs protrude. The bulge can be either reducible, which means that by applying
slight pressure to the area, you can feel the organs being pushed back into the abdominal
cavity and the hernia will flatten and disappear, or non reducible, which means the fat
or tissue cannot be pushed back into the abdomen and the hernia will not flatten. Whether
a hernia is reducible depends on how far it protrudes through the abdominal wall and how
tightly it is held by the abdominal muscles.
Hernias are repaired surgically with a simple surgical procedure.
Without corrective surgery the condition may lead to a strangulation. This is where the
organ or intestine that is protruding through the abdominal wall may have its blood supply
cut and die if it becomes tightly trapped. Strangulation of an intestine causes extreme
pain, can block digestion and may even cause gangrene in that area of intestine. In this
case, emergency surgical repair is required.
Who is at risk of Abdominal Hernia?
A hernia can develop in anyone, from a newborn baby to a senior citizen.
The following may increase risk of developing a hernia by straining or increasing pressure
on the abdominal wall:
 A chronic
cough, such as smoker's cough
Obesity
Straining
during bowel movements or while urinating
Pregnancy
Straining
to lift heavy objects
Persistent
sneezing, such as that caused by allergies
Types of Abdominal Hernias
The following are different types of abdominal hernia:
Inguinal Hernia
When a male's testicles descend into the scrotum, this causes a naturally
weakened area in the wall of the abdomen, called the internal ring. This weakened area makes
men more susceptible to a hernia at this location. An indirect inguinal hernia is the most
common type of inguinal hernia. It occurs at the internal ring in the groin area. The intestine
drops down into the internal ring and can extend down into the scrotum in men or to the
outer folds of the vagina in women. An indirect inguinal hernia can be the result of an
inherited weakness at the internal ring or one that occurs later in life. The latter is
known as an acquired hernia.
Indirect Inguinal Hernia
Less common than an indirect inguinal hernia, a direct inguinal hernia occurs
near the internal ring instead of within it. They are acquired hernias that usually occur
after age 40 as a result of aging or injury.
Epigastric Hernia
This type of hernia occurs as a result of a weakness in the muscles of the
upper-middle abdomen, above the navel. Men are about three times more likely to have an
epigastric hernia than women, and the majority occur in people between 20 and 50 years of
age.
Umbilical Hernia
Another natural area of weakness in the abdomen is the navel, which, like
the internal ring, is made up of tissue that is thinner than that in the rest of the abdomen.
These hernias can occur in babies, children and adults.
Femoral Hernia
A femoral hernia occurs in the area between the abdomen and the thigh, and
appears as a bulge on the upper thigh. This type of hernia is more common in women than
men.
Incisional Hernia
A type of hernia called incisional can occur at the site of an incision
from a previous surgery. The fat or tissue pushes through a weakness created by the surgical
scar. An incisional hernia can occur months or years after the initial surgery.
What are the Warning Signs?
A hernia usually first becomes noticeable as a bulge somewhere in the abdomen
or pelvic area or in the scrotum for men. If the bulge is reducible, it may enlarge when
the person is standing and become smaller when he or she lies down. The changes in the hernia's
size are due to the increased pressure on the abdominal wall caused by gravity when we stand.
A hernia may cause sharp or dull pain that worsens when having a bowel movement, during
urination, or while lifting a heavy object. The pain might worsen as the day progresses,
especially with long periods of standing, because of gravitational pressure. Nonprescription
drugs such as aspirin and acetaminophen may relieve minor discomfort. In the case of a strangulated
hernia that contains intestine, the herniated section of intestine might become blocked.
This blockage may cause blood in the stool, constipation, fever, severe pain, vomiting and
even shock. If these symptoms are experienced, emergency medical attention is needed. Even
with suspected hernias that do not cause these symptoms, it is best to schedule an appointment
with a doctor to avoid these complications. The doctor will probably want to perform a physical
examination and discuss the patient's symptoms and medical history to determine if a hernia
has developed.
How are Hernias Treated?
Laparoscopic Hernia Repair Surgery
Hernia repair surgery is an effective long lasting treatment for hernias.
Successful surgery will end discomfort, repair the hernia, and stop the hernia from progressing.
The surgical procedure for hernia repair is a Laparoscopic procedure in which a fiber optic
viewing tube and special instruments are used to repair the hernia without making a large
incision. This procedure requires less recovery time than traditional hernia repair surgery.
The surgery will result in three small incisions, one is usually located in the naval and
one on each side of the tummy just above the waistline. The surgery will result in scars
about 10 mm in length. These scars will fade in time.
No Treatment
A patient always has the option of not undergoing treatment, but the hernia
may become worse and there is a risk of intestinal strangulation.
What can be Expected from Hernia Repair Surgery?
In preparation for the surgery, blood tests, an electrocardiogram (EKG),
and/or a chest X-ray may be undertaken depending on the age and fitness of the patient.
The patient may be required to stop medications before surgery, including aspirin, because
they thin the blood and reduce the post operative healing capacity also some drugs may have
dangerous interactions with anesthetics or increase the risk of abnormal bleeding.
The patient may be requested to stay a few days after surgery so that they may be carefully
evaluated and returned home in good health. After hernia repair surgery, time should be
allowed for rest and recovery at home.
General Anesthesia
Normally General Anesthesia is used. It is a safe, common method of ensuring
that no pain is felt while the hernia is repaired. There are some risks involved with general
anesthesia, especially if the patient has significant medical problems, which can factor
into the choice of anesthetic. These risks will be discussed with the patient. If a general
anesthetic is chosen, the patient should not eat or drink anything after midnight of the
night preceding the surgery.
During surgery, the surgeon will make an incision at the hernia and either move the contents
within the protruding hernia back into the abdominal cavity or remove the contents, especially
if the protrusion includes strangulated intestines. In order to repair the hernia, the surgeon
will insert a synthetic mesh behind the weekend abdominal wall. In time the synthetic mesh
will grow into the weakened tissue forming a strong barrier preventing reoccurrence of the
condition. The repair should be permanent and not require any further surgery.
After surgery, the patient may receive fluids and pain-relieving medication through an intravenous
(IV) tube for a few hours.
Recovery time will depend on the health of the patient and the type of surgical repair that
was performed. The patient should be able to walk after 24 hours however several days rest
is needed as there will be some discomfort, swelling, brusing and pain. After a few days
once the patient is back at home, they may try to slowly ease back into normal activities.
Light activities can usually be resumed in a few days.
How soon the patient can return to work depends on the type of job that he or she has. A
job that is very physically demanding may require more recovery time before returning than
a job that does not require putting strain on the body. It is recommended that no strain
be put on the body for 6 - 8 weeks after surgery. Light exercise, such as walking, helps
increase blood flow and promotes healing.
Lifting should be avoided, but if it is absolutely necessary, only manageable objects should
be attempted and lifting should be done with the legs, not the back. Activities such as
driving and sex can also strain the incision. The patient should ask when these activities
can be resumed. Pain medications may be prescribed for the first few days at home. A patient
should never drive while taking pain medications.
A doctor should be notified immediately if any of the following symptoms are experienced
after the surgery:
Fever
Difficulty
Urinating
Excessive
Bleeding
Redness
in the Area of the Incision
Excessive
Tenderness or Swelling
Severe
or Increasing Pain
How can a Hernia Recurrence be Prevented?
After a hernia has been treated there are certain things that can be done
to decrease the risk of recurrence. The following suggestions can help reduce the risk of
a hernia recurring:
Maintaining
a healthy weight
Exercising
to tone the muscles of the abdomen
Receiving
medical help for chronic constipation, allergies or a chronic cough
Eating
high-fiber foods
Avoiding
the risk factors mentioned earlier
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