Abdominal and Inguinal Hernias

A hernia develops when the outer layers of the abdominal wall weaken, bulge, or actually rip.

The hole in this outer layer allows the inner lining of the cavity to protrude and to form a sac.  Any part of the abdominal wall can develop a hernia.  However, the most common site is the groin.  A hernia in the groin area is called an inguinal hernia (inguinal is another word for groin).  Inguinal hernias account for 80 percent of all hernias.  In an inguinal hernia, the sac protrudes into the groin toward—and sometimes into—the scrotum.  Although most common in men, groin hernias can also occur in women.

Another type of hernia develops through the navel, and it is called an umbilical hernia.  A hernia that pushes through past a surgical incision or operation site is called an incisional hernia.  A hiatal hernia forms when the upper portion of the stomach slides into the chest cavity through the normal opening created by the oesophagus.

 

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Who Gets Hernias?

Most inguinal hernias in adults result from strain on the abdominal muscles, which have been weakened by age or by congenital factors.  The types of activity associated with the appearance of an inguinal hernia include:

  • Lifting heavy objects
  • Sudden twists, pulls, or muscle strains
  • Marked gains in weight, causing an increase in pressure on the abdominal wall
  • Chronic constipation, which places a strain on the abdomen while on the toilet
  • Repeated attacks of coughing

A hernia is called reducible if the protruding sac of tissue can be pushed back into place inside the abdomen.

If the hernia cannot be pushed back, it is called irreducible, incarcerated, or imprisoned.

The symptoms of inguinal hernias vary.  Sometimes the onset is gradual, with no symptoms other than the development of a bulge.  Other times, the hernia will occur suddenly with a feeling that something has “given way”.  This feeling can be accompanied by pain or discomfort.  Signs and symptoms of inguinal hernias can include:

  • Visible bulges in the scrotum, groin, or abdominal wall
  • A feeling of weakness or pressure in the groin
  • A burning feeling at the bulge
  • A gurgling feeling

In some cases, an irreducible hernia gets so pinched that the blood supply is cut off and the tissue swells.  Rapidly worsening pain or a tender lump is a signal that the hernia has strangulated.  When strangulation occurs, the tissue can die quickly and become infected.

Within hours this condition can lead to a life-threatening medical emergency that requires immediate medical attention.  Hernia repair surgery can be done by either an open or laparoscopic approach and require a one night stay in hospital.

 

Hiatus Hernia

A hiatus hernia is a pouch of stomach pushing up from the abdomen into the chest, usually through the hole in the diaphragm (breathing muscle) for the oesophagus (gullet) to pass through.

Hiatus hernia is extremely common and they are very variable in size.  Most people with this problem have a very small hernia, which usually causes no symptoms nor long term issues.  If the hernia is large and contains a lot of abdominal organs it may cause many symptoms including nausea, difficulty swallowing, regurgitation of food, pain after eating, vomiting after eating, nausea, weight loss and/or shortness of breath after meals.

If you have any or all of these symptoms, it is important to discuss these with your GP to see if there is a need for investigation.  Investigations may include a gastroscopy, barium x-ray or CT scan.  If these tests show an abnormality then your GP will refer you to a surgeon for consultation.

In certain circumstances a hiatus hernia needs to be repaired and patients will undergo a Hiatus Hernia Repair.  This surgery is done laparoscopically and requires a one night stay in hospital.

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