MOST people have heard the term hernia, and many have known someone who is aware of a lump that they suspect is a hernia. But what is it really, what causes it, and what should we do if we suspect we have one? Dr Maré du Plessis, a specialist surgeon operating in private practice at Mediclinic Milnerton in Cape Town, said men are 8-10 times more likely to get a hernia than women.
“A hernia occurs when an organ or fatty tissue squeezes through a weak spot or tear in the surrounding muscle or connective tissue in the abdomen,” he said.
There are many types of hernias, generally identified by their location in the body. Common hernias are:
Inguinal Hernia: The most common type, it appears as a bulge in the groin or scrotum, when the abdominal wall weakens and allows abdominal contents to protrude into the inguinal canal.
Incisional Hernia: Develops at the site of a previous abdominal surgery, where tissue protrudes through the scar tissue or weakened area of the abdominal wall.
Hiatal Hernia: Involves the protrusion of the stomach through the diaphragm, causing part of the stomach to push up into the chest cavity through the esophageal hiatus.
Umbilical Hernia: Occurs when abdominal tissue, usually fat or part of the intestine, protrudes through a weak spot in the abdominal wall near the navel. This is most common in babies but can occur in adults.
One can also have a femoral hernia. It's also in the groin, but it sits in a different position in the groin to the inguinal hernia. A lumbar hernia presents as a lump in the back and is not a very common type of hernia. An obturator hernia is also an uncommon hernia where part of the small intestine or other abdominal organs bulge through a small opening in the pelvic bone called the obturator foramen.
Dr Du Plessis said hernias are either something you are born with, or they're acquired: “The ones that you are born with are either the umbilical hernia or the inguinal hernias. Acquired hernias include the hiatus and incisional hernias.
Hiatus hernias generally develop later in life and can be lifestyle related. They generally cause discomfort and possibly lead to gastro-oesophageal reflux disease (GORD), characterised by symptoms like heartburn. Diagnosis typically involves x-rays or endoscopic investigations, and treatment is mostly via medication or lifestyle adjustments, with surgery rarely necessary.
The incisional hernia occurs in a patient who has had abdominal surgery. The hernia develops where the incision was made, in the scar of the previous surgery.
“With incisional hernias, the timeline is variable - you can have an operation and only develop an incisional hernia twenty years later, or you can present with an incisional hernia six to eight weeks after your procedure. Having a lump and pain in the scar from previous surgeries is not normal, and that should be investigated and attended to,” Dr Du Plessis said.
Hernias can be asymptomatic, or cause discomfort and pain, and can lead to complications if not addressed. The protruding tissue can become trapped and lose its blood supply (this is known as an incarcerated hernia), or if it becomes strangulated, blood flow is cut off entirely and this can lead to a very serious medical emergency, such as sepsis.
He added that patients will almost always notice the lump, but many times they won't have symptoms.
“It should always be seen to, though, we never tell patients to ignore it as it will not go away. There's a hole in the muscle, it won’t heal up or close by itself – you need to have it repaired surgically.”
Treatment for hernias usually involves surgical repair under general anaesthetic, to close the opening in the muscle wall. Some of these are repaired by simply suturing the hole, or the abdominal wall may need reinforcing in that area: “Some hernias are repaired with a mesh.There's a weakening of the tissue, so you have to reinforce the abdominal wall by implanting a prosthetic piece of material,” he concluded.