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A hernia usually occurs when a hole or rupture appears in the wall of the abdomen. The abdominal wall consists of tendons and very tough muscle. It runs from the rib area down to the groin area and stops just before the legs. One of the abdominal wall’s functions is to hold in the intestines. When a rupture occurs, the intestines can begin to push through the abdominal wall.
A hernia can happen to anyone, regardless of age or sex. It is usually felt as a small lump, but if left untreated, can grow to any size. There have been cases in which an untreated hernia has grown to the size of a football, and even larger hernias have been recorded. The hernia can become quite visible to the sufferer and to other people as it presses against the skin.
As it grows larger, with more intestine protruding through the abdominal wall, the hernia can cause more acute pain. It can also be extremely dangerous if the intestine becomes trapped inside the abdomen wall, as it may have a strangulating effect. Hernias will not get better on their own, but must be surgically treated.
Apart from a natural weakness in the abdominal wall, there are a number of reasons hernias may occur. One of the most common is a sporting injury. The most frequent sports injury is a groin injury, in which the muscle can be easily torn or strained. If a lump appears in this area, it may be the result of an inguinal hernia. If physical therapy fails to treat this injury, the only other option is surgery.
Most hernias develop in the abdominal wall, which runs from just below your breastbone down into your groin. This wall is similar to the rubber on a tire: it surrounds and protects your organs the same way a tire surrounds and protects the air-filled tube inside of it.
Hernias develop when a section of the abdominal wall wears down or tears. There are several possible reasons for this:
An area of your abdominal wall is weak at birth.
An area of your abdominal wall weakens over time due to physical stress, injury, pregnancy, or aging.
A weakness or tear develops at the site of a previous surgical incision.
No matter what the cause, it is important to see a doctor for a medical evaluation. Keep in mind, hernias do not get better over time or go away on their own. In fact, they usually grow larger and get worse.
The umbilical area is where the umbilical cord once passed through the abdominal wall.
The inguinal or groin area is around the inguinal canal and is above the inguinal crease.
The femoral area includes the femoral canal below the inguinal crease.
The signs and symptoms of a hernia can range from noticing a painless lump to the severely painful, tender, swollen protrusion of tissue that you are unable to push back into the abdomen (an incarcerated strangulated hernia).
It may appear as a new lump in the groin or other abdominal area.
It may ache but is not tender when touched.
Sometimes pain precedes the discovery of the lump.
The lump increases in size when standing or when abdominal pressure is increased (such as coughing).
It may be reduced (pushed back into the abdomen) unless very large.
It may be an occasionally painful enlargement of a previously reducible hernia that cannot be returned into the abdominal cavity on its own or when you push it.
Some may be chronic (occur over a long term) without pain.
An irreducible hernia is also known as an incarcerated hernia.
It can lead to strangulation (blood supply being cut off to tissue in the hernia).
Signs and symptoms of bowel obstruction may occur, such as nausea and vomiting.
This is an irreducible hernia in which the entrapped intestine has its blood supply cut off.
Pain is always present, followed quickly by tenderness and sometimes symptoms of bowel obstruction (nausea and vomiting).
The affected person may appear ill with or without fever.
This condition is a surgical emergency.
In general, treatment of hernia depends on the type and size of the opening in the abdominal wall, health condition of the person, etc. While, surgery is the ultimate treatment option for people with hernia, in some cases, the doctor may not recommend surgery due to various factors. It has been observed that most of the irreducible hernias (that cannot be pushed back into place) require surgery and reducible hernias (that can be pushed back into place) may sometimes be exempted from surgery.
As mentioned above, in some cases hernia treatment without surgery is preferred and this applies mainly to the reducible ones. Doctors adopt a wait and watch policy, if it is unsafe for the affected person to undergo surgery for hernia repair. In some cases, hernias will be small in size and do not cause any pain or discomfort. Surgery may not be done in such cases too. In some cases, the openings of the hernias will be so large that surgery is not considered as a feasible option. Even the risk of strangulation is minimum in such cases and so, surgery is not necessitated. In such cases, the patients will be advised to use abdominal binders or trusses. These special belts prevent the further bulging of the hernia. However, the use of binders is discouraged by some health experts. According to them, these belts cause formation of scar tissue in the area and this causes difficulties in surgery, which may be done at a later stage.
As mentioned earlier, the ultimate hernia treatment is surgery only. Surgery is recommended for both reducible and irreducible hernias, but in case of the latter, surgery has to be done at the earliest, so as to avoid strangulation. Hernia surgery can be either open or laparoscopic. In some cases, open surgery is the only way to repair the hernia, whereas in some others, laparoscopic surgery can be done. It has also been observed that some of the laparoscopic hernia surgeries are converted to open ones, when the surgeon finds it difficult to repair the hernia through the former procedure. In case of laparoscopic hernia repair, two small incisions will be made by the surgeon, near the hernia. A small tube with a camera on its end will be inserted through one incision and the surgical instruments will be inserted through the other. The surgeon will get a good view of the surgical site from the images displayed in the monitor and conduct the hernia repair surgery. The protruded parts are moved back to their original place and the opening in the abdominal wall is sutured with a synthetic mesh that prevents further protrusion. In case of open surgery, the procedure is done through a long cut made on the abdominal wall. So, an open surgery causes scarring, which is minimal in laparoscopic surgery. Even the hernia treatment recovery time may be longer in an open surgery, which requires the patient to stay in hospital for several days. Hernia treatment cost also varies with the mode of treatment.
In short, hernia treatment is decided on the basis of the nature and type of hernia and the health condition of the patient. However, surgery is always said to be better, so as to avoid complications. It will be advisable to discuss the treatment options with your doctor, so as to get a clear idea about the various aspects of hernia treatment.