Facts about hernias

Hernias — many suffer but help and treatment exist

Anyone can suffer from a hernia. There are many types of hernia and several reasons why one might develop. The most common type is a groin hernia — one out of every four men gets a groin hernia at some point in their lives. Hernias can cause a great deal of trouble for those afflicted with them, regardless of the type or where it develops. Today, however, there are many treatments readily available to cure and heal hernias.

A hernia in the stomach or groin can occur for a variety of reasons: heavy lifting, an intense coughing period, or from weakened scar tissue after surgery. There may also be congenital or anatomical causes. Hernias become more common in older and overweight individuals. Front abdominal wall hernia is a common catch-all term for the many kinds of hernia that can develop in the abdominal wall. These are often incisional or scar-induced hernias, umbilical hernias, and epigastric hernias. It is not uncommon for hernias to develop in people who have had operations for stoma (what are known as stoma hernias). A hernia in the groin is known as a groin or scrotal hernia.


Abdominal hernia —the various types of hernia in the abdomen

The abdominal wall consists of several layers of tissue. At the bottom is the peritoneum, a thin membrane that covers the inside of the abdominal wall. After that comes a layer of fat, one or more muscle layers, and then a layer of subcutaneous fat tissue.

The skin is the outermost layer of the body and is meant to protect everything internal. With a hernia, the peritoneum and abdominal contents (usually fat and bowels) are forced out through a weakening of the abdominal wall. A sort of bulge with the abdominal contents forms underneath the skin. It usually appears as a bump or lump on the stomach. In the beginning, a hernia is usually small; however, left untreated, it can grow quite large.

A hernia (apart from umbilical hernia in newborns) will not disappear by itself but must be treated — either through conservative treatment (with a hernia belt) or by surgical intervention. Surgery is used when the hernia cannot be pushed back and will not fall backwards when the patient lies down.

A hernia from scarring is a common complication after abdominal surgery. The hernia can develop at the surgical scar where the peritoneum was weakened during the operation.

About 10–20 percent of those who have had abdominal operations suffer from hernias from scarring. These hernia can cause pain that makes it difficult to move. Cosmetically, the scarring can become troublesome if it spreads. In order to hold back the hernia, you either need an operation or a hernia girdle/trouser. Several studies show that using a girdle immediately after surgery can also help prevent the onset of hernia. A girdle also reduces pain and makes it easier to start moving again, which has many positive effects for healing and rehabilitation. One should use a girdle day and night for the first 6–8 weeks, then in the daytime for another 6 weeks after that.

A stoma hernia chest is not uncommon among those who have had ostomy operations. The hernia manifests itself as a bulge that can vary in size. It is most common in colostomy surgery (colon stomas).

Extremely severe stoma hernias can only be corrected with surgery as otherwise there is a risk of recurrence In the literature, the incidence of stoma hernias varies between 5–50 percent, with only about 10–20 percent requiring surgery.

Wearing some kind of support belt may provide great comfort while you have a hernia. You can wear a softer belt over an ostomy pouch or a more durable belt with holes for an ostomy bandage (so that the pouch is outside the belt). Choose whatever works best for you as this can vary by individual preference, but it's always good to meet with your nurse or doctor first to get advice on the best route. Using a belt or other brace over the stoma is good for preventative purposes as it can avert the hernias from arising in the first place; this is especially true if your aim is to prevent a hernia from arising, especially if you have to engage in heavy work or have had a colostomy operation.

Umbilical hernia and epigastric hernias can occur even if you haven't had an abdominal operation. Umbilical hernias are relatively common and occur in about two percent of the adult population. The navel is the residual piece of the body after the umbilical cord has been removed from the abdominal wall. Sometimes the area around the naval can grow weak. Congenital umbilical hernias are not unusual. In young children, most will heal on their own, and surgery is not recommended before the age of two. In adults, however, umbilical hernias have a fairly high risk of jamming, and thus surgery is typically recommended. An epigastric hernia can develop on the midriff above the navel, usually against the sternum. It is typically the size of a bullet. It can arise both in children and adults and is usually operated upon.

Groin hernias — the most common hernia

Groin hernias are exceedingly common. Surveys have shown that nearly a quarter of the male population has had a hernia or has undergone an operation for one. Groin hernias can manifest themselves as a soft bulge around the groin. This bulge can be pushed back and will usually disappear when lying down, at least initially. In most cases, groin hernias only cause mild discomfort, usually a feeling of weightiness, bloating, or achiness in the affected area. The hernia usually falls out and worsen when under increased abdominal pressure, such as when lifting heavy objects or during heavy strains of bowel movements.

Groin hernias are very common in men; over 90% of individuals who suffer from groin hernias are men. This is because men have a natural weakening of the abdominal wall in the area where the vas deferens goes through the layers of muscle to reach the scrotum.

In both small and large groin hernias, the contents of the hernia are at risk of being pinched of squeezed. When this happens, what is called a pinched groin hernias develops, which needs to be operated upon as soon as possible. A pinched groin hernia can impede blood circulation around the scrotal and intestinal area; the interior fat tissue is also at risk of being damaged. A pinched groin hernia needs to be addressed rather quickly before it gets worse. The contents of a developed groin hernia can go in and out through the opening in the abdominal wall.

The only way to cure groin hernia is with an operation. However, groin hernias can be treated in other ways. Certain types of bandages can hold back the hernia. Today there exist groin hernia bandages that are discreet and comfortable, completely invisible if worn underneath clothing. Left untreated, a groin hernia can penetrate into the scrotum, where it becomes a scrotal hernia.

Operating on a groin hernia often involves reinforcing the abdominal wall with a plastic mesh that grows firmly around the area and will already provide its fully increased strength the day after the operation. That means that you will be fully recovered as soon as the pain subsides. General advice in the past recommending six weeks of complete rest is no longer applicable. After surgery, there is a risk of experiencing aches or nerve pain. It is estimated that up to twenty percent of all patients who undergo surgery suffer from various degrees of pain in the area of their surgery, some to the point where they are completely disabled. Therefore, only people with severe discomfort or with serious cases should have their hernias operated upon.

Helena Peters NordiCare Ortopedi & Rehab AB

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