UNDERSTANDING HERNIAS
By Dr. Tan Wah Siew & Dr. Lee Ser Yee
Hernias occur when tissues or organs protrude through a weakness in the muscular wall of the
abdomen.
What is a hernia?
Hernias are protrusions of abdominal contents (fat or intestines) through a weakness in the abdominal wall (muscles and fascia) and present as a bulge or swelling. There are many types of hernias but the most common is the inguinal hernia at the groin area.
What are the causes of hernia?
Most hernias are caused by a combination of intra-abdominal pressure and an opening or weakness in the abdominal wall. The pressure pushes an organ or tissue through the opening or weak spot over time. Sometimes the muscle weakness is present at birth; more often, it occurs later in life.
Anything that causes an increase in pressure in the abdomen especially sudden or frequent increases in intra-abdominal pressure can cause a hernia, these include -
- Lifting heavy objects without stabilizing the abdominal muscles
- Chronic constipation
- Persistent coughing or sneezing
- Weakness in the abdominal muscles/ fascia after surgery and/or contributed by poor healing
- Weakening of our muscles and fascia with age
- Obesity, poor nutrition and smoking can all weaken muscles and make hernias more likely
What are the signs and symptoms of hernia?
Hernias may become more apparent or bigger when the patient is standing or straining and it may disappear when lying down. It may also be associated with discomfort, a pulling or a heavy sensation and pain.
If left untreated, hernias may become irreducible and obstructed or strangulated. This happens when the blood supply to the contents of the hernia e.g. intestines, is cut off by the narrow opening of the hernia sac (neck). If left untreated, the patient will become very ill and the condition is potentially fatal as the intestines within can die.
If you suspect you have a hernia, or you have an abnormal swelling/bulge, pain or discomfort in the groin, it is advisable to consult a hernia surgeon. You may be advised to undergo hernia surgery to prevent potential complications.
What are the Treatments for Hernia?
Once a hernia forms, it will not heal by itself. Hernia surgery can be performed to repair a hernia, and to prevent complications such as strangulation or obstruction from occurring.
Hernia surgery and treatment involves returning the abdominal contents to the abdominal cavity, and reinforcing the weakened area of the abdominal wall. This is usually done with the insertion of a mesh over the weakened area. The mesh provides the scaffolding for the body to form strong scar tissue in the region in where it is placed and strengthens the abdominal wall in that region. There are different types and sizes of mesh and your hernia surgeon will choose the best and most suitable one depending on the size and type of hernia you have.
Approaches
- Laparoscopic Approaches
- Traditional (Open)
Laparoscopic Hernia Surgery
Laparoscopic techniques can result in less pain and smaller scars and may be beneficial in certain situations e.g. bilateral inguinal hernia; but not all hernias are suitable for laparoscopic approaches.
Open Hernia Surgery
Open approaches may still be recommended and may be better in certain situations where laparoscopic approaches are not ideal e.g. large, chronic hernias.
The hernia repair treatment can be done under general anaesthesia, or under regional anaesthesia.
HOW LONG WILL I TAKE TO RECOVER FROM A HERNIA SURGERY?
In fit, young patients with no significant medical problems, the hernia surgery can be performed as day surgery. Elderly patients or patients with more serious medical problems may require admission and may need to stay a day or two after surgery to recover.
After a hernia surgery, you may feel some numbness over the inner thigh (if surgery is performed for an inguinal hernia) and some tightness over the region of the surgery. This is due to the fibrosis and scarring that is taking place. This will mostly resolve over a few weeks.
You will be advised to refrain from carrying heavy loads and strenuous activities during the immediate post-operative period to allow healing to occur and to minimise recurrences; but you may gradually return to carrying loads and normal activities after a few weeks.
WHAT ARE THE COMMON TYPES OF HERNIAS?
Paraumbilical Hernias
Paraumbilical hernias are hernias that develop next to the belly-button(umbilicus). They usually present as enlarging lumps or bulges that are more prominent when standing or straining. They can also become incarcerated and cause pain.
lncisional Hernias
lncisional hernias occur when the muscle and fascia layer underneath surgery scars become weak over time and/or contributed by poor healing e.g. wound infection. They can occur at various parts of the abdomen that have undergone abdominal surgery.
Femoral hernia
Femoral hernias occur when the intestine or fat enters the canal carrying the femoral vessels into the upper thigh, near the lower groin-inner thigh area. Femoral hernias are more common in women, especially in older, thin women.
If you suspect you have a hernia, consult your hernia surgeon, or make an appointment with our hernia specialists at Surgical Associates. Our surgeons strive to provide the best possible hernia treatment for every patient.
