Hernia

A hernia occurs when an organ or fatty tissue protrudes through a weak point or tear in the muscles or tissues that surround it. When most people talk about a hernia, they're referring to an abdominal hernia. According to the National Center for Health Statistics, about five million Americans have an abdominal hernia.

The protrusion can be either reducible, which means it can be pushed back into the abdominal cavity and seem to disappear, or nonreducible, which means it cannot be pushed back into the abdominal cavity. A nonreducible hernia can also be called an incarcerated hernia. The American Medical Association says that when a nonreducible protrusion involves a portion of the intestine, it can become tightly trapped, lose its blood supply and die. This dangerous condition is called strangulation and often necessitates immediate surgical repair.

What can cause a hernia? According to the National Digestive Disease Information Clearinghouse (NDDIC), potential causes include anything that creates increased pressure in the abdomen. This includes:

• coughing
• vomiting
• straining/constipation (Read about "Constipation")
• sudden physical exertion
• obesity (Read about "Obesity")
• pregnancy (Read about "Healthy Pregnancy")

Types of hernias

There are different types of hernias:

Inguinal hernia - An inguinal hernia most often occurs when a portion of intestine protrudes through the lower abdominal wall in the groin area. The American Medical Association says this is the most common type of hernia, affecting about 2 percent of American men. This type of hernia can also occur in women, though less often. A direct inguinal hernia creates a bulge in the groin area, and an indirect hernia descends into the scrotum in men or to the outer folds of the vagina in women, according to AMA. (Read about "Genital Health - Male" and "Genital Health - Female") The American College of Surgeons (ACS) says most inguinal hernias in adults result from strain on abdominal muscles that have been weakened by age or due to congenital reasons. According to ACS, this type of hernia can develop over time, or it can appear suddenly. It can exist without symptoms, or it can be accompanied by pain or discomfort.

Hiatal hernia - Hiatal hernia occurs when the upper part of the stomach moves up into the chest through a small opening in the diaphragm (diaphragmatic hiatus). The diaphragm is the muscle separating the stomach from the chest. According to NDDIC, many otherwise healthy people age 50 and over have a small hiatal hernia, although hiatal hernias can affect people of all ages. NDDIC says hiatal hernias usually do not require treatment. However, treatment may be necessary if the hernia is in danger of becoming strangulated (twisted in a way that cuts off blood supply, for example a paraesophageal hernia). Treatment may also be needed if the hernia is causing esophagitis (inflammation of the esophagus) or a condition called gastroesophageal reflux disease or GERD. GERD results when the acidic contents of the stomach flow back up into the esophagus, leading to persistent heartburn. NDDIC says studies show that the opening in the diaphragm acts as an additional sphincter around the lower end of the esophagus. Studies also show that hiatal hernia results in retention of acid and other contents above this opening. These substances can reflux easily into the esophagus, potentially leading to GERD. (Read about "GERD") In such cases, a doctor may perform surgery to reduce the size of the hernia or to prevent strangulation.

Femoral hernia - A femoral hernia occurs in the area between the abdomen and the thigh, and appears as a bulge on the upper thigh. The AMA says this type of hernia is more common in women than men.

Incisional hernia - This type of hernia occurs at the site of a surgical incision and can form months or even years after the surgery. The protrusion pushes through a weakness created by the surgical scar.

Umbilical hernia - This type of hernia develops through the navel. It can be found in infants as well as children and adults, according to AMA.

Diaphragmatic hernia - Diaphragmatic hernia occurs when a portion of an abdominal organ protrudes into the chest through a hole in the diaphragm. This congenital type of hernia, which can be diagnosed during pregnancy by ultrasound (Read about "Ultrasound Imaging"), occurs when the fetus' diaphragm fails to develop completely. It is extremely dangerous and requires immediate surgery. A diaphragmatic hernia may also develop after a serious injury such as from a motor vehicle accident.

Treatment & prevention

In infants, umbilical hernias often close on their own. If it does not disappear in the first few years of life, surgical repair may be needed. Umbilical hernias in adults, as well as other types of hernias, may also need intervention. For most people who develop a hernia, AMA suggests seeing a doctor, even if there are no symptoms other than the protrusion. In order to reduce the risk of future strangulation, the doctor may recommend surgery (herniorrhaphy). ACS says there are two basic methods:

• Conventional surgery - which involves an abdominal incision, after which the protruding tissue is either removed or pushed back into the abdomen and the abdominal wall is repaired and strengthened. ACS says the abdominal wall can be strengthened by sewing surrounding muscle over it, or it can be strengthened with a special type of mesh. The Food and Drug Administration (FDA) says patients who are considering hernia surgery should let the surgeon know about any past reaction to materials used in surgical mesh or sutures.
• Laparoscopic surgery - which uses a long metal viewing tube and special surgical instruments inserted through small incisions. The operation is performed, using the viewing tube's camera as a guide. (Read about "Endoscopy") After the protruding tissue is either removed or pushed back in place, a special mesh is then used to strengthen the area.

ACS reports that over half a million people undergo hernia surgery each year.

For those who've had hernia surgery and for those who want to try to avoid getting a hernia in the first place, there are some ways to reduce your hernia risk. Basically, this involves avoiding those things that contribute to hernias. For example, avoid heavy lifting or strain. Since smoking often leads to chronic coughing, quitting smoking can help. (Read about "Quit Smoking") A high-fiber diet combined with plenty of fluids can help avoid constipation (Read about "Constipation") and strain during bowel movements. (Read about "Fiber and Health") Losing weight can reduce abdominal strain as well. (Read about "Losing Weight") If you have any concerns, talk with your doctor.