What is a hernia?

A hernia is an opening or weakness in the muscular structure of the wall of the abdomen. This defect causes a bulging of the abdominal wall. This bulging is usually more noticeable when the abdominal muscles are tightened, thereby increasing the pressure in the abdomen. Any activities that increase intra-abdominal pressure can worsen a hernia; examples of such activities are lifting, coughing, or even straining to have a bowel movement. Imagine a barrel with a hole in its side and a balloon that is blown up inside the barrel. Part of the inflated balloon would bulge out through the hole. The balloon going through the hole is like the tissues of the abdomen bulging through a hernia.
Serious complications from a hernia can result from the trapping of tissues in the hernia -- a process called incarceration. Trapped or incarcerated tissues may have their blood supply cut off, leading to damage or death of the tissue. The treatment of an incarceration usually involves surgery.

Types of Hernias

Inguinal Hernias

Inguinal (pronounced: in-gwuh-nul) hernias are more likely to occur in guys than girls. More than 70% of all hernias that occur are inguinal hernias, which means that a part of the intestines protrudes through an opening in the lower part of the abdomen, near the groin, called the inguinal canal. In guys, the inguinal canal is a passageway between the abdomen and the scrotum through which a cord called the spermatic cord passes (the testicles hang from the spermatic cord). In girls, the inguinal canal is the passageway for a ligament that holds the uterus in place. Nearly all cases of inguinal hernias in teens are due to a congenital defect of the inguinal canal. Instead of closing tightly, the canal leaves a space for the intestines to slide into.
If you have an inguinal hernia, you might be able to see a bulge where your thigh and your groin meet. In guys, the protruding piece of intestine may enter the scrotum, which can cause swelling and pain. Other symptoms of an inguinal hernia might include pain when you cough, lift something heavy, or bend over. These types of hernias require surgery to repair; in fact, inguinal hernia operations are the most common type of surgery performed on kids and teens.

Umbilical Hernias

Umbilical hernias are common in newborns and infants younger than 6 months. They occur when part of the intestines bulge through the abdominal wall next to the belly button. In babies with umbilical hernias, parents may see bulging around the belly button area when the baby cries. Unlike other types of hernias, umbilical hernias may heal on their own, usually by the time a baby is 1 year old. If not, surgery can repair the hernia.

Epigastric Hernias

In an epigastric (pronounced: eh-pih-gas-trik) hernia, which is also called a ventral hernia, part of the intestines protrude through the abdominal muscles located between the belly button and the chest. It's mostly guys who have to worry about this type of hernia — about 75% of epigastric hernias occur in males. People with this type of hernia may notice a lump. Surgery is a common way to fix this problem.

Incisional Hernias

If you've had surgery in your abdominal area, you might experience this type of hernia. In incisional hernias, part of the intestines bulge through the abdomen around a surgical incision. In this case, surgery actually weakened the muscle tissue in the abdomen. This type of hernia requires another surgery to repair it.

Hiatal Hernias

This type of hernia occurs at the opening of the diaphragm where the esophagus (the pipe that food travels down) joins the stomach. If the muscle around the opening to the diaphragm becomes weak, the uppermost part of a person's stomach can bulge through the diaphragm. Hiatal (pronounced: high-a-tul) hernias are common, although small ones don't usually cause any symptoms. Unlike the other types of hernia, you won't be able to see a bulge on the outside of your body, but you might feel heartburn, indigestion, and chest pain. Hiatal hernias can be treated with medication and diet changes, but they do sometimes require surgery.

What are hernia symptoms and signs?

Symptoms of a hernia include pain or discomfort and a localized swelling somewhere on the surface of the abdomen or in the groin area.

 Diagnosis & Investigation

A hiatal hernia is often discovered during a test or procedure to determine the cause of heartburn or chest or upper abdominal pain, such as:

• An X-ray of your upper digestive tract. During a barium X-ray, you drink a chalky liquid containing barium that coats your upper digestive tract. This provides a clear silhouette of your esophagus, stomach and the upper part of your small intestine (duodenum) on an X-ray.
• Using a scope to see inside your digestive tract. During an endoscopy exam, your doctor passes a thin, flexible tube equipped with a light and video camera (endoscope) down your throat and into your esophagus and stomach to check for inflammation.

What can be done to prevent a hernia?

Most of the factors that lead to the development of hernias are beyond the control of the individual. Some of those factors are inherited and develop as the individual grows. The arrangement of the local tissues and their thickness and strength may greatly affect the relative risk of developing a hernia over a lifetime. However, that risk can be increased by failure to use good body mechanics when lifting, poor abdominal support posture, and weight-control problems.

Treatments and Pharmacology

Most people with hiatal hernia don't experience any signs or symptoms, and won't need treatment. If you experience signs and symptoms, such as recurrent heartburn and acid reflux, you may require treatment, which can include medications or surgery.
Medications for heartburn
If you experience heartburn and acid reflux, your doctor may recommend medications, such as:

• Antacids that neutralize stomach acid. Over-the-counter antacids, such as Maalox, Mylanta, Gelusil, Rolaids and Tums, may provide quick relief. But antacids alone won't heal an inflamed esophagus damaged by stomach acid. Overuse of some antacids can cause side effects, such as diarrhea or constipation.
• Medications to reduce acid production. Called H-2-receptor blockers, these medications include cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR) or ranitidine (Zantac 75). H-2-receptor blockers don't act as quickly as antacids, but they provide longer relief. Stronger versions of these medications are available in prescription form.
• Medications that block acid production and heal the esophagus. Proton pump inhibitors block acid production and allow time for damaged esophageal tissue to heal. Over-the-counter proton pump inhibitors include lansoprazole (Prevacid 24HR) and omeprazole (Prilosec OTC). Stronger versions of these medications are available in prescription form.

Surgery to repair a hiatal hernia
In a small number of cases, a hiatal hernia may require surgery. Surgery is generally reserved for emergency situations and for people who aren't helped by medications to relieve heartburn and acid reflux. Hiatal hernia repair surgery is often combined with surgery for gastroesophageal reflux disease.
An operation for a hiatal hernia may involve pulling your stomach down into your abdomen and making the opening in your diaphragm smaller, reconstructing a weak esophageal sphincter, or removal of the hernia sac. In some cases, this is done using a single incision in your chest wall (thoracotomy) or abdomen (laparotomy). In other cases, your surgeon may insert a tiny camera and special surgical tools through several small incisions in your abdomen. The operation is then performed while your surgeon views images from inside your body that are displayed on a video monitor (laparoscopic surgery).

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