Abdominal hernia – types, symptoms, risk factors, treatments and prevention
Abdominal wall hernias are defined as bulging of abdominal contents through weak parts of the abdominal wall. These hernias cause a lot of trouble to the patients even though it is completely curable by surgery. Moreover, untreated abdominal wall hernias may cause complications like strangulation; ischemia of a part of the bowel and even death. In this article, you will further get to know about Abdominal Hernia symptoms, types etc.
How do the abdominal hernias occur?
Abdominal wall hernias occur through a weak spot in the abdominal wall, typically with a slow onset and progression. Moreover, our interior abdominal wall consists of several layers of muscles and tissues. Within this wall is a cavity known as the peritoneal cavity. The peritoneal cavity contains the abdominal organs including stomach, liver, small intestine, and large intestine. Due to an acquired or an inherited cause, these contents; most commonly the bowels, protrude through a weak spot. This is known as an abdominal hernia.
Causes of abdominal hernias/ Risk factors for hernia
Increased pressure inside the abdominal cavity favors the formation of abdominal hernias. It includes the following,
- Heavy lifting
- Straining with defecation or urination
- ascites and peritoneal dialysis
- Previous abdominal surgeries
How do abdominal hernias present?
They commonly present in the routine physical examination as a bulge on an area of the abdomen; most commonly in the groin. However, the bulge may appear on the upper medial part of the thigh, as in a case of a femoral hernia. A characteristic finding of most of the hernias is, having a cough impulse. Any lump that gets bigger with a cough should be considered as a hernia. But not all the lumps with cough impulse are hernias.
Types of abdominal hernias
Abdominal hernias are classified as congenital and acquired depending on the age of onset. Congenital ones present from birth. The best example is a diaphragmatic hernia, which can either be sliding or rolling in type. An umbilical hernia is another one.
The commonest hernia, the inguinal hernia occurs in the region of the groin. In children with inguinal hernia, the abdominal content even may descend till the scrotum.
Femoral hernias are frequent among females who are in their forties, typically occurring on the upper medial part of the thigh. Femoral hernias usually progress rapidly and complications are very frequent.
Para-umbilical hernia and epigastric hernia occur in the anterior midline of the abdomen due to fascial (a skin layer) defects
Incisional hernias can occur following any abdominal surgery if the adhesions don’t occur properly at the surgical site.
What are the features/ symptoms of an abdominal hernia?
- The commonest symptom of an abdominal hernia is a bulge or a lump in the affected area.
- Most of the time you can push it back inside to the abdomen
- When standing up or cough, the lump becomes more prominent.
- In small children, the size of the lump increases with crying.
- There could be pain or discomfort in the area.
Complications of abdominal hernia
- strangulation/ Incarceration – The protruded part of the bowel may undergo ischemia and necrosis. Typically, pain at the site indicates ischemia.
- Rupture – The infarcted (died) bowel may rupture releasing its infected contents into the abdominal cavity
- Peritonitis –Infection of the peritoneal cavity with fluid accumulation. Severe, diffuse abdominal pain with abdominal distention indicates this.
- Septic shock – Severe peritonitis ultimately leads to septic shock with multi-organ failure.
What is the treatment for abdominal hernia?
Treatment of an abdominal hernia depends on size, type, and symptoms. The mainstay of management is the surgery; herniotomy and mesh repair.
This procedure can be done either by open or laparoscopic (Without opening abdomen, using a camera) surgery. Classically, in an inguinal hernia where bowel contents have gone to the scrotum, the repair is done by open surgery.
Conservative therapy is another way of management if the hernia is mild and uncomplicated. Lifestyle changes include dietary changes. Patients are advised not to have large meals. Not to lie down or bend after a meal. Also, emphasis should be made on reducing body weight. Exercises may strengthen the abdominal muscles. Proper exercises are advised in patients with mild abdominal hernias. In patients with acid reflux, spicy foods and smoking should be restricted.
For the symptomatic relief, doctors may prescribe antacids, H2 receptor blocker (eg-Ranitidine) and proton pump inhibitors (eg- omeprazole)
How is the outcome of the abdominal hernia surgeries?
Abdominal hernias have a complete resolution following surgical treatment. But some may have recurrences, particularly through the incision. Notably, there can be surgical complications including infections and a condition known as paralytic ileus where the bowel becomes transiently paralyzed for few days following the surgery.
What are the advices for patients with abdominal hernias? / Prevention
- Generally, people with abdominal hernias should not lift heavyweights.
- They should not have heavy meals.
- Smoking & alcohol cessation.
- If you have constipation, inform your doctor. The doctor may prescribe some laxatives which relieve constipation, as straining increases the risk of recurrence.
- Also, chronic cough should be treated with medications due to the same reasons.
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