What is a Hernia?

What Is A Hernia?

Have you noticed a small-medium sized bulge in your upper groin or at the belly button or above that between your ribs that disappears when you lie down at night and reappears at the end of the day?  There might be an ache there too.   It might feel better when you push it back inside.  Sometimes you cannot push it back in.

You have a Hernia.  If you cannot push it back in it’s called an incarcerated hernia.

A hernia is a mechanical bulge or swelling coming out from the abdominal cavity coming through a natural area of muscular weakness. We all have such areas of weakness, some worse than others . Rarely, you can suffer compressive trauma to the torso where abdominal contents that can burst through an area is quite strong, as in a motor vehicle crash.

A hernia occurs when an internal organ or fatty tissue of a muscle pushes out through a weak spot in the muscle or the tight strong fascia that surrounds the organ or abdominal cavity. It is an internal muscle tear or weakness visibly evident on the outside as a bulge especially common in your groin or umbilical (belly button) area.

You can imagine a Hernia like a bulge in a damaged wheel. The inner tube of a wheel has a sturdy tire that protects it. When the tire wears down over time it weakens, the inner tube then protrudes through the damaged area resulting in a lump that you can see and feel on the outside.

Although a hernia isn't usually life threatening, the pain can be progressively more severe. It is advisable to solicit medical advice.

Types of Hernia

A hernia occurs between your chest and hips. In men, it is common to find lumps in the groin and umbilicus areas.

Depending on the damaged part, hernias are classified into the following types:

1. Inguinal Hernia
2. Femoral Hernia
3. Umbilical Hernia
4. Incisional Hernia
5. Epigastric Hernia
6. Spigelian Hernia
7. Hiatal Hernia
8. Diaphragmatic Hernia

The first 6 types occur around your abdominal wall and are called abdominal wall hernias.  The remaining are internal hernias.

Inguinal Hernia

A very common hernia in your groin, just above thigh crease.  This commonly occurs in very young children and in older men than women.  A part of the fatty tissue or the intestine protrudes through the lower abdominal wall and bulges via the inguinal canal. It forms a small bump on the groin area.  It can result from a weakness at birth or simply as you get older, but from lifting heavy weights, long standing, cough or constipation.

Femoral Hernia

When the intestine or a small part of tissue pushes through the groin or upper thigh, it forms a small-sized lump below the groin crease. It is more common with women than men.

Umbilical Hernia

As the name implies Internal tissues push themselves out through a weak umbilical cord area.This hernia is commonly visible around your belly button or navel as an ‘outie’, or it looks simply flat.

Hiatal Hernia

When the stomach pushes through a weak point in the diaphragm muscle, the bulge forms internally that you cannot see or feel.  Most people who experience a Hiatal hernia will show symptoms of ACID REFLUX and heartburn technically termed GERD or GastroEsophageal Reflux Disease. The vast majority (>95%) are not repaired surgically, but managed with acid blocking medicines.

Diastasis Recti

This bulge in the upper abdomen has the looks of an impressive hernia from just below the breastbone to just above and sometimes involves the umbilical hernia.  However this is refuted when one does an ultrasound or CT scan.  It turns out not to be a true hernia but just a weakness of the fascia, the ‘tire’ that protects the ‘inner tube’.

Incisional Hernia

The intestine or the omentum (a layer of fat that lies on top your internal organs) protrudes through the incision, which was made during a previous abdominal surgery results in an incisional hernia. If the stomach has bulges without having surgery earlier, it is not an incisional hernia, but an Epigastric Umbilical or Spigelian hernia also termed Ventral hernias.

Epigastric Hernia

Epigastric Hernia is a type of hernia that pushes the fatty tissue through the upper part of the abdominal wall. It appears above the umbilicus or belly button and the bulge is noticed and rarely painful. You can often feel the hole, perhaps the lump, or lumps and we may be able to push it back in.

Spigelian Hernia

This hernia occurs  below the umbilicus but not in the middle, usually off to the side a little.

Diaphragmatic Hernia

When one or more abdominal organs move through a birth defect opening in the diaphragm breathing muscles at the top of the abdomen. It is a very rare type of hernia and occurs in babies while they are still in the womb itself. This can also very rarely occur as a result of abdominal trauma like the extreme pressures during a car crash for example.  A common form is a hiatal hernia.

Why Do You Get Hernias?

Numerous factors might contribute to a hernia. The cause of hernia varies from birth defects to overstrain on the abdominal wall muscles. Each type of hernia occurs depending on congenital factors, weakness in the stomach muscles, and age.

Common causes of hernias include:

• Congenital condition
• Aging
• Weak abdominal muscles
• Obesity
• Injury from surgery
• Chronic cough
• Multiple pregnancies
• Lifting heavy objects
• Constipation and straining when passing stool

Symptoms of Hernia

A physical symptom of a hernia is the bulge, accompanied by pain in some cases. Sometimes, the bulge disappears when lying down and might reappear upon lifting heavy objects or coughing.

Despite not being fatal, if the bulge stays even if you push it in, it requires immediate treatment. Hernias may also cause:

• Pain either a dull ache or rarely sharper pain that usually disappears on pushing it back it or when lying down
• Bulge cannot be pushed back into the abdomen (Incarcerated hernia)
• Specific symptoms like heartburn, chest pain is also common in hiatal hernia.  The vast majority are not repaired surgically but treated with acid blockers.
• Pain or dull ache during bowel movements
• Pain increases as you move or lift objects
• Nausea
• Vomiting (You should go to hospital if you have this and a hernia)
• Fever
• Skin changes: hot or blue/black under the skin of the hernia (You should go to hospital if you have this and a hernia)

Diagnosis of Hernia

• Physical Examination:
  Your doctor does a thorough physical examination to feel the bulge. He/she will ask you to cough, and stand to examine the lump in your groin or stomach area.
• CT Scan:
  For conditions that are difficult to determine by physical examination, the doctor orders an X-ray image of the organs. Sometimes ordered if the hernia is exceptionally large.
• MRI Scan:
  Some hernia occurs due to the tear in the muscle. It is ordinary with sports, and athletes.  The muscle tear can be detected using an MRI scan.  This type of diagnosis also provides another way to look at the abdominal wall.  This is very rarely ordered. Some surgeons operate without a hernia being present.  We do not. We do not take care of sports hernias.  If there is no defect or bulge, we do not believe in operating on injured but healthy intact tissues, where no hernia is diagnosable.
• Ultrasound:
  Very commonly ordered if the bulge is not easily felt by feeling with a doctor’s hand.

When Should You Consult A Doctor for A Hernia?

A hernia is somewhat in between high-risk and low-risk diseases, but from a health standpoint, you should not ignore it. You might not know to differentiate if you are having a hernia or not, or if it is significant enough to need operation, but our guide can help you.

Ansa Healthcare is a Global Leader in Non-Mesh Hernia Repair.  Our treatment approach uses Non-plastic mesh, natural muscle - Shouldice Technique repair performed by experienced American Board of Surgery certified surgeons, using state of the art suture materials.

We believe in a partnership between patient and surgeon to effect a successful and optimal outcome to every surgery. We intend to narrow the knowledge gap between patient and surgeon to allow you to more fully participate in your care. Once you understand our philosophy for the surgical care we offer, you will be sure that we are the right choice for you.

At Ansa Healthcare, we encourage self-analysis and a thorough understanding of the physical health condition to help the patients to be confident on how to seek medical guidance for a hernia.

• If you notice a bulge that is visibly protruding from your original skin, seek a general consultation with your trusted health professional, perhaps your family or primary care doctor to find out if it is indeed a hernia.
• Sometimes the lump is in the abdomen or upper inner thigh. So, if you notice something abnormal and if it disappears when lying down, seek help from a trusted health professional and please contact us at nthr@ansahealthcare.com
• Also, when you try to lift something normal in your day-to-day activities, and if you experience pain at your groin, stomach, or between your upper inner thighs, please reach out to your trusted health care provider and our team at 1 (877) 681-6002.
• If, however, the pain is severe and doesn’t go away when you lie down and try to gently massage back inside go to the hospital and seek help there. This is especially important if you develop nausea and vomiting. If the hernia that you had for a time used to be painless now is causing pain and/or may be causing changes in the skin colour or becomes hot.
• Sometimes there are lumps under the skin (in the groin/armpits or neck) that can’t be made to go away or don’t go away with lying down, these can be enlarged lymph nodes (like the tonsils) seek out medical advice.

Self-diagnosis questions for hernia from Ansa Healthcare Surgeons:

• When did you notice the bulge? Does it hurt or is tender when you touch it?
• Any nausea or vomiting?
• Any trouble straining when passing stool or urine?
• Do you think of a particular reason that may have caused it to occur?
• Do you exercise vigorously or have lifted or regularly lift heavy weights?
• Do you have a history of smoking/coughing?
• Does your occupation involve heavy lifting?
• Do you have a personal history of hernias?
• Have you had any prior surgeries in the area of your abdomen or groin?

Complications of Hernia

When left untreated, a hernia worsens your pain and develops additional complications.

Strangulation:

If you continue to have pain that does not go away this can lead to compromising blood supply of the tissues in your hernia. Thus could put you in a life-threatening condition.

Incarceration:

When part of your intestine or the fatty tissue that lies on top of the bowel gets trapped through the hernia into your abdominal wall under the skin. When we cannot push it back inside, this is called incarceration.

Obstruction:

When the gut herniates it can lead to cramps, intestinal blockage and the easy passage of food and waste. This results in pain, nausea and vomiting, sometimes fever.

Traumatic Hernia:

The intense pressure or traumatic accidents damages the abdominal wall of the hernia. Sometimes seen on CT or MRI scan.

Hernia Treatments

Treating a hernia has become now very complex with the use of robotic surgery and super expensive and most times unnecessary implantation of mesh because of the emphasis on high-end technology in the healthcare industry.

Hernia surgeries can be open or keyhole, depending upon the associated complications. There are three types of hernia surgeries.

There are a variety of surgery methods for hernia repair. Our team at Natural Tissue Hernia Repair Associates provides safe, durable, effective hernia surgeries perfected over decades. We specialize in the Shouldice method, which was developed during World War II to keep recruits healthy enough for training. Read on to learn more about the procedure.  None of the advanced technical advances like robotic or laparascopic surgery has shown to to definitive at being superior, in fact in many aspects they are inferior.

 

Shouldice Technique Natural Tissue/No-Mesh Repair Surgery

(ANSA offers this technique)

The Shouldice repair - Natural Tissue and Hernia Repair has been refined over several decades and is the gold standard for the prosthesis, plastic free treatment of inguinal hernias. The Shouldice method is exceptionally safe, secure and reliable for hernia repair.

Ansa Health Care adheres to the Shouldice technique of repair. The incision itself depends on your size, but is generally only 3-4 inches in length. It is quite comfortable for patients after surgery. We prefer this 'open' technique of surgery as it allows your surgeon the best view of all your tissues at the surgery site. We are able to see nerves and vessels up close to manage them properly. In the repair of groin hernias we design a tailored (to you), hand sewn, continuous, meshwork of flexible, permanent, modern suture and is placed, in layers, into the floor of the inguinal canal. The muscles are gently placed without undue tension (pulling) into a flexible, vital, alive and reinforced framework next to each other using the inguinal ligament (forming the groin crease) at it's base.

At ANSA, we repair hernias of the abdominal wall (not internal hernias) directly with plastic surgery techniques using your own tissues to move them, without tension, into a new position and make the area of weakness, the hernia disappear.  No fancy robots, cameras, or mesh; tried, only true natural tissue hernia repair!

Learn more about no-mesh surgery.

 

Other surgery methods using artificial mesh (not offered at ANSA)

Minimal access surgery relies on newer laparoscopic or small (minimal access surgery) incision techniques. The thinking is that such minimal access incisions allows fixing of the hernia with minimal discomfort. We feel this compromises the view and the assessment your surgeon has of your tissues.

Open Surgery:

The cut or the surgical incision is made exactly at the location of the hernia and it’s contents, either intestines or omentum, reduced back into the abdomen where it belongs.  The abdominal wall is also checked for strength to hold the organs in to prevent a recurrence. If not, a mesh in rare cases, to maintain stability when the nearby tissues are too weak. This mesh related surgery has many complications .

Laparoscopic Surgery:

This advanced, is surgically easier, but not necessarily better technique. Instead of a straight cut on the weakened spot, laparoscopy uses small incisions and a camera and surgical instruments that are passed into the abdomen.  This fixes the hernia from the inside usually with plastic mesh.  Surgeons operate by looking at a screen. Although the recovery time is quicker for this surgery than open surgery, the surgeon is forced to implant plastic mesh into the abdomen to fix the weakness, even when nearby tissues are strong.  This is despite well accepted surgical techniques available like the Shouldice technique, where nearby tissues are used to fix the defect in the the abdominal wall.  These pieces of mesh are secured by clips or plastic screws into the abdominal wall.  They are prone to pulling through, infection, which may require removal of the mesh, shrinkage and ultimately failure of the repair.

Robotic Surgery:

The procedure is the similar to that of laparoscopy.   It uses the more complex surgical instruments and repair methods with artificial mesh most times.

To learn more about the risks and complications of mesh surgery, visit our Procedure page.

Contact ANSA Health Care

Reach out to ANSA to assure yourself of competent diagnosis, natural hernia repair with very low incidence of complications.

ANSA Contact Information:

Natural Tissue Hernia Repair Associates

33 Beverly Hills Dr.

Toronto ON M3L 1A2

 

Toll-Free Phone: 1 (877) 681-6002

Email: nthr@ansahealthcare.com