Demystifying hernias: Insights and expertise

In his latest online article, Mr Muhammed Hanif Shiwani gives us his insights into hernia. He talks about what it is, development, typical symptoms, different types of hernia and if they require different treatments, complications and recovery process.

What is a hernia and how does it develop?

A hernia, commonly known as a rupture, occurs when there is a breach in the muscular layer. There are two main types: external hernias, visible or palpable outside the body, and internal hernias. When patients refer to hernias, they typically mean external hernias, which manifest as a protrusion of the viscous layer through a weakened area in the abdominal muscle wall. This protrusion can result in swelling, discomfort, or pain. The exact cause of hernia development is not precisely understood, but weaker areas in the abdominal wall, such as the belly button or inguinal (groin) region, are more susceptible. Factors like pushing, pulling, increased abdominal pressure due to chronic coughing, heavy lifting, or straining during bowel movements contribute to the hernia by pushing the abdominal contents through the weakened muscle wall. In essence, a hernia is essentially a rupture in the abdominal muscle wall.

What are the typical symptoms of hernia?

A hernia may not always exhibit noticeable symptoms. Patients might discover a swelling around the belly button or groin during routine activities like washing or showering. This presentation can be subtle. On the other hand, hernias can also manifest dramatically, presenting as a sudden, painful lump that is firm, tender, and doesn't recede—this constitutes a medical emergency.

More commonly, patients experience a swelling around the belly button, groin area, or abdominal wall, causing discomfort. They become aware of the protrusion during activities that involve pushing, pulling, heavy exercise, or manual labour, leading to discomfort and pain, particularly during physical exertion. These symptoms are typical of hernias.

Are there different types of hernias and do they require different treatments?

There are various types of hernias, as mentioned earlier. Generally categorised as external hernias and internal hernias, the former occur in the abdominal wall—specifically around the belly button or groin, referred to as inguinal or femoral hernias. Occasionally, hernias develop in the scar tissue from previous surgeries, known as incisional hernias. These occur in weakened areas of the previously operated tummy wall, resulting in swelling. 

Incisional hernias are sometimes referred to as ventral hernias. It is common for patients to point to the solar plexus area, and claim to have a hernia. However, what they might be referring to is a hiatal hernia, which is not an external hernia. Hiatal hernias are internal and situated in the diaphragm, between the chest and the abdominal wall. Unlike external hernias, you cannot feel or see a hiatal hernia externally; it is internal.

What are the potential complications?

If left unattended, a hernia can lead to complications. As previously mentioned, hernias occur when the contents of the body cavity protrude through a weakened abdominal wall. This protrusion can obstruct the bowel, causing symptoms such as pain, nausea, vomiting, abdominal bloating, and constipation—the key indicators of intestinal obstruction. In severe cases, the blood supply to the protruded contents may be compromised, resulting in bowel strangulation. This constitutes a critical emergency, demanding immediate medical attention and intervention through emergency surgery to prevent life-threatening risks. While smaller hernias in less active individuals may not pose immediate problems if left untreated, physically active individuals with untreated hernias are more prone to serious complications.

What is the recovery process like after hernia surgery?

Hernia surgeries are typically performed under general anaesthesia, although certain cases may involve spinal anaesthesia. With spinal anaesthesia, patients are not fully unconscious; instead, a needle is inserted at the back of the spine to numb the lower half of the body, allowing for surgery to be conducted in that specific area.

Recovery experiences differ slightly between the two anaesthesia methods. General anaesthesia often necessitates 24-hour postoperative care, while spinal anaesthesia, when administered alone, may not require as much attention. However, if spinal anaesthesia is combined with sedation, patients may need someone to assist them for 24-48 hours after the procedure.

In general, the recovery period spans two to four weeks. Keyhole surgery, a minimally invasive approach, tends to result in less postoperative pain compared to open surgery. Painkillers may be needed for a few days to up to two weeks. It's advisable to refrain from lifting heavy weights for six weeks as the hernia operation site is in the process of healing, and the initial tissues are weaker and susceptible to breakdown, potentially leading to hernia recurrence. The overall recovery process typically involves two to four weeks, with a cautionary period of up to six weeks to avoid heavy lifting.

Mr Muhammed Hanif Shiwani is an esteemed general and laparoscopic surgeon with over 25 years of experience. You can schedule an appointment with Mr Shiwani on his Top Doctors profile.