Insights into hernia: Causes, symptoms, and treatment

In his latest online article, Mr Christian Macutkiewicz gives us his insights into hernia. He talks about the causes, symptoms, what a strangulated hernia is, the different types of hernia, ignoring a hernia and treatment.

What causes a hernia?

A hernia is a weakness in the abdominal wall muscles or fascia. It's caused often when we get older, and our muscles and tissues lose their elasticity. Professions involving significant force or exertion, such as labour-intensive jobs like plumbing or electrical work, often contribute to this condition. The weakened abdominal wall muscles can lead to a noticeable bulge, commonly occurring in areas like the groin or abdominal region.

What are the symptoms of a hernia?

The initial symptom people usually notice before any lumps appear is a sensation or pain in the hernia area. For groin hernias, some may feel a burning or pressure before the actual lump forms. In abdominal hernias, individuals might experience pins and needles or sharp pricks where the hernia is beginning. These are the early indicators. When a lump becomes visible, it confirms that something is bulging out, and often, coughing can make the bulge more noticeable.

What is a strangulated hernia?

A strangulated hernia is a severe type of hernia where a portion of the bowel or intraabdominal fat protrudes and becomes trapped at the hernia site. Strangulation occurs when the blood supply to the protruding bowel or fat is compromised, often due to a twist in the hernia, cutting off the blood flow.

If it involves fat, intense pain is common, and there may be a risk of infection, leading patients to seek medical attention. However, if it involves the bowel, it becomes highly dangerous. The bowel can only survive for about four hours without proper blood supply, making it crucial for individuals with an acutely painful and strangulated hernia to seek emergency medical care promptly. Emergency surgery is often necessary in such cases.

Are there different types of hernia?

Various types of hernias can occur depending on weaknesses in the abdominal wall. If you visualise the abdominal wall, particularly where the six-pack muscles are located, hernias can develop anywhere along that area. The most common hernias occur in the groin and are known as inguinal hernias. Hernias in the lumbar region or back are exceptionally rare. Additionally, individuals with significant reflux issues may experience hernias higher up in the diaphragm, distinct from abdominal wall hernias.

What happens if the hernia is ignored?

In cases of CHAPs in men, if a hernia lacks symptoms such as pain and other issues, the advice often given is to leave it untreated, especially when the hernias are small and not causing problems. The rationale behind this is that any surgery inherently carries risks, including a slight chance of causing scarring or hematoma, which is the collection of blood or fluid. Specifically in groin hernias, there is a minor risk (between two and five percent, depending on the technique used) of inducing chronic groin pain.

It's not mandatory to undergo hernia repair if the hernia is asymptomatic. However, if a symptomatic hernia is ignored, it is likely to enlarge over time. Fixing hernias when they are smaller is advantageous because it requires less dissection, a smaller mesh, and generally results in lower complication rates and less post-operative pain. Additionally, ignoring a hernia with bowel involvement could lead to incarceration and strangulation, posing a serious danger.

How is a hernia treated?

A hernia can be managed conservatively using an implement or truss, a device that pushes the hernia back into place. This approach is often recommended for individuals who are unwell with various medical issues that preclude them from undergoing surgery. However, for patients deemed fit for surgery, there are typically two options for hernia repair. The first option involves an open approach, where an incision is made above the hernia site, precisely where the bulge is most prominent. The second option utilises keyhole methods, involving the insertion of small ports into the abdomen to fix the hernia from within the abdominal wall. This minimally invasive approach, particularly favoured for groin hernias, is known for its reduced pain and quicker post-surgery recovery.

Mr Christian Macutkiewicz is an esteemed consultant general, HPB and laparoscopic surgeon with over 25 years of experience. You can schedule an appointment with Mr Macutkiewicz on his Top Doctors profile.