Hernia is a general term used to describe a bulge or protrusion of an organ through the structure or muscle that usually contains it.
There are many different types of hernias. The most familiar type are those that occur in the abdomen, in which part of the intestines protrude through the abdominal wall. This may occur in different areas and, depending on the location, the hernia is given a different name.
An inguinal hernia appears as a bulge in the groin and may come and go depending on the position of the person or their level of physical activity. It can occur with or without pain
. In men, the protrusion may descend into the scrotum. Inguinal hernias account for 80% of all hernias and are more common in men.
Femoral hernias are similar to inguinal hernias but appear as a bulge slightly lower. They are more common in women due to the strain of pregnancy
A ventral hernia is also called an incisional hernia because it generally occurs as a bulge in the abdomen at the site of an old surgical scar. It is caused by thinning or stretching of the scar tissue, and occurs more frequently in people who are obese or pregnant.
An umbilical hernia appears as a soft bulge at the navel (umbilicus). It is caused by a weakening of the area or an imperfect closure of the area in infants. This type of hernia is more common in women due to pregnancy, and in Chinese and black infants. Some umbilical hernias in infants disappear without treatment within the first year.
A hiatal or diaphragmatic hernia is different from abdominal hernias in that it is not visible on the outside of the body. With a hiatal hernia, the stomach bulges upward through the muscle that separates the chest from the abdomen (the diaphragm). This type of hernia occurs more often in women than in men, and it is treated differently from other types of hernias.
Causes and symptoms
Most hernias result from a weakness in the abdominal wall that either develops or that an infant is born with (congenital). Any increase in pressure in the abdomen, such as coughing, straining, heavy lifting, or pregnancy, can be a considered causative factor in developing an abdominal hernia. Obesity
or recent excessive weight loss, as well as aging
and previous surgery, are also risk factors.
Most abdominal hernias appear suddenly when the abdominal muscles are strained. The person may feel tenderness, a slight burning sensation, or a feeling of heaviness in the bulge. It may be possible for the person to push the hernia back into place with gentle pressure, or the hernia may disappear by itself when the person reclines. Being able to push the hernia back is called reducing it. On the other hand, some hernias cannot be pushed back into place, and are termed incarcerated or irreducible.
A hiatal hernia may also be caused by obesity, pregnancy, aging, or previous surgery. About 50% of all people with hiatal hernias do not have any symptoms. If symptoms exist they will include heartburn
, usually 30-60 minutes following a meal. There may be some mid chest pain due to gastric acid from the stomach being pushed up into the esophagus. The pain and heartburn are usually worse when lying down. Frequent belching and feelings of abdominal fullness may also be present.
Generally, abdominal hernias need to be seen and felt to be diagnosed. Usually the hernia will increase in size with an increase in abdominal pressure, so the doctor may ask the person to cough while he or she feels the area. Once a diagnosis of an abdominal hernia is made, the doctor will usually send the person to a surgeon for a consultation. Surgery provides the only cure for a hernia through the abdominal wall.
With a hiatal hernia, the diagnosis is based on the symptoms reported by the person. The doctor may then order tests to confirm the diagnosis. If a barium swallow is ordered, the person drinks a chalky white barium solution, which will help any protrusion through the diaphragm show up on the x ray that follows. Currently, a diagnosis of hiatal hernia is more frequently made by endoscopy. This procedure is done by a gastroenterologist (a specialist in digestive diseases). During an endoscopy the person is given an intravenous sedative and a small tube is inserted through the mouth, then into the esophagus and stomach where the doctor can visualize the hernia. The procedure takes about 30 minutes and usually causes no discomfort. It is done on an outpatient basis.
Once an abdominal hernia occurs it tends to increase in size. Some patients with abdominal hernias wait and watch for a while prior to choosing surgery. In these cases, they must avoid strenuous physical activity such as heavy lifting or straining with constipation
. They may also wear a truss, which is a support worn like a belt to keep a small hernia from protruding. People can tell if their hernia is getting worse if they develop severe constant pain, nausea and vomiting
, or if the bulge does not return to normal when lying down or when they try to gently push it back in place. In these cases they should consult with their doctor immediately. But, ultimately, surgery is the treatment in almost all cases.
There are risks to not repairing a hernia surgically. Left untreated, a hernia may become incarcerated, which means it can no longer be reduced or pushed back into place. With an incarcerated hernia the intestines become trapped outside the abdomen. This could lead to a blockage in the intestine. If it is severe enough it may cut off the blood supply to the intestine and part of the intestine might actually die.
When the blood supply is cut off, the hernia is termed "strangulated." Because of the risk of tissue death (necrosis) and gangrene
, and because the hernia can block food from moving through the bowel, a strangulated hernia is a medical emergency requiring immediate surgery. Repairing a hernia before it becomes incarcerated or strangulated is much safer than waiting until complications develop.
Surgical repair of a hernia is called a herniorrhaphy. The surgeon will push the bulging part of the intestine back into place and sew the overlying muscle back together. When the muscle is not strong enough, the surgeon may reinforce it with a synthetic mesh.
Surgery can be done on an outpatient basis. It usually takes 30 minutes in children and 60 minutes in adults. It can be done under either local or general anesthesia and is frequently done with a laparoscope. In this type of surgery, a tube that allows visualization of the abdominal cavity is inserted through a small puncture wound. Several small punctures are made to allow surgical instruments to be inserted. This type of surgery avoids a larger incision.
A hiatal hernia is treated differently. Medical treatment is preferred. Treatments include:
- avoiding reclining after meals
- avoiding spicy foods, acidic foods, alcohol, and tobacco
- eating small, frequent, bland meals
- eating a high-fiber diet.
There are also several types of medications that help to manage the symptoms of a hiatal hernia. Antacids
are used to neutralize gastric acid and decrease heartburn. Drugs that reduce the amount of acid produced in the stomach (H2 blockers) are also used. This class of drugs includes famotidine (sold under the name Pepcid), cimetidine (Tagamet), and ranitidine (Zantac). Omeprazole (Prilosec) is not an H2 blocker, but is another drug that suppresses gastric acid secretion and is used for hiatal hernias. Another option may be metoclopramide (Reglan), a drug that increases the tone of the muscle around the esophagus and causes the stomach to empty more quickly.
There are alternative therapies for hiatal hernia. Visceral manipulation, done by a trained therapist, can help replace the stomach to its proper positioning. Other options in addition to H2 blockers are available to help regulate stomach acid production and balance. One of them, deglycyrrhizinated licorice (DGL), helps balance stomach acid by improving the protective substances that line the stomach and intestines and by improving blood supply to these tissues. DGL does not interrupt the normal function of stomach acid.
As with traditional therapy, dietary modifications are important. Small, frequent meals will keep pressure down on the esophageal sphincter. Also, raising the head of the bed several inches with blocks or books can help with both the quality and quantity of sleep.
Abdominal hernias generally do not recur in children but can recur in up to 10% of adult patients. Surgery is considered the only cure, and the prognosis is excellent if the hernia is corrected before it becomes strangulated.
Hiatal hernias are treated successfully with medication and diet modifications 85% of the time. The prognosis remains excellent even if surgery is required in adults who are in otherwise good health.
Some hernias can be prevented by maintaining a reasonable weight, avoiding heavy lifting and constipation, and following a moderate exercise
program to maintain good abdominal muscle tone.
Bare, Brenda G., and Suzanne C. Smeltzer. Brunner and Suddarth's Textbook of Medical-Surgical Nursing. 8th ed. Philadelphia: Lippincott-Raven Publishers, 1996.
— A diagnostic procedure in which a tube is inserted through the mouth, into the esophagus and stomach. It is used to visualize various digestive disorders, including hiatal hernias.
— A hernia that can not be reduced, or pushed back into place inside the intestinal wall.
— A hernia that can be gently pushed back into place or that disappears when the person lies down.
— A hernia that is so tightly incarcerated outside the abdominal wall that the intestine is blocked and the blood supply to that part of the intestine is cut off.
the abnormal protrusion of part of an organ or tissue through the structures normally containing it. adj., adj
her´nial. A weak spot or other abnormal opening in a body wall permits part of the organ to bulge through. A hernia may develop in various parts of the body, most commonly in the region of the abdomen (abdominal hernia),
and may be either acquired or congenital. An old popular term for hernia is rupture,
but this term is misleading because it suggests tearing and nothing is torn in a hernia. Although various supports and trusses can be tried in an effort to contain the hernia, the best treatment for this condition is herniorrhaphy
, surgical repair of the weakness in the muscle wall through which the hernia protrudes.
congenital posterolateral diaphragmatic hernia
, with extrusion of bowel and other abdominal viscera into the thorax; due to failure of closure of the pleuroperitoneal hiatus.
cerebral hernia (hernia ce´rebri) protrusion of brain substance through a defect in the skull.
fat hernia hernial protrusion of peritoneal fat through the abdominal wall.
protrusion of a loop of intestine into the femoral canal, a tubular passageway that carries nerves and blood vessels to the thigh; this type occurs more often in women than in men. Called also crural hernia
) protrusion of a structure, often a portion of the stomach, through the esophageal hiatus of the diaphragm; see diaphragmatic hernia
an inguinal hernia
that has turned outward into the groin.
a hernia so occluded that it cannot be returned by manipulation; it may or may not become strangulated. Called also irreducible hernia
incisional hernia hernia after operation at the site of the surgical incision, owing to improper healing or to excessive strain on the healing tissue; such strain may be caused by excessive muscular effort, such as that involved in lifting or severe coughing, or by obesity, which creates additional pressure on the weakened area.
hernia occurring in the groin, or inguen, where the abdominal folds of flesh meet the thighs. It is often the result of increased pressure within the abdomen, whether due to lifting, coughing, straining, or accident. Inguinal hernia accounts for about 75 per cent of all hernias.
A sac formed from the peritoneum and containing a portion of the intestine or omentum, or both, pushes either directly outward through the weakest point in the abdominal wall (direct hernia) or downward at an angle into the inguinal canal (indirect hernia). Indirect inguinal hernia
(the common form) occurs more often in males because it follows the tract that develops when the testes descend into the scrotum before birth, and the hernia itself may descend into the scrotum. In the female, the hernia follows the course of the round ligament of the uterus.
Inguinal hernia begins usually as a small breakthrough. It may be hardly noticeable, appearing as a soft lump under the skin, no larger than a marble, and there may be little pain. As time passes, the pressure of the contents of the abdomen against the weak abdominal wall may increase the size of the opening and, accordingly, the size of the lump formed by the hernia. In the early stages, an inguinal hernia is usually reducible—it can be pushed gently back into its normal place. Inguinal hernia usually requires herniorrhaphy
intra-abdominal hernia (intraperitoneal hernia) a congenital anomaly of intestinal positioning, occurring within the abdomen, in which a portion of bowel protrudes through a defect in the peritoneum or, as a result of abnormal rotation of the intestine during embryonic development, becomes trapped in a sac of peritoneum.
an intra-abdominal hernia
in which the small intestine rotates incompletely during development and becomes trapped within the mesentery of the colon.
congenital retrosternal diaphragmatic hernia
, with extrusion of tissue into the thorax through the foramen of Morgagni.
paraesophageal hernia hiatal hernia
in which part or almost all of the stomach protrudes through the hiatus into the thorax to the left of the esophagus, with the gastroesophageal junction remaining in place.
Paraesophageal hernia. From Dorland's, 2000.
posterior vaginal hernia
downward protrusion of the pouch of Douglas, with its intestinal contents, between the posterior vaginal wall and the rectum; called also enterocele
. See illustration.
Posterior vaginal hernia. From McKinney et al., 2000.
reducible hernia one that can be returned by manipulation.
sliding hernia hernia of the cecum (on the right) or the sigmoid colon (on the left) in which the wall of the viscus forms a portion of the hernial sac, the remainder of the sac being formed by the parietal peritoneum.
sliding hiatal hernia
the most common type of diaphragmatic hernia
; a hiatal hernia
in which the upper stomach and the cardioesophageal junction protrude upward into the posterior mediastinum. The protrusion, which may be fixed or intermittent, is partially covered by a peritoneal sac.
Sliding hiatal hernia. From Dorland's, 2000.
strangulated hernia one that is tightly constricted. As any hernia progresses and bulges out through the weak point in its containing wall, the opening in the wall tends to close behind it, forming a narrow neck. If the neck becomes pinched tight enough to cut off the blood supply, the hernia will quickly swell and become strangulated. This is a very dangerous condition that can appear suddenly and requires immediate surgical attention. Unless the blood supply is restored promptly, gangrene can set in and may cause death. If a hernia suddenly grows larger, becomes tense, and will not go back into place, and there is pain and nausea, it is strangulated. Occasionally, especially in the elderly, hernia strangulation may occur without pain or tenderness.
hernia into the vagina; called also colpocele
hernia (her'ne-a ) [L. hernia, rupture]
COMMON LOCATIONS OF HERNIAS
The protrusion of an anatomical structure through the wall that normally contains it. Synonym: rupture
(2) See: illustration
Hernias may be caused by congenital defects in the formation of body structures, defects in collagen synthesis and repair, trauma, or surgery. Conditions that increase intra-abdominal pressures, e.g., pregnancy, obesity, weight lifting, straining (the Valsalva maneuver), and abdominal tumors, may also contribute to hernia formation.
Surgical or mechanical reduction is the treatment of choice.
ABDOMINAL WALL HERNIA
A hernia through the abdominal wall. See: illustration
A hernia that develops any time after birth in contrast to one that is present at birth (congenital hernia).
The protrusion of the bladder or part of the bladder through a normal or abnormal orifice. Synonym: cystic hernia
Cloquet hernia See: Cloquet, Jules G.
A hernia in which the sac and its contents have passed through the aperture.
A hernia that is not easily palpated.
A hernia existing from birth.
A hernia that protrudes behind the femoral sheath. Synonym: femoral hernia.
cystic herniaBladder hernia.
Herniation of abdominal contents into the thoracic cavity through an opening in the diaphragm. The condition may be congenital, acquired (traumatic), or esophageal.
direct inguinal herniaInguinal hernia.
The protrusion of an intestinal congenital diverticulum.
A scrotal protrusion that, enveloped in its own sac, passes into the tunica vaginalis.
A hernia through a defect in the linea alba above the umbilicus.
Protrusion of muscular tissue through its fascial covering.
The prolapse of fat from its normal, anatomical position, e.g., from behind the peritoneum into the inguinal canal.
femoral herniaCrural hernia.
The protrusion of the stomach into the chest through the esophageal hiatus of the diaphragm. ;
A hernia in which the presenting content cannot be returned to its site of origin, e.g., a hernia in which a segment of intestine cannot be returned to the abdominal cavity. It may produce pain or intestinal obstruction. If left untreated, an incarcerated hernia may cause strangulation of the bowel.
A hernia through a surgical scar.
A hernia that has not gone completely through the aperture.
indirect inguinal herniaInguinal hernia.
The protrusion of a hernial sac containing intraperitoneal contents (e.g., intestine, omentum, or ovary) at the superficial inguinal ring. In an indirect inguinal hernia, the sac protrudes lateral to the inferior epigastric artery through the internal inguinal ring into the inguinal canal, often descending into the scrotum (in males) or labia (in females). In a direct inguinal hernia, the sac protrudes through the abdominal wall within Hesselbach's triangle, a region bounded by the rectus abdominis muscle, inguinal ligament, and inferior epigastric vessels. The sliding hernia is a kind of indirect inguinal hernia, in which a portion of the wall of the protruding cecum or sigmoid colon is part of the sac, the rest composed of parietal peritoneum. Femoral hernias occur where the femoral artery passes into the femoral canal. Indirect and direct inguinal hernias and femoral hernias are collectively referred to as groin hernias. Inguinal hernias account for about 80% of all hernias. Synonym: direct inguinal hernia
; indirect inguinal hernia
; hernia inguinalis
; lateral hernia
; medial hernia
; oblique hernia
Preoperative: The surgical procedure and expected postoperative course are explained to the patient. The patient should understand that the surgery will repair the defect caused by the hernia but that surgical failures can occur. If the patient is undergoing elective surgery, recovery usually is rapid; if no complications occur, the patient probably will return home the same day as surgery and usually can resume normal activity within 4 to 6 weeks. Patients who undergo emergency surgery for a strangulated or incarcerated hernia may remain hospitalized longer commensurate with the degree of intestinal involvement. The patient is prepared for surgery.
Postoperative: Vital signs are monitored. The patient is instructed on the changing of position to avoid undue stress on the wound area. Stool softeners may be administered to prevent straining during defecation, and the patient is instructed in their use. Early ambulation is encouraged, but other physical activities are modified according to the surgeon's instructions. The patient should void prior to discharge and be able to tolerate oral fluids. The patient is taught to check the incision and dressing for drainage, inflammation, and swelling and to monitor his/her temperature for fever, any of which should be reported to the surgeon. Analgesics are administered as prescribed, and the patient is taught about their use and supplied with a prescription for home use. Male patients are advised that scrotal swelling can be reduced by supporting the scrotum on a rolled towel and applying an ice bag. The patient is warned to avoid lifting heavy objects or straining during bowel movements. Drinking plenty of fluids should help the patient prevent constipation and maintain hydration. The patient is advised to make and keep a postoperative surgical visit and to resume normal activity and return to work only as permitted by the surgeon.
hernia inguinalisInguinal hernia.
A hernia that is both femoral and inguinal.
A hernia that occurs within the abdominal cavity. It may be intraperitoneal or retroperitoneal.
A form of inguinal hernia in which the hernial sac lies between the layers of the abdominal muscles.
A hernia that cannot be returned to its original position out of its sac by manual methods. See: incarcerated hernia
The protrusion of a loop of bowel or other intraperitoneal organ into the labia majora.
lateral herniaInguinal hernia.
A hernia through the inferior lumbar triangle (Petit) or the superior lumbar triangle (Grynfelt). It occurs most often in association with surgery on the kidneys or ureters.
medial herniaInguinal hernia.
A hernia between the layers of the mesocolon.
A hernia into the canal of Nuck.
oblique herniaInguinal hernia.
A hernia through the obturator foramen.
A hernia containing a portion of the omentum.
The presence of an ovary in a hernial sac.
A hernia in the abdominal wall adjacent to a constructed stoma, e.g., a colostomy or iliostomy.
A hernia projecting through the diaphragm into one of the pleural cavities.
posterior vaginal hernia
A hernia of Douglas' sac downward between the rectum and posterior vaginal wall. Synonym: enterocele
A hernia located between the parietal peritoneum and the transversalis fascia.
REDUCIBLE HERNIA: Umbilical Hernia
REDUCIBLE HERNIA: Hernia reduces with digital pressure
A hernia whose contents can be replaced by manipulation. See: illustration
A hernia protruding into the retroperitoneal space, e.g., duodenojejunal hernia, Treitz's hernia.
A hernia in which only a portion of intestinal wall protrudes, the main portion of the intestine being excluded from the hernial sac and the lumen remaining open. The patient may present with groin swelling and vague abdominal complaints; when incarcerated the hernia may produce bowel ischemia and related complications.
A hernia that descends into the scrotum.
A hernia in which a portion of the wall of the herniated structure forms part of the hernia sac, e.g. an inguinal hernia in which a wall of the cecum or sigmoid colon forms a portion of the sac, the remainder of the sac being parietal peritoneum.
A defect that occurs at or below the linea semicircularis but above the point at which the inferior epigastric vessels cross the lateral border of the rectus abdominis muscle. This type of hernia may contain preperitoneal fat or may be a peritoneal sac containing intraperitoneal contents. It is rare and difficult to diagnose unless large, because it is typically not palpable when small. Large Spigelian hernias may be mistaken for sarcomas of the abdominal wall. Ultrasonography or computed tomography scans are often used in diagnosis.
Small Spigelian hernias are easily repaired; larger ones may require a prosthesis.
sports herniaAthletic pubalgia.
A hernia in which the protruding viscus is so tightly trapped that gangrene results, requiring prompt surgery. Once strangulation of the contents occurs, a nonsurgical attempt to reduce it may severely compromise treatment and outcome.
Protrusion of a portion of synovial membrane through a tear in the stratum fibrosum of a joint capsule.
A hernia occurring at the navel, seen mostly in children. Usually it requires no therapy if small and asymptomatic. An umbilical hernia usually resolves when the child begins to walk (and muscles strengthen).
The presence of the uterus in the hernial sac.
vaginal herniaPelvic organ prolapse.
A hernia of a viscus into the posterior end of the labia majora.
Patient discussion about hernia
Q. do you know of a good gastro doctor in staten island ny. I have acid refex so bad cant sleep, or lay flat.. years ago was told I had a hiatus hernia, and would only have fLare ups once in a while, have taken nexium for years, and it worked, but not anymore.. I really need to find a good doctor to test me again.
A. yazmine, if you want, you can try consume daily yogurt with a little apple cider vinegar in it (just add 5ml of ACV in your yogurt). some of gastric problems are believed to be caused by some bacteria. apple cider vinegar will help regulate the normal condition inside your gastric mucosa, so that for the long run it probably can help improve your condition.
Q. I have a low back pain that radiates to my leg when i pick up stuff. Is it a disc herniation? I am a 43 years old bank teller. During the past 5 months I've suffered from a low back pain. The pain is not very strong, but it gets much worse while doing physical activity. When i walk or lift heavy things the pain is even stronger, and it radiates to my left leg. Can it be signs for disc herniation?
A. It's possible that you have a nerve impingement from a disc herniation, but not necessarily so. What you need to know is that even if you have a herniated disc, the question is what would the recommended treatment be? More discussions about hernia
90% or more of herniated discs resolve without surgical treatment within 6 months. MRI imaging is generally only indicated if one is considering surgery; in other words, your pain and neurological status is such that surgery is clinically indicated. Then, an MRI may be helpful for the surgeon. If surgery is not indicated based on clinical/symptoms, then it probably is unwise to get an MRI. They often show abnormalities that are simply 'red herrings' and often prompt people to proceed with surgery that really is not needed. Beware!