How to heal hernia

Elaborating on the kinds of hernia, dr jayaraj mansard suggests surgery as the only treatment option

CHENNAI: The internal organs in the human body are surrounded by a wall of muscles and connective tissue that keeps the organs in place. For some people, a tear or hole develops in this wall and a part of one or more internal organs protrude or squeeze out of this hole. This condition is called hernia and the bulge so created is called a hernial sac. Hernia, if left untreated, can cause various complications, so it is important to recognise the symptoms and take timely action.

Types of hernia
Depending on the location of hernia, the cause and the organs involved, there are many types and sub-types of hernia. The major ones include:

• Inguinal Hernia: This is the most common hernia. In the groin area, there is a small hole to a canal (inguinal canal) through which tubes (blood vessels and cords) from the abdominal cavity to the groin region (scrotum/ labia) pass. This hole is larger, and the region might be weaker in some patients. In these patients, the intestine(s) or fat from within the abdomen can protrude into the groin region. It is more common in men than in women.
• Umbilical Hernia: There was a hole in all of us in childhood at the umbilicus, which closes after birth. The umbilical cord with blood vessels from the mother to the child has passed through this hole. In some patients, this hole does not close completely. When this region becomes weak, the intestine(s) or other abdominal content protrudes out through this hole. This is common in newborn, women who are obese and women who have had multiple childbirths.
• Incisional Hernia: The hole in the abdominal wall can be manmade. After any surgery in the abdominal cavity, if the wound does not heal properly, or if the sutures at the incision give way, the patient can develop an incisional hernia. The abdominal contents can protrude through the gap in the incision. Older people who have had open or incisional surgery in the abdomen area or obese people who are inactive after incisional surgery in the abdomen area are at risk of this condition. 
• Other hernias: There are various other points of weakness in the abdomen, through which a hernia can develop rarely. Femoral hernia, obturator hernia, lumbar hernia and spigelian hernias are some examples.
• Hiatal Hernia: The diaphragm is a wall of muscles that separates the chest and abdomen regions. This has a small gap or hiatus for the oesophagus to pass through. In this type of hernia, the upper part of the stomach pushes against this gap and bulges into the chest region.

Causes and risk factors
In some people, the muscles in the enclosing wall are weak since birth or become weak later in life due to poor nutrition. In such a scenario, a tear or hole in the wall develops easily. Then the weight of the organ nearby exerts a natural pressure causing the organ to bulge out of the hole. This is what causes hernia. There are various risk factors for hernia:

• Carrying or lifting heavy objects, repeatedly, with the wrong posture
• Diarrhoea or constipation
• Repeated vomiting
• Any health condition that causes persistent coughing or sneezing
• Cystic fibrosis (A condition in which the cells that produce mucous, digestive juices or sweat become sticky and block ducts and passageways.)
• Enlarged prostate
• Urinating or defecating with difficulty
• Poor eating habits that cause poor nutrition
• Cigarette smoking which weakens the muscles
• Obesity
• Chronic obstructive pulmonary disease or COPD
• Ascites in which fluid starts accumulating in the abdominal cavity
• A family history of hernias
• Peritoneal dialysis, one type of dialysis done on people with kidney failure
• Pregnancy
• Multiple childbirths
• Abdominal surgeries
• Un-descended testes
• Age of 50 years and above
• Being born prematurely or with a low birth-weight A combination of two or more of the above factors increases the risk further.

Symptoms
Depending on the type and severity of hernia, symptoms include:

•  A bulge or lump in the affected area
• The bulge disappears when you’re lying down
• Hernia can be felt by touch while standing up, bending down, sneezing or coughing
• Heartburn, chest pain and trouble swallowing
• Pain and discomfort that become worse when standing, bending over, straining or lifting heavy items
• Hernia aches but is not tender when touched

When to see a doctor?
Whenever a hernia is suspected, surgical consultation should be sought, so that the problem can be addressed before complications arise. An uncomplicated hernia can be treated safely in a planned intervention. A patient presenting with complications will require an emergency intervention with its associated risks.

Complications
All hernias can be divided into two types; the first is reducible wherein the hernia can be pushed back and the symptoms are not severe. The second type is irreducible or incarcerated, wherein the hernia cannot be pushed back. This type causes two major complications:

• Strangulation: Pressure at the neck of a hernia caused by the contents in the bulge impairs blood supply to the herniated part of the organ such as the intestine. This can cause ischemia and gangrene in the herniated area. This is a life-threatening situation and requires immediate surgery to reduce or repair the hernia.
• Obstruction: When part of the intestine herniates, the contents of the bowel cannot pass through the herniated part. This leads to obstruction in the bowel and is characterised by crampy abdominal pain, inability to defecate and vomiting. This too is a medical emergency and requires immediate surgery to reduce or repair the hernia.

Diagnosis and treatment
If you are showing any of the above symptoms, consult the gastroenterology department of a reputed hospital. A specialist will conduct one or more of these: a physical exam, ultrasound scan, CT scan, MRI scan, barium X-ray or endoscopy to rule out/confirm hernia.

Treatment includes medication to reduce the symptoms, followed by either:

Open Hernia Repair: Here, open surgery is done to access the herniated area and repair the condition. The abdominal content (intestine and abdominal fat) that is protruding outside replaced into the abdomen. The hernia defect is closed. A mesh is placed over the hole to provide additional support to the weakened area.

Laparoscopic Surgery: This is a minimally invasive surgery performed using an endoscope that has been fitted with a light and video camera. The minimally-invasive approach ensures a smaller incision which causes lesser pain and leads to a faster recovery when compared to open surgery.

(The writer is a senior consultant - gastro-intestinal surgeon, Department of Minimally Invasive Bariatric & Gastro-Intestinal Surgery, Gleneagles Global Health City, Chennai)