Hernia - Everything You Need To Know About

What is a Hernia?

A hernia is a medical condition that occurs due to the weakening of muscle tissues in an organ near the abdomen causing the intestine or tissues to protrude through the weak spots nearby. Mostly, a hernia can occur in the abdomen between the chest and hips but can also appear in the upper thigh and groin areas. There are several reasons concerning the occurrence of a hernia. Some of them revolve around smoking, poor nutrition, chronic constipation, consuming tobacco etc. Although most hernias aren’t immediately severe, sometimes certain cases might require surgery to prevent life-threatening complications as they don’t go away on their own. A hernia can appear among people of any age group.

How do Hernias form?

A hernia forms when muscle tissues become weak or ruptured, causing internal organs like the intestines to protrude. Hernias can be classified into two categories which are, acquired and congenital. A person may be born with a hernia, or a hernia may be acquired from obesity or daily activities like heavy weightlifting, persistent sneezing or coughing and certain changes in lifestyle.

Types of Hernia

• Umbilical hernia
• Incisional hernia
• Femoral hernia
• Hiatal hernia
• Epigastric hernia

How are Hernias Caused ?

• Obesity
• Pregnancy
• Increased physical exertion in the abdomen
• Heavy and frequent coughing or sneezing
• Heavy or regular weightlifting
• Chronic Constipation

Hernia Symptoms

• A small lump initially in the affected area
• Discomfort or pain in the groin or abdomen while performing physical activities
• Discomfort while coughing or sneezing
• Constipation
• Discomfort while walking, sitting
• Burning and aching sensations in the abdomen of groin
• The lump might disappear or get reduced in size while lying down

Hernia Diagnosis

Hernia Test

If one consults a doctor for hernia, the doctor might carry out certain tests depending upon the symptoms and severity of the hernia. Generally, a physical examination is all it takes for the doctor to diagnose a hernia. However, in certain cases where the diagnosis isn’t clearly apparent, the doctor might prescribe an imaging test such as an abdominal ultrasound, CT scan or MRI.

Hernia Self-Diagnosis

A hernia can affect different areas of the body in different ways, although hernias in and around the abdomen or groin area are the most common types of hernia. During the initial stages, one might not feel any sort of pain or discomfort, however, they might experience a lump or swelling in and around the affected areas of the abdomen. The swelling or lump will be clearly visible while coughing, standing up or sitting down and the same lump or swelling might disappear or get reduced in size once the person lies down.

Hernia Diagnosis By Doctor

The only treatment to permanently repair a hernia is surgery. But, before opting for surgery, the doctor will physically examine the protruding area. For an accurate diagnosis, the patient might be asked to stand, strain or cough. The doctor might recommend watchful waiting in case the hernia isn’t painful and causing any discomfort. In most cases, doctors recommend a surgical repair of the hernia as hernias don’t generally repair themselves and can get worse with time, leading to severe life-threatening complications.

How Severe is Hernia?

Grade 1 – Formation of a Lump Around the Abdomen

Generally, in the first stage, a person might experience a lump or swelling in and around the areas of the abdomen. The lump will be clearly visible while straining, coughing, and carrying out other physical activities but the same lump might disappear or get reduced as soon as the person lies down. Initially, the person would not feel any sort of pain or discomfort.

Grade 2 – Small Bowel Obstruction

Gradually, the loop of the intestine becomes trapped, and one loses the ability to make the bulge flatten out. This can lead to several complications and can also involve severe pain and discomfort. Such cases can worsen over time and might require immediate medical attention. Generally, it is a bad idea to leave it untreated as it can lead to further swelling of the loop and eventual strangulation of the tissue or intestine that can be life-threatening.

Grade 3 – Incarceration or Strangulation

If the hernia resists manual pressure and can’t be popped back through the abdominal wall, it is known as a non-reducible hernia or strangulated hernia. At this stage, the hernia blocks the muscle tissue from inside, stopping blood circulation in the small intestine leading to infections in the dead cells. There might be signs like blood in stools, fatigue, fever, acute pain in the abdomen, nausea, vomiting and constant fever when a hernia becomes strangulated.

Prevention of Hernia

To prevent a hernia from developing, it is important to maintain a healthy body weight as an obese person is more likely to acquire a hernia. Certain other ways to prevent the occurrence of a hernia involve inclusion of high-fibre food in one’s diet, avoiding smoking, proper treatment of persistent coughing and sneezing, and using proper techniques while lifting heavy objects.

Which doctor to consult for Hernia?

The hernia in any given condition might not keep bulging, but neither will a hernia heal on its own. Delaying its treatment can result in severe complications as it wouldn’t even come with warning signs. The complications might appear suddenly which would lead the patient to be rushed in an emergency medical condition. If there is a noticeable bulge or protrusion accompanied by nausea, vomiting, fever or chills, or if one is unable to have a normal bowel movement, it might mean that the person is suffering from strangulated/incarcerated hernia and should immediately seek medical help.

Questions to ask your doctor for Hernia Treatment

• What is the best treatment for hernia?
• Is it necessary to place a mesh on the affected area?
• Can the hernia be repaired without placing a mesh?
• Is it safe to place the surgical mesh inside my body?
• What are the measures to be taken to ease the pain and discomfort?
• Will the anaesthesia have an effect on my body, given my health conditions?
• When will I be able to return to performing my daily activities?
• What are the possible chances of my hernia returning back?

Hernia Treatment Options & Cost

Non-Surgical Hernia Treatment

There are certain non-surgical treatment options to treating hernia that include medication and lifestyle changes. If a person is awaiting a surgery or is not fit for the surgery, they might be able to ease the pain or discomfort for a particular amount of time by wearing a corset, binder, or truss. However, these are temporary solutions as a hernia usually does not go away on its own without surgery.

Surgical Hernia Treatment

Undergoing a hernia repair surgery is the only treatment to permanently repair a hernia. If the hernia does not cause any pain or discomfort, the doctor may recommend a watchful waiting and continue observing the hernia until the patient is ready to undergo a surgery. In most cases, doctors recommend surgical repair of the hernia to prevent potential complications that can be life-threatening.

Types of Hernia Surgery

1)  Open Hernia Repair Surgery – This is the conventional and commonly performed hernia repair surgery around the globe. In an open surgery for hernia repair, the surgeon makes a cut or incision in the groin after which the hernia “sac” containing the bulging intestine is identified. The surgeon then pushes the hernia back into the abdomen and closes the abdominal wall with stitches. In case the opening is large, the surgeon may use a synthetic mesh to strengthen the closure through which the hernia protrudes.

2)  Laparoscopic Hernia Repair Surgery – This is comparatively a much-advanced procedure for inguinal hernia treatment. Laparoscopic hernia repair surgery, also known as minimally invasive surgery refers to the surgical procedure that is performed through tiny incisions instead of a large opening. The surgeon will make minute incisions depending upon the severity of the hernia, through which a thin laparoscope with a camera attached to it is inserted and the abdomen is inflated with a harmless gas (CO2), which creates space for the surgeon to view the internal structures. The surgeon in this procedure might use a synthetic mesh to strengthen the abdominal wall. After the procedure is completed, the small abdominal incisions are closed and within a month, the incisions are barely visible. Doctors don’t advise this procedure of hernia repair for children and pregnant women.

3)  Robotic Hernia Repair Surgery – A Robotic Hernia Repair Surgery is very similar to that of a laparoscopic hernia repair surgery as it uses a laparoscope that guides the surgeon to view inside the abdomen and repair the hernia. This type of surgery only differs from laparoscopic surgery to the extent that, in this type of surgery, the surgeon is seated at a console in the operating room and handles the surgical instruments from the console in the operation theatre. The use of the robot provides excellent three-dimensional images of the inside of the abdomen, and it allows the surgeon to use minimal stitches and place the artificial mesh to reconstruct the abdominal wall.

Preparing for Hernia Surgery

• As with most surgeries, preparation for hernia surgery will involve restrictions in terms of diet. To ensure a safe treatment, one will be asked to refrain from drinking water, food, or any other fluids for six hours prior to the treatment as food present within the digestive system might lead to certain complications during the surgery.
• While some drugs might be prescribed to be taken beforehand to aid the surgery, a certain number of drugs should be avoided for up to a week before the surgery because of the various effects they can have over the body.
• Drugs like aspirin, blood thinners, anti-inflammatory medications (arthritis medications) and Vitamin E should be avoided prior to a week before the surgery.
• Preoperative preparations include medical evaluations such as blood tests, chest x-rays and electrocardiography tests depending on the person’s age and medical condition.
• It is recommended to take a shower before going for the operation as the surgical area must be kept dry after the operation.

What to expect during Hernia Repair Surgery?

• The patient will be given a general anaesthesia so that the patient does not feel any sort of pain or discomfort during the surgery.
• Depending upon the severity of the given condition, small incisions will be made around the affected area, which will help the surgeon to push back the hernia inside.
• Through one of the incisions, the surgeon inserts a laparoscope which is a medical device having an inbuilt camera which enables them to view the internal structures.
• A surgical mesh is inserted through the incision which supports the damaged tissue around the hernia as it heals.
• After placing the mesh over the open hernia, the surgeon uses additional medical devices such as tacks, sutures, and surgical glue to hold the surgical mesh in its place.
• The small incisions are then closed with stitches or sutures that dissolve on their own over time.

What to expect after Hernia Repair Surgery?

•  It is best advised to avoid lifting anything that can make one strain and exert physical pressure for a particular time duration as it can lead the hernia to reoccur and can also invite certain other complications post the surgery.

• It is important to maintain a diet that includes a good amount of fibre and fluids after a hernia surgery or any surgery in general as it is best not to have constipation. It is always advisable to follow the diet prescribed by the doctor.

• The surgical area must be kept dry and clean for at least 48 hours and even if one takes a shower, the area surrounding the surgery should be pat dry to avoid any further infection.

• One should keep themselves hydrated and drink as much water as possible to avoid complications like constipation or straining during bowel movements.

Cost of a laparoscopic hernia surgery

The cost of a laparoscopic hernia surgery may vary depending on various factors such as the type of hernia, severity of the condition and hospitalization. The cost of a laparoscopic hernia repair surgery may vary between Rs 65,000 to Rs 1,25,000. To find out about a hernia surgery cost for yourself, you may contact the medical assistance team of a particular Pristyn Care clinic or hospital.

Comparison - Before and After Hernia Surgery

The intestine or the protruding tissues through the abdominal wall are pushed back and a surgical mesh is placed around the damaged tissue. Over a period of time, the hernia will itself. However, to prevent the hernia from recurring, it is extremely important to avoid physically stressful activities and take adequate precaution to get the most effective results.