Introduction
A hernia is an abnormal
protrusion of internal organs through an abnormal opening in the wall of the
cavity. A combination of increased pressure inside the body with weakness in
the wall is responsible for this condition. In this condition internal organs
or parts of organs are protruded out forming a swelling that will increase the
size with coughing and lifting weight, and while passing stool and urine. In
lying down position the swelling goes inside except in strangulated and
irreducible hernia.
Causes:-
1) Weakness in the body
wall:--
a) Congenital weakness.
b) Acquired weakness due
to injuries, wasting of muscles, suppurative lesions in the wall and presence
of weak natural openings, obesity, lack of exercise, repeated pregnancy.
c) Surgical operation
with improper suturing or sepsis of operated site.
2) Increased pressure
inside the body.
a) Chronic constipation.
b) Recurrent cough.
c) Weight lifting.
d) Stricture of urethra.
Common sites for
hernia:--
Hernia can occur
anywhere in the body. However there are some common sites for hernia. Due to
the presence of hard bony covering the chest wall is normally not affected. Hernia
in the lower back is also rare due to spine and back muscles and tough
ligaments and sheaths. The common site for hernia is the abdominal wall. Compared
to other parts the abdominal wall is weak due to the presence of some natural
orifices. There are some areas wherein the abdominal muscles are weaker and
thin and all these factors make a chance for herniation. The common sites for
hernia are the following.
a) Inguinal hernia:
Here the abdominal
contents protrude through the inguinal canal (passage in the lower abdominal
wall just above the inguinal ligament.It is seen on either side). This type is
common in males. Initially the swelling comes only while straining and goes
back while lying down. Later the large portion of the intestine may come out
which may not go back easily.
b) Femoral hernia:
This type of hernia is
more in females. Here the abdominal contents pass through the femoral canal
which is seen just below the junction between the thigh and lower abdominal
wall(Inside the femoral triangle). The contents pass downwards and come out
through the saphenous opening in the thigh and forms a swelling under the skin.
c) Umbilical hernia:
This is common in
children. The umbilicus is the weaker part of the abdomen. The contents of the
abdomen may protrude as a bulb-like swelling while crying and defecating.
d) Incisional hernia:
These hernias are seen
in operated sites. Due to improper suturing or sepsis the operated site becomes
weak resulting in a hernia.
e) Epigastric hernia:
Here the herniation
occurs in the epigastrium. It is a rare type.
f) Lumbar hernia:
Here the hernia appears
in the lumbar area on either side of the lumbar spine(in the lumbar triangle). This
is also a rare type.
g) Obturator hernia:
This is a rare type of
hernia. Here the contents pass through obturator foramen in the pelvic bone.
Complications of
hernia:--
1) Strangulation:
If the hernial orifice
is narrow the abdominal contents may not go back easily, and later the blood
flow to the herniated tissues may be blocked due to constriction. This can
cause the death of protruded intestine.
2) Intestinal
obstruction:
This occurs when the
whole portion of the intestine is protruded into the hernial sac. The narrow
hernial orifice will block the passage of bowels.
3) Infection and
peritonitis:
If there is
strangulation with the death of a portion of intestine there will be spread of
infection to the abdomen resulting in peritonitis.
Treatment of hernia:--
Initial treatment: In
the initial stages of hernia the following steps may be useful
1) Use of hernia belt:
Special types of hernia
belts are available for each type of hernia. This will prevent the protrusion
and will reduce pain.
2) Constipation, recurrent
cough, urinary obstruction, etc should be treated.
3) Fat reduction will
increase the strength of the abdominal wall.
4) Abdominal exercises
to increase the muscle tone.
5) Take plenty of leafy
vegetables, fruits and fibrous diet for easy bowel movements.
6) Try other systems
like Homoeopathy, Herbal medicine,etc..
If no relief by the
above steps consult a general surgeon for surgical management.
Surgical treatment.
The following operations
are done depending upon the type and nature of hernia.
1) Hertniotomy: In this
operation, the contents of hernial sac is pushed into the abdomen and neck of
the sac is ligated with transfixion ligature and the sac is cut off.
2) Herniorrhaphy: Here
along with herniotomy the posterior wall is repaired.
3) Hernioplasty: This
operation is done if herniotomy is not possible due to the wide neck of the
sac. Here the repair is done with the help of non-absorbable materials like
tantalum gauze, polypropylene mesh or stainless steel mesh.