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Condition
Hernia
Class
Gastro-intestinal system
Description
If there is a weakness or a tear in the muscle surrounding the intestines in the abdomen, part of the intestine can push through the muscle wall and will appear as a lump under the skin. This lump is called a hernia or a rupture. Hernias commonly occur in the area of the groin but can occur anywhere on the abdomen or under some other weak point, like an operation scar. Hernias affect males and females of all ages, although some types of hernia are more common in males and occur more frequently in those over the age of 50.
Causes
A hernia occurs when part of the gut or intestine pushes out of a weak area in the body (abdominal) wall. Some experts believe that the weakness is caused by a deficiency of collagen in the muscle. Hernias can occur after lifting something heavy or as a result of a bout of strenuous coughing, but sometimes they just appear. Being overweight or pregnant can sometimes cause the intestine to push through the abdominal wall. If someone is badly constipated, straining to pass stools can also be a cause of a hernia.

The most common type of hernia is called an inguinal hernia in which a loop of intestine passes through a weakness in the inguinal canal, a narrow channel leading from the abdomen to the scrotum. The hernia appears as a swelling in the groin or scrotum. The fact that the inguinal canal is much larger in men than women means that inguinal hernias invariably affect men and male babies rather than women, although some women are affected.

Another common type of hernia is a femoral hernia where abdominal contents pass into the weak area of the femoral canal, a natural channel through which the large blood vessel (the femoral artery) for the leg passes. Femoral hernias occur more commonly in women, particularly those who are over weight.

An umbilical hernia occurs when the abdominal contents pass through a weakness in the muscle wall through which the umbilical cord passed near the navel. Umbilical hernias affect infants, particularly male infants, but may also occur in adults, particularly over weight or pregnant women.

An incisional hernia occurs as a result of a weakness in the abdominal wall following a surgical operation.
Symptoms
A small lump will appear in the area of the hernia. If it is an inguinal hernia, the lump will appear in the area of the groin or as a swelling in the scrotum. If it is a femoral hernia, the lump will appear on the upper and inner part of the thigh. A swelling will appear in the area of the navel if it is an umbilical hernia, or under an operation scar if it is an incisional hernia. The lump is not usually painful but it may ache. As time goes on, the lump will inevitably become larger.

Hernias are not usually serious. However, if too much intestine comes out of the abdomen, it can become squeezed or 'strangulated'. If this occurs, the blood supply to that part of the intestine may be cut off allowing gangrene to set in. This is extremely dangerous and can be life-threatening and requires urgent surgery.
Treatment
A hernia is usually treated by 'keyhole' surgery called a laparoscopic repair. The most common methods are transabdominal preperitoneal (TAPP) and a totally extraperitoneal (TEP) repair. In TAPP the surgeon cuts into the abdominal cavity and places a mesh over the hernia to reinforce the abdominal wall. In TEP, the abdominal cavity is not entered but a mesh is used to seal the hernia from outside the peritoneum (the thin membrane covering the organs in the abdomen). TEP is considered to be more difficult than TEPP, but may have fewer complications. Both TAPP and TEP are usually performed under a general anaesthetic. For most cases, the procedures are performed as day surgery, and the person can return to work within a fortnight.

While waiting for surgery, the person may be offered a truss which is a belt-like appliance with a pad that exerts pressure over the hernia. The pad prevents the intestine coming out into the hernia. A truss can help ease the discomfort of your hernia, but it will not cure it.
When to see your pharmacist
Some pharmacists and surgical appliance contractors provide a truss measuring and fitting service. If your doctor decides that you need a truss, you will be provided with a prescription stating the position of your hernia, whether it is a single or double hernia and the type of truss. When you take the prescription to your pharmacist or surgical appliance contractor, your waist will be measured and an appropriate truss will be ordered for you.
When to see your doctor
Consult your doctor if you suspect that you or a relative has a hernia that has not yet been diagnosed. Seek medical advice immediately if you experience extreme tenderness or redness in the area of the bulge, your hernia may have become strangulated and it should be treated urgently.
Living with a hernia
If your hernia is small and it is not causing discomfort then the best thing to do is to try to forget about it. The hernia will not repair itself, but it may remain stable and will not require any form of treatment.

To prevent the hernia from getting larger, try to avoid lifting heavy objects. Also, learn to lift things properly, bending your knees and keeping a straight back will reduce pressure on the abdomen and reduce the likelihood of the intestines being forced through the hernia and making it larger.

Take regular exercise and eat a well balanced diet, rich in fruit and fibre to maintain regular bowel movements, avoid constipation and so avoid straining when in the toilet.


Reviewed on 6 June 2010


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