What is an abdominal hernia?
An abdominal hernia occurs when an organ or other piece of tissue protrudes through a weakening in one of the muscle walls that enclose the abdominal cavity. The sac that bulges through the weak area may contain a piece of intestine or fatty lining of the colon (omentum) if the hernia occurs in the abdominal wall or groin. If the hernia occurs through the diaphragm, the muscle that separates the chest from the abdomen, part of the stomach may be involved.
The abdominal wall is made up of layers of different muscles and tissues. Weak spots may develop in these layers to allow contents of the abdominal cavity to protrude or herniate. The most common abdominal hernias are in the groin (inguinal hernia), in the diaphragm (hiatal hernia), and the belly button (umbilical hernia). Hernias may be present at birth (congenital), or they may develop at any time thereafter (acquired).
What are the different types of abdominal hernias?
1. Hernias of the abdominal and pelvic floor.
▪️ Inguinal hernias.
are the most common of the abdominal hernias. The inguinal canal is an opening that allows the spermatic cord and testicle to descend from the abdomen into the scrotum as the fetus develops and matures. After the testicle descends, the opening is supposed to close tightly, but sometimes the muscles that attach to the pelvis leave a weakened area. If later in life there is a stress placed on that area, the weakened tissues can allow a portion of small bowel or omentum to slide through that opening, causing pain and producing a bulge. Inguinal hernias are less likely to occur in women because there is no need for an opening in the inguinal canal to allow for the migration and descent of testicles.
▪️ A femoral hernia.
may occur through the opening in the floor of the abdomen where there is space for the femoral artery and vein to pass from the abdomen into the upper leg. Because of their wider bone structure, femoral hernias tend to occur more frequently in women.
▪️ Obturator hernias.
are the least common hernia of the pelvic floor. These are mostly found in women who have had multiple pregnancies or who have lost significant weight. The hernia occurs through the obturator canal, another connection of the abdominal cavity to the leg, and contains the obturator artery, vein, and nerve.
2. Hernias of the anterior abdominal wall.
The abdominal wall is made up of two sets of muscles on each side of the body that mirror each other. They include the rectus abdominus muscles, the internal obliques, the external obliques, and the transversalis.
▪️ Epigastric hernias.
When epigastric hernias occur in infants, they occur because of a weakness in the midline of the abdominal wall where the two rectus muscles join together between the breastbone and belly button. Sometimes this weakness does not become evident until later in adult life as it appears as a bulge in the upper abdomen. Pieces of bowel, fat, or omentum can become trapped in this type of hernia.
▪️ Umbilical hernias.
The belly button, or umbilicus, is where the umbilical cord attached the fetus to mother allowing blood circulation to the fetus. Umbilical hernias cause abnormal bulging in the belly button and are very common in newborns and often do not need treatment unless complications occur. Some umbilical hernias enlarge and may require repair later in life.
▪️ Spigelian hernias.
occur on the outside edges of the rectus abdominus muscle and are rare.
▪️ Incisional hernias.
occur as a complication of abdominal surgery, where the abdominal muscles are cut to allow the surgeon to enter the abdominal cavity to operate. Although the muscle is usually repaired, it becomes a relative area of weakness, potentially allowing abdominal organs to herniate through the incision.
▪️ Diastasis recti is not a true hernia but rather a weakening of the membrane where the two rectus abdominus muscles from the right and left come together. The diastasis causes a bulge in the midline. It is different than an epigastric hernia because, the diastasis does not trap bowel, fat, or other organs inside it.
3. Hernias of the diaphragm.
▪️ Hiatal hernias.
occur when part of the stomach slides through the opening in the diaphragm where the esophagus passes from the chest into the abdomen.
▪️ A sliding hiatal hernia.
is the most common type and occurs when the lower esophagus and portions of the stomach slide through the diaphragm into the chest.
▪️ Paraesophageal hernias.
occur when only the stomach herniates into the chest alongside the esophagus. This can lead to serious complications of obstruction or the stomach twisting upon itself (volvulus).
▪️ Traumatic diaphragmatic hernias.
may occur due to major injury where blunt trauma weakens or tears the diaphragm muscle, allowing immediate or delayed herniation of abdominal organs into the chest cavity. This may also occur after penetrating trauma from a stab or gunshot wound. Usually these hernias involve the left diaphragm because the liver, located under the right diaphragm, tends to protect it from herniation of bowel.
▪️ Congenital diaphragmatic hernias.
are rare and are caused by failure of the diaphragm to completely form and close during fetal development. This can lead to failure of the lungs to fully mature, and it leads to decreased lung function if abdominal organs migrate into the chest.
▪️ The most common type is a Bochdalek hernia at the side edge of the diaphragm.
▪️ Morgagni hernias are even rarer and are a failure of the front of the diaphragm.
_ The most common symptom of a hernia is a bulge or lump in the affected area. For example, in the case of an inguinal hernia, you may notice a lump on either side of your pubic bone where your groin and thigh meet.
_ You may find that the lump “disappears” when you’re lying down. You’re more likely to feel your hernia through touch when you’re standing up, bending down, or coughing. Discomfort or pain in the area around the lump may also be present.
_ Some types of hernia, such as hiatal hernias, can have more specific symptoms. These can include heartburn, trouble swallowing, and chest pain.
_ In many cases, hernias have no symptoms. You may not know you have a hernia unless it shows up while you’re undergoing a medical exam for an unrelated problem or a routine physical.
Hernias are caused by a combination of muscle weakness and strain. Depending on its cause, a hernia can develop quickly or over a long period of time.
Some common causes of muscle weakness or strain that can lead to a hernia include:
▪️ a congenital condition, which occurs during development in the womb and is present from birth.
▪️ damage from an injury or surgery.
▪️ strenuous exercise or lifting heavy weights.
▪️ chronic coughing or chronic obstructive pulmonary disorder (COPD).
▪️ pregnancy, especially having multiple pregnancies.
▪️ constipation, which causes you to strain when having a bowel movement.
▪️ being overweight or having obesity.
Risk Factors .
There are also certain risk factors that make you more likely to develop a hernia. They include:
▪️ being born prematurely or having a low birth weight.
▪️ being older.
▪️ chronic cough (likely due to the repetitive increase in abdominal pressure).
▪️ cystic fibrosis.
▪️ chronic constipation.
▪️ being overweight or having obesity.
▪️ smoking, which leads to the weakening of connective tissue.
▪️ a personal or family history of hernias.
To diagnose your condition, your doctor will first perform a physical examination. During this examination, the doctor may feel for a bulge in your abdominal or groin area that gets larger when you stand, cough, or strain.
Your doctor will then take your medical history. They may ask you a variety of questions, including:
When did you first notice the bulge?
Have you experienced any other symptoms?
Do you think something in particular may have caused it to occur?
Tell me a little bit about your lifestyle. Does your occupation involve heavy lifting?
Do you exercise rigorously?
Do you lift weights professionally or recreationally?
Do you have a history of smoking?
Do you have a personal or family history of hernias?
Have you had any surgeries in your abdominal or groin area?
Your doctor will also likely use imaging tests to aid in their diagnosis. These can include:
▪️ Abdominal ultrasound. Abdominal ultrasound uses high-frequency sound waves to create an image of the structures inside the body.
▪️ Abdominal CT scan. Abdominal CT scan combines X-rays with computer technology to produce an image.
▪️ Abdominal MRI scan. Abdominal MRI scan uses a combination of strong magnets and radio waves to create an image.
If your doctor suspects a hiatal hernia, they may use other tests that allow them to assess the inside of your stomach:
▪️ X-rays of your digestive tract. A healthcare professional will have you drink a liquid containing diatrizoate meglumine/diatrizoate sodium (Gastrografin) or a liquid barium solution. These liquids help your digestive tract appear highlighted on X-ray images.
▪️ Endoscopy. During an endoscopy, a healthcare professional threads a small camera attached to a tube down your throat and into your esophagus and stomach.
The only way to effectively treat a hernia is through surgical repair. Whether or not you need surgery depends on the size of your hernia and the severity of your symptoms.
Your doctor may want to simply monitor your hernia for possible complications. This approach is called watchful waiting.
In some cases, wearing a truss may help to ease the symptoms of a hernia. A truss is a supportive undergarment that helps to hold the hernia in place. Always see your doctor to make sure that a truss fits properly before using it.
If you have a hiatal hernia, over-the-counter (OTC) and prescription medications that reduce stomach acid can relieve your discomfort and improve symptoms. These include antacids, H2 receptor blockers, and proton pump inhibitors.
Hernia repair surgery.
If your hernia is growing larger or causing pain, a surgeon may decide it’s best to operate.If the hernia causes an extra hole in your abdominal wall, they may repair your hernia by sewing the hole in the abdominal wall closed during surgery. This is commonly done by patching the hole with surgical mesh.
Sometimes a hernia results in one of the body’s passageways opening even wider than it should. For example, this can occur in the space where the esophagus is meant to pass through the diaphragm. In these cases, surgery can be performed to tighten the opening.
Hernias can be repaired with either open orDuring open surgery, the surgeon makes an incision close to the site of the hernia, and then pushes the bulging tissue back into the abdomen. They then sew the area shut, sometimes reinforcing it with surgical mesh. Finally, they close the incision.
Laparoscopic surgery uses a tiny camera and miniaturized surgical equipment to repair the hernia. It only requires a few small incisions and is less damaging to the surrounding tissue.
Not all hernias are suitable for laparoscopic surgery. If your hernia requires an open surgical repair, your surgeon will work with you to determine which technique is best for your condition. Find out more about inguinal hernia repair.
Benjamin Wedro, “Hernia (Abdominal Hernia)”، www.medicinenet.com
Carmella Wint ,Valencia Higuera (3-8-2017), “Hernia”، www.healthline.com