What are the different types of abdominal wall hernias. How can you recognize the symptoms of a hernia. What causes abdominal wall hernias to develop. How are hernias diagnosed by medical professionals.

Understanding Abdominal Wall Hernias: An Overview

Abdominal wall hernias occur when an organ or tissue protrudes through a weakened area in the surrounding muscle wall. These hernias can develop in various locations around the abdominal region, each with its own unique characteristics and potential complications. Understanding the different types of hernias, their symptoms, and causes is crucial for early detection and proper treatment.

Types of Abdominal Wall Hernias: A Comprehensive Guide

There are several types of abdominal wall hernias, each named based on their location and specific characteristics. Here’s a detailed look at the most common types:

Epigastric Hernia: Upper Abdominal Protrusion

An epigastric hernia develops in the upper abdomen, between the breastbone and the navel. These hernias are typically small and may occur in multiples. While they often don’t cause symptoms, some patients may experience discomfort or pain in the upper abdominal region.

Incisional Hernia: Post-Surgical Weakness

Incisional hernias form at the site of previous abdominal surgeries. They occur when the surgical incision doesn’t heal properly or becomes infected, leading to a weakness in the abdominal wall. These hernias can develop soon after surgery or gradually over time, often appearing alongside vertical incisions.

Spigelian Hernia: The Hidden Hernia

Spigelian hernias are unique in that they occur within the abdominal muscles rather than immediately beneath the skin. This positioning makes them less visible and potentially more difficult to detect. Due to their typically small size, spigelian hernias have a higher risk of strangulation, which requires immediate medical attention.

Umbilical Hernia: Navel Protrusion

Umbilical hernias appear near the belly button when a weak spot in the abdominal wall allows fat, fluid, or intestine to push through. These hernias are common in infants and often heal on their own. However, in adults, umbilical hernias typically require treatment as they tend to grow larger over time.

Recognizing Hernia Symptoms: When to Seek Medical Attention

How can you identify a potential hernia? Most abdominal wall hernias present as a visible lump or bulge beneath the skin. While they may not always cause discomfort, some individuals might experience mild pain, especially when straining or lifting heavy objects.

Are there any warning signs of a serious hernia complication? If a hernia becomes strangulated, cutting off blood supply to the protruding tissue, more severe symptoms may occur, including:

• Intense pain
• Nausea
• Vomiting
• Redness in the area of the hernia

If you experience these symptoms, it’s crucial to seek immediate medical attention, as a strangulated hernia is a life-threatening condition requiring emergency surgery.

Exploring the Causes of Abdominal Wall Hernias

What factors contribute to the development of abdominal wall hernias? While hernias can occur in people of all ages, including infants, the risk generally increases with age. Several factors can contribute to the weakening of the abdominal wall, leading to hernia formation:

1. Natural aging process
2. Chronic coughing
3. Collagen vascular diseases
4. Frequent heavy lifting
5. Genetic predisposition
6. Previous hernia history
7. Infections, particularly post-surgery
8. Abdominal injuries
9. Obesity
10. Pregnancy
11. Straining during bowel movements or urination
12. Surgical incisions

Understanding these risk factors can help individuals take preventive measures and seek early medical attention when necessary.

Diagnosing Abdominal Wall Hernias: Medical Approaches

How do medical professionals diagnose abdominal wall hernias? In most cases, a doctor can diagnose a hernia through a physical examination, which involves visual inspection and gentle palpation of the affected area.

When might additional tests be necessary for hernia diagnosis? If the diagnosis isn’t immediately clear, your doctor may order imaging tests such as:

• Abdominal ultrasound
• CT scan
• MRI

These imaging techniques can help visualize the hole in the muscle wall and the protruding tissue, providing a more detailed assessment of the hernia’s size and location.

Treatment Options for Abdominal Wall Hernias

What are the available treatment options for abdominal wall hernias? The appropriate treatment depends on the type, size, and location of the hernia, as well as the patient’s overall health. Here are some common approaches:

Watchful Waiting

In some cases, particularly with small, asymptomatic hernias, doctors may recommend monitoring the condition without immediate intervention. This approach is often used for umbilical hernias in infants, which frequently resolve on their own.

Surgical Repair

Surgery is the most common treatment for adult hernias, especially those that are growing, painful, or at risk of complications. Surgical options include:

• Open hernia repair: The surgeon makes an incision near the hernia site to push the protruding tissue back into place and reinforce the weakened muscle wall.
• Laparoscopic hernia repair: A minimally invasive technique using small incisions and a camera to guide the repair process.
• Robotic hernia repair: A advanced approach using robotic technology to assist in the surgical procedure.

Mesh Reinforcement

In many hernia surgeries, doctors use a mesh material to strengthen the repaired area and reduce the risk of recurrence. The mesh can be synthetic or made from animal tissue.

Preventing Abdominal Wall Hernias: Lifestyle Modifications

Can abdominal wall hernias be prevented? While not all hernias are preventable, certain lifestyle changes can help reduce the risk of developing one:

• Maintaining a healthy weight to reduce abdominal pressure
• Avoiding heavy lifting or using proper lifting techniques
• Quitting smoking to improve overall tissue health
• Treating chronic coughs promptly
• Managing constipation through diet and lifestyle changes
• Engaging in regular exercise to strengthen abdominal muscles

By implementing these preventive measures, individuals can potentially lower their risk of developing abdominal wall hernias.

Living with a Hernia: Management and Quality of Life

How does living with a hernia impact daily life? For many people with small, asymptomatic hernias, day-to-day activities may not be significantly affected. However, it’s important to be aware of any changes or increasing discomfort. Here are some tips for managing life with a hernia:

• Avoid activities that strain the abdominal area
• Wear supportive garments as recommended by your doctor
• Maintain open communication with your healthcare provider about any changes in symptoms
• Follow a healthy diet to prevent constipation and maintain a healthy weight
• Consider gentle exercises that strengthen the core without putting excessive pressure on the hernia

Remember, while some hernias can be managed conservatively, others may require surgical intervention to prevent complications and improve quality of life.

Advances in Hernia Research and Treatment

What recent developments have occurred in hernia treatment and research? The field of hernia repair is continually evolving, with new techniques and materials being developed to improve outcomes and reduce recovery times. Some areas of ongoing research include:

• Development of biocompatible mesh materials that integrate better with the body’s tissues
• Advances in minimally invasive surgical techniques, including single-incision laparoscopic surgery
• Exploration of tissue engineering approaches to strengthen weakened abdominal walls
• Investigation of genetic factors that may predispose individuals to hernias
• Improvement of post-operative pain management strategies

These advancements aim to enhance the effectiveness of hernia treatments while minimizing complications and improving patient comfort.

When to Consult a Hernia Specialist

How do you know when it’s time to see a hernia specialist? While not all hernias require immediate medical attention, certain situations warrant consultation with a healthcare professional:

• Discovery of a new lump or bulge in the abdominal area
• Increasing pain or discomfort associated with an existing hernia
• Difficulty in reducing a hernia (pushing it back in)
• Symptoms of hernia strangulation (severe pain, nausea, vomiting, or fever)
• Concerns about the impact of a hernia on daily activities or quality of life

A hernia specialist can provide a thorough evaluation, discuss treatment options, and help develop a management plan tailored to your specific situation.

Abdominal Wall Hernias in Special Populations

How do abdominal wall hernias affect different demographic groups? While hernias can occur in anyone, certain populations may have unique considerations:

Hernias in Infants and Children

Umbilical hernias are common in newborns and young children. Most of these hernias close on their own by age 3-4. However, larger hernias or those persisting beyond this age may require surgical intervention.

Hernias in Pregnant Women

Pregnancy can increase the risk of developing hernias due to increased abdominal pressure. Treatment may be delayed until after delivery unless complications arise. Proper prenatal care and abdominal support can help manage hernia-related discomfort during pregnancy.

Hernias in the Elderly

Older adults may be at higher risk for hernias due to weakening abdominal muscles and prior surgeries. Treatment decisions for elderly patients often consider overall health status and potential risks of surgery.

Hernias in Athletes

Athletes, especially those involved in high-impact or weightlifting sports, may be at increased risk for certain types of hernias. Early detection and proper management are crucial for maintaining athletic performance and preventing complications.

Understanding these population-specific considerations can help individuals and healthcare providers make informed decisions about hernia prevention, monitoring, and treatment.

Abdominal Wall Hernias | Michigan Medicine

A hernia occurs when an organ protrudes through the wall of muscle that encircles it. There are several different types of hernias that can occur in the abdominal and surrounding areas. These include umbilical hernias, epigastric hernias, incisional hernias, and others. For more information on these specific types of hernias, including symptoms and treatment methods, see below.

Types of Abdominal Wall Hernias

Epigastric Hernia

An epigastric hernia occurs when a weakened area in the abdominal wall allows a bit of fat to push through. Epigastric hernias are typically small. They occur in the middle of the belly, in the area between the belly button and the breastbone.

Some patients develop more than one epigastric hernia at a time. These hernias typically don’t cause symptoms, but you may experience pain in your upper belly.

Treatment of epigastric hernias typically involves surgery, but your doctor will discuss all your options with you in detail.

Incisional Hernia

A hernia that occurs in the area of a previous surgery is known as an incisional hernia. These hernias may occur when the abdominal wall has been weakened by surgery, or when a surgical incision becomes infected, further weakening the area.

Incisional hernias are relatively common because surgical incisions weaken the abdominal area. That weakness makes it easier for a part of the intestine or other tissue to protrude.

Incisional hernias can develop soon after surgery, or they can develop slowly, over months or even years. They typically occur alongside vertical incisions. Incisional hernias tend to be large and rather painful.

Incisional hernias will not heal on their own. Talk to your doctor for more details about your treatment options.

Spigelian Hernia

Spigelian hernias occur throughout the spigelian fascia. Unlike other types of hernias, which develop immediately below layers of fat, spigelian hernias occur in the midst of abdominal muscles. This means that spigelian hernias may not be immediately visible as a bulge or lump. They can go undetected for longer periods of time.

Because spigelian hernias tend to be small, the risk of developing a strangulated hernia is higher.

Spigelian hernias tend to occur more rarely than other types of hernias.

Umbilical Hernia

An umbilical hernia occurs when a weak spot in the belly allows a bit of fat, fluid, or intestine to push through, creating a lump or bulge near the belly button.

Umbilical hernias frequently occur in infants. In most cases, these hernias will heal on their own. Occasionally, however, surgery may be required.

Umbilical hernias also occur in adults, particularly those with health issues that cause increased pressure in the belly. Those issues may include obesity, pregnancy, chronic coughing or constipation, and difficulty urinating.

Because they tend to grow bigger over time, umbilical hernias require treatment. Treatment typically involves surgery, but your doctor will discuss all your options with you in detail. Without treatment, you are at risk of developing a strangulated hernia, which means that blood supply to the tissue has been cut off. Strangulation is life threatening and requires emergency surgery.

Symptoms

Abdominal wall hernias are generally visible: they will look like a lump or bulge beneath the skin. These hernias don’t usually cause any other symptoms except for mild pain or discomfort, usually when you are straining (for instance, lifting something heavy).

If the hernia becomes strangulated, however, you may experience more serious symptoms, such as severe pain, nausea, vomiting, and/or redness in the area of the hernia. Contact your doctor immediately if you begin to experience these symptoms. A strangulated hernia is life-threatening.

Causes 

Abdominal wall hernias can occur in people of any age, including infants. However, the risk of developing a hernia tends to increase as you age. Most abdominal wall hernias are caused by an area of weakness in the abdominal walls. A number of different factors can contribute to the development of that weakness. These factors include:

• Aging
• Chronic coughing
• Collagen vascular disease
• Frequent heavy lifting
• Genetic defects   
• History of previous hernias
• Infection (especially following surgery)
• Injuries to the abdominal area
• Obesity
• Pregnancy
• Straining during bowel movements or urination
• Surgical openings

Diagnosis

In most cases, your doctor will be able to determine whether you are in fact suffering from a hernia simply by looking and by gently palpating the affected area.

If for some reason a diagnosis isn’t immediately apparent, your doctor may decide to order an imaging test, such as an abdominal ultrasound, CT scan, or MRI. These imaging tests can help to show the hole in the muscle wall, along with the tissue protruding from it.

Treatment

Abdominal wall hernias that have no associated symptoms may not require any treatment at all. Your doctor will discuss your options with you which may include surgery or watchful waiting.

Larger hernias, however, or hernias that are causing pain, may require surgical repair to relieve pain as well as to prevent complications.

There are two types of surgical hernia repair: open and minimally invasive surgery. The type of surgery chosen will depend on the severity and type of hernia you’ve developed, the anticipated recovery time, your past medical and surgical history, and your surgeon’s expertise.

Open Surgery: During this procedure, your surgeon will make a small incision into your groin, and then push the protruding tissue back into your abdomen. Your surgeon will then sew up the weakened area. In some cases, your surgeon will use a mesh  to reinforce that weakened area.

Open surgery can be performed either with general anesthesia or with sedation or local anesthesia.

After your surgery, it might be several weeks before you’re able to fully resume your normal activities. However, it’s still important that you begin moving about again as soon as possible for a healthier recovery.

Minimally Invasive Surgery: Minimally invasive surgery is typically performed under general anesthesia.

During this procedure, your surgeon will make a few small incisions in your abdomen. Your surgeon will then inflate your abdomen, using a special gas, in order to make your internal organs easier to see.

Your surgeon will then insert a small, narrow tube into one of the incisions in your abdomen. This tube has a tiny camera, or laparoscope, at the end of it. That camera serves as a kind of guide for your surgeon, who is then able to insert surgical instruments through the other incisions in your abdomen. Your surgeon will repair the hernia using  and may use mesh.

Patients who are candidates for minimally invasive surgery may experience less scarring and discomfort following surgery than those who undergo open surgery. Patients may also be able to return more quickly to their normal activities.

Your doctors will speak with you in detail about all of your treatment options and will recommend a course of action best suited to your individual needs.

Make an Appointment

To discuss a potential hernia surgery, contact the Surgery Call Center at (734) 936-5738.

Do I have a hernia?

Can I Diagnose Myself?

It helps to have an idea of what a hernia is. See Types of Hernia.

In basic terms, a hernia is simply a hole – a hole through which something can protrude. The hole itself is often not really painful (unless the hernia strangulates ) – just uncomfortable when something pushes through.

When something protrudes through the hole – usually intestine or the fat around the intestine – you will see or feel a swelling under the skin. It is the swelling or lump that is there when you stand or cough and that goes away when you lie down. This is the most common and obvious sign of a hernia.

No swelling or lump to see or feel means no hernia, but a hernia is not always obvious to the patient and a proper examination by an experienced practitioner is often required.

Diagnosis

To summarise – in cases where there is an obvious swelling in the areas of the abdomen commonly associated with hernia and which is more obvious when you cough, strain or stand up and which gets smaller or goes completely when you lie down. No other tests are usually needed.

See the section on sport, groin pain and hernia

Would I need any tests, x-rays or scans?

Not usually and even less if you are examined by a clinician with extensive experience in diagnosing all kinds of hernias. However in a small number of cases, where the symptoms are inconclusive, there are special tests that can be performed.

• Herniagram
  This is a special x-ray (not often done now, partly because it is ‘invasive’) that involves an injection with a needle. A liquid that shows on x-rays (radio-opaque) has to be injected into the abdominal cavity. If there is a hernia (hole in the abdominal wall) the liquid trickles through the hole and can be seen on the x-ray.  It’s sometimes helpful if there is a question about whether a previously repaired hernia has returned (recurred).

• Ultrasound
  Similar to the ultrasound exam used on pregnant women. Ultrasound gives a shadowy black and white picture. The result is operator dependent, meaning it depends on who is doing it.

• MRI scan
  Uses magnetism. A good, modern test

However, in the vast majority of cases, special  tests are not needed and your doctor or surgeon should be able to confirm just on examination. More challenging diagnoses are best performed by experienced hernia specialists.

Next: Is having NO Treatment a Good Idea?

Ultrasound image Image by falco from Pixabay

Is having NO treatment an option?

There is always the option to do nothing –

but what happens then?

Doing nothing leaves things as they are – and avoids any surgery (for the time being). This is obviously an attractive proposition on first sight, especially in cases where the hernia does not hurt so we think to ourselves it cannot be serious. However:

• any symptoms, such as discomfort and pain will also worsen, affecting your quality of life and ability to work (and play)
• delaying surgical repair and allowing the hernia to enlarge significantly is likely to make later operations more complicated if (when!) you do eventually have surgery
• there is always the risk of strangulation (where the bowel becomes trapped in the hernia and loses its blood supply) which requires emergency surgery

Do I have any non-surgical options?

Wear a corset or belt.  Not ideal, can cause additional problems and it is difficult to find a good one. This was a favoured remedy in the last millennium as this old American advert shows. (The euphemistic word ‘Rupture’ has the same meaning in this context as ‘Hernia’.)

Note: Please do NOT send to us for such a booklet!!!

A truss is old-fashioned now. It is a belt with a pad that presses on the hernia defect to block the opening and stop the hernia popping out.

They never work well and carry the risk of unpleasant side-effects. They were popular when surgery was complex, dangerous and had a universally poor success rate.

Watchful Waiting

Two groups of surgeons looked at what would happen if you did not fix the hernia and just observed. It was called watch and wait.

The results at two years, published in the Journal of the American Medical Association (JAMA) and in the Annals of Surgery in 2006, were surprisingly similar and showed  that almost one-quarter of the non-operated patients converted to surgery.

The conclusion was :

“This study has confirmed previous findings that most patients with minimal symptoms from an inguinal hernia develop pain over time. Pain was the most common reason for requesting operation, followed by effect on quality of life and increase in size of the hernia. Surgical repair is recommended for medically fit patients with a painless inguinal hernia.”

A subsequent study published by the American College of Surgeons found that the vast majority of patients who waited ended up having to have surgery anyway. Watchful waiting was held NOT to be an effective strategy.

Our advice is to find a specialist hernia unit and have the hernia repaired as soon as possible.

Next: What Methods of Repair Are There?

Are You Ignoring the Symptoms of a Hernia?

June is National Hernia Awareness Month!

Are You Ignoring the Symptoms of a Hernia?

Each year, hernias affect millions in this country. According to the National Center for Health Statistics, approximately five million Americans have a hernia, but only 750,000 Americans seek treatment each year. National Hernia Awareness Month is observed each June to raise public awareness about hernias and effective treatment. Most people don’t understand what a hernia is or what causes one, much less the treatment options available.

What is a Hernia?

A hernia occurs when parts of an organ (usually the intestines) protrudes through a weak point or tear in the thin muscular wall that holds the abdominal organs in place. People at risk of developing a hernia are typically those performing chronic lifting or activities that require straining, which increases intra-abdominal pressure. However, the various types of hernias can occur in both males and females of any age.

Often there is no obvious cause as to why someone develops a hernia, but awareness of the common symptoms can help in diagnosing their occurrence. Identifying hernias in a timely manner is crucial. Left unchecked, hernias can lead to serious medical issues.

Signs and Symptoms

Most people with hernias have a common set of signs and symptoms. The questions below can help you determine if you have a hernia.

Is there a bulge under the skin on your abdomen or in your groin area?

A bulge is the most typical sign of a hernia.

If you have a bulge under your skin, does it ever disappear?

If the bulge flattens out when you lay down or press on it, the hernia probably needs prompt, but not emergency, medical attention. If the bulge does not flatten out when you lay down or press on it, it may be trapped or strangulated. The hernia requires immediate medical attention.

Do you have discomfort or pain when you lift, cough, sneeze, strain, or perform physical activities?

Hernias can cause discomfort or pain during your daily activities—especially when you exert yourself. They can also cause discomfort or pain during urination or bowel movements and a feeling of weakness or pressure in the groin area. Hernia pain may be sharp and sudden, dull and achy, or a combination of both.

Does your discomfort or pain get worse toward the end of the day?

Hernia pain typically becomes more intense as the day goes on. The pain can also worsen after standing for long periods of time.

Types of Hernias

Groin or Inguinal Hernias: These occur on one or both sides of the groin or scrotum. An inguinal hernia may be unilateral, occurring on one side of the groin, or bilateral, occurring on both sides of the groin. A majority of hernias are found in this area and are most common in men. Approximately 70% of inguinal hernias are indirect, meaning they occur in a natural weak spot of the groin around the spermatic cord. Approximately 30% of inguinal hernias are direct, caused by weak tissue being aggravated by straining or lifting over time.

Hiatal or Paraesophageal Hernias: These occur when the stomach or esophagus slide up through the diaphragm into the chest. Common symptoms are heartburn or gastroesophageal reflux disease (GERD). Paraesophageal hernias occur when part of the stomach is squeezed up into the chest beside the esophagus. The stomach can be strangulated, restricting blood supply to the related tissues. Hiatal hernias may be recurrent, which means that a previously repaired hernia has returned.

Femoral Hernias: These are most common in women and occur when there is a weakness near the femoral artery in the groin of the upper thigh.

Umbilical Hernias: These occur around the umbilicas or navel and are common in women during or after pregnancy.

Ventral or Abdominal Hernias (incisional hernias): These occur when the intestine pushes through a weakened area in the abdominal wall and can result from previous surgical incisions.

Treatment of a Hernia

Patients should seek medical help if a hernia is suspected and should seek further evaluation by a medical professional—especially when pain or discomfort persists. The treatment of a hernia is almost always surgery, although a temporary measure may include simply pushing the hernia content back into the abdomen then applying pressure to prevent it from reoccurring. During surgical hernia repair, the herniated segment can usually be placed back into the abdominal cavity through an incision and the muscle then stitched closed to complete the repair.

Some patients perceive surgery to be an inconvenience to their daily lifestyle and to those around them. Others may think the surgery requires an extended hospital stay followed by a long and painful period of recovery. Fortunately, a variety of safe, simple, and quick surgical procedures can eliminate these worries and have patients back to their daily activities in very little time. Hernia repairs are now common and routine surgical procedures—tools and technologies have evolved to drastically reduce a patient’s “down time.”

Many hernia repairs are typically performed:

• In an outpatient setting at a hospital or ambulatory surgery center;
• Using local or epidural anesthesia;
• Through one small incision;
• Within 45 minutes;
• Without the need of pain medication;
• With patients going home a few hours after surgery; and
• With patients returning to normal activities within a few days.

A hernia can be uncomfortable, unsightly, painful, and even cause life threatening complications. Don’t let a hernia restrict you and keep you from the activities you enjoy. The knowledgeable and experienced team of physicians at CCHC Southern Gastroenterology Associates, New Bern, is ready to answer any questions you may have. Call (252) 634-9000 to make an appointment.

Can You Have Hernia Without A Lump?

A hernia is usually characterized by a bulge (lump) that occurs when the abdominal tissues come through the hole in the abdominal wall fascia. Sometimes it can be painful to touch, and also worsen when you have extra pressure in the abdomen such as when standing, walking, coughing, and straining. And it usually relieves when lying down. But a challenging question, can hernia occur without a lump? The answer is probably ‘yes’ especially in women.

Invisible hernia (hidden inside)

Fascia is a sheet (layer) of connective tissues in the abdominal wall that runs from the chest to the groin area. This strength layer is responsible to keep some abdominal contents (such as abdominal tissues) in place. And a tear (breach) or hole in the wall abdominal fascia is, by definition, a hernia.

In general, hernias are more common in elderly people. We can say that the risk of developing hernias usually increases with age, though not always (some are there after surgery or even at birth). A continued weakening and tearing of the abdominal fascia may eventually form a weakening spot or hole that allows the abdominal contents to push through, causing a bulge or lump.

When abdominal contents push through the hole – typically, abdominal tissue and intestine – you will feel or notice a lump under the skin. It will usually become more visible (lager in size) with coughing, standing, or other activities that put more pressure in the abdomen. On the other hand, it will usually improves or goes away for a while when you’re lying down. This characteristic is the most common and obvious (visual) symptom of a hernia.

Hernias are commonly thought of as a male health issue, because they affect men much more often than women. For example, men are about 10 times more likely to develop inguinal hernia, which is the most common type of hernia. On the other hand, women only account about 8 % of all hernia cases in the United States. That sounds like good news for women, but wait …

Men’s hernias are relatively easier to diagnose since an obvious lump usually appears in the abdominal areas commonly associated with hernia – they often push outward to the point that can be discovered ‘easily’. But for women’s hernias, the symptoms may not be the same as in men.

In women, sometimes diagnosing hernia can be tough, because it’s generally smaller and harder to see (hidden inside). So it’s possible women to have the disease without a lump, making it harder to clearly detect. In their search for diagnosis and relief, they are often shuttled from psychiatrists to doctors to pain specialists. Correct diagnosis can take longer, months or even years. Also, women tend to have pain, and life can be more miserable – though the visual symptoms are less likely to present.

Furthermore, female lower abdominal pain (including pelvic pain) can be attributed by many factors and conditions. The common ones include ovarian cysts, endometriosis, fibrosis, menstrual cramps, appendicitis, irritable bowel syndrome, pelvic inflammatory disease, uterine fibroids, complications of past surgical procedures, and many more.

Among those possibilities, hernia may be the last scenario to look for – this especially true if you see a gynecologist, a health professional who tends to consider a ‘female’ issue as the reason for the pain! As a result, you may need to follow a battery of procedures and tests before the real (main) culprit is discovered. Even sometimes the exact cause is unknown even after following a lot of tests.

Hernia symptoms with no bulge

In both men and women, treatment options are similar. Surgery is usually the main treatment for hernias, though there are also some non-surgical procedures. Since surgery carries some risks, treatment is not necessary as long as the disease isn’t bothering you. But it’s recommended to keep monitoring the disease so early treatment can be given (if required).

Though treatment options for both genders are not different, again the challenging thing is how to early catch the disease especially in women. As well we know that a physical exam is usually enough to determine whether or not a bulge is hernia. But this could be different for some women with hernias.

If you have some symptoms of hernia and you don’t feel /see any lump in your abdominal areas, some tests are usually required to get correct diagnosis. These include ultrasounds, X-rays, MRI, and CT-scans. An ultrasound test is the cheapest option to confirm a hernia, but it’s not effective if you have had a surgery in the abdominal cavity since you may have scar tissue and mesh that remain in there after operation! You may need to take several times of imaging tests.

Female hernias may not cause a lump since they are sometimes too small to protrude. But if you do believe that there’s something wrong in your abdominal areas, see a doctor promptly! Some hernia signs and symptoms with no bulge are as follows:

Types, Treatments, Symptoms, Causes & Prevention

Overview

Common types of hernia

What is a hernia?

A hernia occurs when an internal organ or other body part protrudes through the wall of muscle or tissue that normally contains it. Most hernias occur within the abdominal cavity, between the chest and the hips.

The most common forms of hernia are:

• Inguinal hernia: In men, the inguinal canal is a passageway for the spermatic cord and blood vessels leading to the testicles. In women, the inguinal canal contains the round ligament that gives support for the womb. In an inguinal hernia, fatty tissue or a part of the intestine pokes into the groin at the top of the inner thigh. This is the most common type of hernia, and affects men more often than women.
• Femoral hernia: Fatty tissue or part of the intestine protrudes into the groin at the top of the inner thigh. Femoral hernias are much less common than inguinal hernias and mainly affect older women.
• Umbilical hernia: Fatty tissue or part of the intestine pushes through the abdomen near the navel (belly button).
• Hiatal (hiatus) hernia: Part of the stomach pushes up into the chest cavity through an opening in the diaphragm (the horizontal sheet of muscle that separates the chest from the abdomen).

Other types of hernias include:

• Incisional hernia: Tissue protrudes through the site of an abdominal scar from a remote abdominal or pelvic operation.
• Epigastric hernia: Fatty tissue protrudes through the abdominal area between the navel and lower part of the sternum (breastbone).
• Spigelian hernia: The intestine pushes through the abdomen at the side of the abdominal muscle, below the navel.
• Diaphragmatic hernia: Organs in the abdomen move into the chest through an opening in the diaphragm.

How common are hernias?

Of all hernias that occur:

• 75 to 80% are inguinal or femoral.
• 2% are incisional or ventral.
• 3 to 10% are umbilical, affecting 10 to 20% of newborns; most close by themselves by 5 years of age.
• 1 to 3% are other types.

Symptoms and Causes

What causes a hernia?

Inguinal and femoral hernias are due to weakened muscles that may have been present since birth, or are associated with aging and repeated strains on the abdominal and groin areas. Such strain may come from physical exertion, obesity, pregnancy, frequent coughing, or straining on the toilet due to constipation.

Adults may get an umbilical hernia by straining the abdominal area, being overweight, having a long-lasting heavy cough or after giving birth.

The cause of hiatal hernias is not fully understood, but a weakening of the diaphragm with age or pressure on the abdomen could play a part.

What are the symptoms of a hernia?

A hernia in the abdomen or groin can produce a noticeable lump or bulge that can be pushed back in, or that can disappear when lying down. Laughing, crying, coughing, straining during a bowel movement, or physical activity may make the lump reappear after it has been pushed in. More symptoms of a hernia include:

• Swelling or bulge in the groin or scrotum (the pouch that contains the testicles).
• Increased pain at the site of the bulge.
• Pain while lifting.
• Increase in the bulge size over time.
• A dull aching sensation.
• A sense of feeling full or signs of bowel obstruction.

In the case of hiatal hernias there are no bulges on the outside of the body. Instead, symptoms may include heartburn, indigestion, difficulty swallowing, frequent regurgitation (bringing food back up) and chest pain.

Diagnosis and Tests

How is a hernia diagnosed?

It is usually possible to see or feel a bulge in the area where a hernia has occurred by physical exam. As part of a male’s typical physical exam for inguinal hernias, the doctor feels the area around the testicles and groin while the patient is asked to cough. In some cases, soft-tissue imaging like a CT scan will accurately diagnose the condition.

Management and Treatment

What kind of doctor do you see for a hernia?

When you have a hernia, treatment will start with your primary care provider. If you need surgery to repair the hernia, you’ll be referred to a general surgeon. In fact, ventral hernia repairs are one of the most common operations U.S. general surgeons perform.

If you think you have a hernia, don’t wait to seek help. A neglected hernia can grow larger and more painful — this can lead to complications and possibly emergency surgery. Early repair is more successful, less risky and offers a better recovery and outcome.

How is a hernia treated?

Hernias usually do not get better on their own, and surgery may be the only way to repair them. However, your doctor will recommend the best therapy to address your hernia, and may refer you to a surgeon. If the surgeon thinks it is necessary to repair your hernia, then the surgeon will tailor the method of repair that best meets your needs.

In the case of an umbilical hernia in a child, surgery may be recommended if the hernia is large or if it has not healed by the age of 4 to 5 years old. By this age, a child can usually avoid surgical complications.

If an adult has an umbilical hernia, surgery is usually recommended because the condition will not likely improve on its own and the risk of complications is higher.

One of three types of hernia surgery can be performed:

• Open surgery, in which a cut is made into the body at the location of the hernia. The protruding tissue is set back in place and the weakened muscle wall is stitched back together. Sometimes a type of mesh is implanted in the area to provide extra support.
• Laparoscopic surgery involves the same type of repairs. However, instead of a cut to the outside of the abdomen or groin, tiny incisions are made to allow for the insertion of surgical tools to complete the procedure.
• Robotic hernia repair, like laparoscopic surgery, uses a laparoscope, and is performed with small incisions. With robotic surgery, the surgeon is seated at a console in the operating room, and handles the surgical instruments from the console. While robotic surgery can be used for some smaller hernias, or weak areas, it can now also be used to reconstruct the abdominal wall.

Each type of surgery has its advantages and disadvantages. The best approach will be decided by the patient’s surgeon.

What can happen if a hernia is not treated?

Other than umbilical hernias in babies, hernias will not disappear on their own. Over time, a hernia can grow larger and more painful or can develop complications.

Complications of an untreated inguinal or femoral hernia may include:

• Obstruction (incarceration): Part of the intestine becomes stuck in the inguinal canal, causing nausea, vomiting, stomach pain, and a painful lump in the groin.
• Strangulation: Part of the intestine is trapped in a way that cuts off its blood supply. In such cases, emergency surgery (within hours of occurring) is necessary to prevent tissue death.

Prevention

How can a hernia be prevented?

• Maintain ideal body weight by eating a healthy diet and exercising.
• Eat enough fruits, vegetables and whole grains to avoid constipation.
• Use correct form when lifting weights or heavy objects. Avoid lifting anything that is beyond your ability.
• See a doctor when you are ill with persistent coughs or sneezing.
• Don’t smoke, as the habit can lead to coughing that triggers a hernia.

Outlook / Prognosis

What can be expected following surgical treatment for a hernia?

After surgery, you will be given instructions. These include what diet to follow, how to care for the incision site, and how to take care to avoid physical strain. Hernias may recur regardless of the repair operations. This is sometimes caused by inherent tissue weakness or protracted healing. Smoking and obesity are also major risk factors for hernia recurrence.

Causes, Symptoms, Diagnosis & Treatment

Overview

Ventral hernia

What is a ventral hernia?

A hernia occurs when there is a hole in the muscles of the abdominal wall, allowing a loop of intestine or abdominal tissue to push through the muscle layer. A ventral hernia is a hernia that occurs at any location along the midline (vertical center) of the abdomen wall. There are three types of ventral hernia:

• Epigastric (stomach area) hernia: Occurs anywhere from just below the breastbone to the navel (belly button). This type of hernia is seen in both men and women.
• Umbilical (belly button) hernia: Occurs in the area of the belly button.
• Incisional hernia. Develops at the site of a previous surgery. Up to one-third of patients who have had an abdominal surgery will develop an incisional hernia at the site of their scar. This type of hernia can occur anytime from months to years after an abdominal surgery.

Symptoms and Causes

What are the causes and risk factors for developing a ventral hernia?

There are many causes including:

• Weakness at the incision site of a previous abdominal surgery (which could result from an infection at the surgery site or failed surgical repair/mesh placement).
• Weakness in an area of the abdominal wall that was present at birth.
• Weakness in the abdominal wall caused by conditions that put strain on the wall. These include:
  • Being overweight
  • Frequent coughing episodes
  • Severe vomiting
  • Pregnancy
  • History of lifting or pushing heavy objects
  • Straining while having a bowel movement/urinating
  • Injuries to the bowel area
  • Lung diseases (chronic obstructive pulmonary disease and emphysema; struggling to breathe puts strain on the abdominal wall)
  • Prostatism (enlargement of the prostate gland, which causes straining while urinating in older men)
  • Older age (general loss of elasticity to abdominal wall)

What are the signs and symptoms of a ventral hernia?

Some patients don’t feel any discomfort in the early stages of ventral hernia formation. Often, the first sign is a visible bulge under the skin in the abdomen or an area that is tender to the touch. The bulge may flatten when lying down or pushing against it.

A ventral hernia causes an increasing level of pain when a person:

• Lifts heavy objects.
• Strains to have a bowel movement/urinate.
• Sits or stands for long periods of time.

Severe abdominal pain can occur if part of the intestine bulges through the abdominal wall and becomes trapped in the opening. If this happens, the trapped portion of the intestine becomes strangled, loses its blood supply and starts to die. This is a medical emergency that requires immediate care.

Diagnosis and Tests

How is a ventral hernia diagnosed?

Your doctor will review your medical and surgical history. He or she will also perform a physical exam of the abdominal area where a ventral hernia may have occurred. Your doctor may then order imaging tests of the abdomen to look for signs of a ventral hernia. These tests may include an ultrasound, computed tomography (CT) scan or a magnetic resonance imaging (MRI) study.

Management and Treatment

How is a ventral hernia repaired?

Ventral hernias do not go away or get better on their own and require surgery to repair. In fact, without treatment, ventral hernias can get larger and worsen with time. Untreated hernias can become difficult to repair and can lead to serious complications, such as strangulation of a portion of the intestine.

The goal of ventral hernia surgery is to repair the hole/defect in the abdominal wall so that the intestine and other abdominal tissue cannot bulge through the wall again. The surgery often restores the tone and shape of the abdominal wall by repairing the hole and bringing the muscles back to their normal position.

There are three main types of hernia repair surgeries: open, laparoscopic and robotic:

• Open hernia repair: An open incision is made in the abdomen where the hernia has occurred, and the intestine or abdominal tissue is pushed back into place. A mesh material is placed to reinforce this repair and reduce hernia recurrences. The skin is usually closed with dissolvable stitches and glue.
• Laparoscopic surgery: Several small incisions are made away from where the hernia has occurred. A laparoscope (a thin lighted tube with a camera on the tip) is inserted through one of the openings to help guide the surgery. A surgical mesh material may be inserted to strengthen the weakened area in the abdominal wall. Advantages of this approach compared with open hernia repair include a lower risk of infection, because smaller-sized incisions are used.
• Robotic hernia repair: Like laparoscopic surgery, robotic surgery uses a laparoscope, and is performed in the same manner (small incisions, a tiny camera). Robotic surgery differs from laparoscopic surgery in that the surgeon is seated at a console in the operating room, and handles the surgical instruments from the console. While robotic surgery can be used for some smaller hernias, or weak areas, it can now also be used to reconstruct the abdominal wall. Other benefits of robotic hernia surgery are that the patient has tiny scars rather than one large incision scar, and there may be less pain after this surgery compared to open surgery.

Your surgeon will consider several factors to help determine the best surgical hernia repair method for you, including:

• Your age
• Existing health problems and medical history
• The size of the hernia
• The size and contour of the abdominal wall
• Amount of skin that can be used for the repair, and
• Presence of infection.

Importantly, your hernia repair is tailored to your specific situation based on the goals of the procedure and expected outcomes.

Where can I learn more about open ventral hernia repair?

You can learn more about the open ventral hernia repair from this surgery guide.

90,000 treatment, hernia surgery, laparoscopy

A hernia of the white line of the abdomen is a protrusion that is located along the midline of the abdomen, both above and below the umbilical ring, containing preperitoneal fatty tissue, as well as the peritoneum, which serves as a shell for the formed hernial sac.

The appearance of such hernias is due to the peculiarities of the anatomical structure of the anterior abdominal wall.The main support that maintains the shape of the abdominal wall is made up of the muscular frame, which is arranged in several layers. The muscle layer is lined with a connective tissue sheath that supports the anterior abdominal wall and forms a fascia that provides connection to the muscle layer, as well as covers areas not protected by the muscle cover.

The anatomy of the structure of the abdomen is such that all of its muscles are topographically located symmetrically to the left and right relative to the midline, which itself is not covered by the muscular component.The fascia covering the right and left rectus abdominis muscle not only connects them together, but also strengthens the abdominal wall as a whole, being a frame. This fascia is white, due to which the midline is also called the “white line of the abdomen”. The width of this line varies along its entire length and is not the same in different parts: above the umbilical ring, it is always wider – from 1 to 3 centimeters, below the level of the umbilical ring it narrows from a few millimeters to 1 centimeter. Due to its specific structure, the white line of the abdomen is more prone to herniation slightly above the navel.

How common are hernias of the white line of the abdomen?

The most common hernias are inguinal and umbilical hernias, while hernias of the white line of the abdomen are much less common. This type of hernia affects more women after pregnancy and young men when engaging in heavy physical activity.

There are many reasons for the formation of white line hernias.

The most significant factor may be genetic predisposition.The inherited physiological and anatomical failure of the connective tissue structures of the body can lead to stretching of the white line, the formation of ectasia (expansion) of the rectus abdominis muscles, which further entails thinning of the fascia; in it, dilatations and gaps are formed, through which the formation of a hernia is possible.

Metabolic disorders, diabetes mellitus and other pathological conditions of the body, leading to changes in metabolic processes, can cause depletion of the connective tissue structure of the white line.There are many diseases that can lead to a tendency to hernia protruding, as well as the effects that entail an increase in pressure in the abdominal cavity: the accumulation of fluid in it, heavy physical activity, pregnancy, severe labor, chronic lung diseases, chronic constipation …

Stages of the formation of a hernia of the white line

The formation of this type of hernia takes place in several stages.

• At the earliest stage, usually invisible to the patient, through the slit defect in the connective tissue, the preperitoneal adipose tissue protrudes, forming the so-called preperitoneal lipoma.

• Following this, the peritoneum is pulled out, and a hernial sac is formed, which can be palpated. Subsequently, at the stage of an already formed hernia, other organs of the abdominal cavity are involved: the omentum, loops of the small intestine, the umbilical-hepatic ligament, the transverse colon. At this stage of an already formed hernia, it is possible to find absolutely all the components of the pathological process: the hernial orifice and the hernial sac with hernial contents. The risk of infringement of the hernial protrusion, as a very formidable condition, directly depends on the shape and size of the hernial orifice, the dimensions of which can vary from a few millimeters to several centimeters and take the form of an oval, circle or even a rhombus; in this case, the smaller the gate, the higher the likelihood that the hernia will suddenly be impaired.

Rarely, but it happens that the type of hernias described in this article reaches large sizes, in their total mass they are relatively small. Often, the formation of a hernia does not occur beyond the stage of preperitoneal lipoma, which does not cause painful sensations, and without the influence of aggravating factors does not evolve in progression and does not spread beyond the boundaries of the white line.

Manifestations of hernia of the white line of the abdomen

The disease can be suspected if a small bulge is suddenly palpated in the midline of the abdomen in the patient.Very often it does not cause painful sensations and can be discovered by accident by the patient himself or by a doctor during examination. Due to the fact that in a normal state, a neoplasm, as such, may not bring painful sensations, one of the indicators that still allows it to be suspected is the appearance of pain during hard work, after eating or in other situations leading to increased intra-abdominal pressure. An increase in pain may be associated with the tension of organs and other structures fixed to the hernial sac, or be a consequence of the infringement of the contents of the hernial protrusion, which in turn requires urgent surgical intervention.Painful sensations can be given to all sorts of areas of the chest, abdomen and back. During relaxation of the muscles of the abdominal wall in a horizontal position on the back, the hernial protrusion, and with it the painful sensations, often disappear. In the event of such a formidable and extremely dangerous complication as an infringement of a hernia, all the symptoms of an acute abdomen appear and the general intoxication of the body increases: the temperature rises, piercing, intensely intensifying abdominal pains, nausea and vomiting, stool and gas retention, there is bloody discharge in the feces , and the hernial protrusion can no longer correct in the supine position.Often, the symptoms accompanying the disease are disorders of the digestive system such as nausea, heartburn, belching, associated with the ingestion of the digestive tract organs into the hernial sac.

Diagnostics of the hernia of the white line of the abdomen

The diagnosis of a hernia of the white line of the abdomen for a doctor does not require any complex examination. When taking anamnesis and examining with tension of the muscles of the anterior abdominal wall, it is possible to visualize hernia protrusion, and the patient may note that in this state, pain in this region of the abdomen is determined.In addition to visual examination, palpation is necessary, in which a dense oval or round structure is determined in the area of ​​the protrusion in sizes from less than 1 cm to more than 10 cm, located in the area of ​​the white line of the abdomen. If the hernia of the white line of the abdomen is independently adjustable, then during palpation, weak points can be detected – a slit hernial gate. If the contents of the hernia are a loop of the intestine or the wall of the stomach, then during auscultation of the hernial sac, intestinal noises can be heard. Additional examination methods – such as ultrasound, CT of the abdominal organs, X-ray examination, gastroscopy are necessary only to clarify the state of the organs fixed in the hernial sac with large formed hernias, as well as to select the method of operation.

Hernia treatment

Hernias of the white line of the abdomen are not treated with medication and conservatively, their therapy requires mandatory surgical intervention.

Wearing a bandage will not allow the patient to get rid of a hernia, no matter how long and diligently the patient wears it. Abuse of it can greatly aggravate the situation: the muscles, when wearing the bandage, impose their supporting and supportive function on it, which leads to their weakening to a significant extent.And as a result, their weakness is aggravated, and as a result, the “abdominal muscles” are even more stretched, and the hernia is enlarged. In addition, as a result of friction in the hernial sac, adhesions are formed, disrupting the work of the organs fixed in it.

Physical activity and training of the “abdominal muscles” can also give a negative result in the form of an even greater divergence of the muscle layer, an increase in ectasia and an increase in hernia.

Surgery to remove a hernia of the white line of the abdomen

There is not a single type of hernia that could be treated conservatively; this type of pathology requires a purely surgical intervention in a hospital setting.The main point of the operation is that it is necessary to eliminate the hernia itself and perform plastic (restoration) of the anterior abdominal wall.

A feature of surgical intervention for a hernia of the white line of the abdomen is the simultaneous elimination of ectasia of the abdominal muscles. To date, many methods of treating hernias of the anterior abdominal wall through surgical intervention have been mastered (more than 300). In practical medicine, both simple techniques are used with the use of autotissue (own tissues) of the patient, and combination reconstructive operations with the installation of synthetic implants.

Types of operations:

Plastic with own fabrics

• The incision is made in the midline above the hernial protrusion.
• The hernia defect is sutured with a non-absorbable suture, while eliminating the likelihood of divergence of the abdominal muscles.

This type of surgery is used for small hernia orifices and the patient does not have conditions and diseases that cause failure of the connective tissue structures of the body.

The disadvantages of this type of surgery include the need to create tension on the tissues of the anterior abdominal wall, which can lead to a relapse of the disease. Another disadvantage is a long midline incision and a long rehabilitation period with limited physical activity.

Plastic using synthetic dentures and meshes

It is also a traditional (open) intervention performed through an incision over the hernial protrusion.However, this type of surgery does not create tension on the abdominal wall’s own tissues, and the defect is closed by a prosthesis made of synthetic material. Artificial implants and meshes germinate over time by a person’s own tissues and create a solid support; in this regard, the possibility of recurrence of the disease is reduced to almost zero.

Laparoscopic hernia repair of the white line of the abdomen.

With the advent of high-tech devices, this technique in the treatment of hernias is becoming more and more popular.The operation does not require a long skin incision.

Several punctures are made in the abdominal wall, located mainly in the lateral sections, through which the hernial sac is released, the adhesions, if any, are separated, and a special mesh prosthesis is installed.

Laparoscopic surgery is less traumatic than open surgery. The period of rehabilitation and recovery after laparoscopy is much shorter than with other techniques.Even with large hernias, after a month, you can return to the usual rhythm of life and habitual stress. In addition, the postoperative period does not require wearing a bandage. The remoteness of skin punctures from the site of the mesh prosthesis installation reduces the risk of pyoinflammatory complications, which can be of great importance in people with reduced immunity (for example, with diabetes mellitus, obesity) and significantly reduces the risk of hernia recurrence.

A relative disadvantage of laparoscopic repair of a hernia of the white line of the abdomen can be considered the lack of correction of diastasis of the rectus muscles and, therefore, incomplete restoration of the shape of the anterior abdominal wall, especially in lean people.The widespread use of this technique also limits the significant cost of the implant, which has a special coating that prevents adhesions, and instruments for its laparoscopic installation. Such operations are also not suitable for patients with severe diseases of the cardiovascular and respiratory systems. All surgical procedures are performed under general anesthesia. The postoperative hospital stay depends on many factors and concomitant diseases and ranges from 2 to 10 days.

Rehabilitation after surgery

With traditional methods of plasty, wearing a bandage is recommended in the postoperative period. In addition, during the period of convalescence, it is important to follow all the recommendations of the attending physician: follow a special sparing diet and avoid any physical exertion. Ignoring such a disease as a hernia and conniving at one’s health can lead to life-threatening conditions and, in the future, to serious complications.Despite the fact that the only method of treating this disease is surgery, the current variety of types of operations allows you to choose the optimal type of plastic for each patient, taking into account his individual characteristics.

Inguinal hernia, umbilical hernia, white line of the abdomen in Yekaterinburg, treatment in the clinic RZD-Medicine

Surgical clinic | Hospital | Specialists | Cost

Surgical treatment of hernias of the anterior abdominal wall (hernia of the groin, umbilical, white line of the abdomen) is successfully carried out at the Clinical Hospital “Russian Railways Medicine” in Yekaterinburg using modern medical technologies and synthetic implants (meshes).

What is a hernia

For most ordinary people who are not involved in medicine, any hernia is associated with an unusual bulge in a certain area of ​​the abdomen. The formation of a bulge is caused by the “escape” of the internal organs of water through the skin through the weak points of the anterior abdominal wall, which are devoid of muscles. These places are located in the navel, groin, thigh, other parts of the abdomen, as well as in the area of ​​postoperative scars.

Adipose tissue or organs, for example, intestinal loops, emerge as part of the hernial contents through these defects.This leads to the formation of a noticeable subcutaneous bulge, and the pressure of the tissues coming out through the weak points of the abdominal wall is the cause of pain of varying intensity, discomfort in the hernia, and sometimes intestinal dyspepsia.

When a hernia occurs

In the majority of young people, hernias occur against the background of excessive physical exertion (heavy lifting), less often the formation of hernias in young people is congenital. In old and old age, hernias can occur against the background of weakness of the muscles of the abdominal wall, as well as against the background of chronic constipation.

Why the presence of a hernia is dangerous

The main danger of hernias is the possibility of infringement (compression) of the organ with its subsequent necrosis. It manifests itself as a sharp, unbearable pain in the area of ​​the hernia. This situation directly threatens the patient’s life. Delay can lead to the most serious consequences, including death.

Diagnosis of abdominal hernia

Diagnosis of hernias of the anterior abdominal wall, as a rule, does not cause difficulties and is based on the determination of hernial protrusion either by the patient himself or during a preventive examination by a surgeon.Difficulties in diagnosis can occur in obese patients. For the final diagnosis and determination of the size of the hernial orifice and the nature of the hernial contents, computed tomography and ultrasound examination are used.

Only a qualified specialist – a surgeon can confirm or remove the diagnosis of a hernia, as well as determine the tactics of treatment !!!

Treatment of hernias of the anterior abdominal wall

There is no medical treatment for hernias of the anterior abdominal wall!

It is important to start hernia treatment on time.If the hernia is not treated, it will not only not go away on its own, but will increase in size and become painful, which threatens with serious complications, thereby posing a threat to life.

Surgical operations performed in our clinic for hernias can be divided into two large groups:

• Endoscopic;
• Open.

The essence of the operation is to remove the hernia membrane and close the defect in the muscles of the anterior abdominal wall with adjacent tissues or artificial materials – a special mesh.The mesh can be installed through incisions or punctures. This is decided by a specialist – a surgeon.

A modern trend in the surgical treatment of hernias is the use of synthetic materials (implants or meshes) to close the hernial orifice without tension. In the “Clinical Hospital” of Yekaterinburg, only proven materials of foreign production by the companies Ethicon, Covidien, Bard are used.

The difference between endoscopic and open surgery is that during endoscopic surgery, the surgeon works through the punctures of the abdominal wall, looking at the monitor, which displays an image of the organ being operated.

Laparoscopic hernioplasty is performed from 3 punctures of 5 and 10 mm and consists in the preperitoneal installation of a mesh endoprosthesis, which is fixed with a special stapler.

The advantages of this technique are early recovery after surgery, minor pain syndrome and the absence of a postoperative suture.This method, along with open surgery in a number of clinics in Europe and the United States, is the “gold standard”. The surgeons of the Clinical Hospital have accumulated many years of experience in such interventions.

In open surgery (Lichtenstein hernioplasty), it is required to cut the membranes, starting from the skin, the peritoneum above the hernia. A mesh prosthesis is installed, after which layer-by-layer suturing of the tissues of the anterior abdominal wall is performed.

The figures on the right show the scheme of Liechtenstein hernioplasty and the appearance of the surgical area after Liechtenstein hernioplasty.

In the “Clinical Hospital” in Yekaterinburg, all the above operations are performed

Umbilical hernia

Classification of umbilical hernias

All hernias of this localization can be classified as congenital and acquired.

• In addition to the embryonic umbilical hernia, the hernia of the umbilical cord belongs to congenital.
• Acquired pathologies include direct and oblique umbilical hernias. In the first case, the violation is associated with thinning of the fascia, which is adjacent to the umbilical ring, the hernial sac moves into the subcutaneous tissue through the umbilical ring.With an oblique hernia, a protrusion appears under or above the umbilical ring, enters through the hernial opening between the umbilical canal and the white line of the abdomen, and exits through the umbilical ring under the skin.

Also, a hernia can be reducible or non-reducible – an option is a restrained umbilical hernia.

Causes of the appearance of an umbilical hernia

In normal newborns, the umbilical ring, after the umbilical cord falls off, closes and closes with scar-connective tissue, while the muscles play the role of additional strengthening.However, before the end of obliteration (closure), an increase in intra-abdominal pressure can lead to the formation of a hernia. In addition, hereditary weakness of structures can become the cause of a hernia, then even with one close relative, the probability of developing a hernia is 70%. In adults, the disease can also lead to obesity, the presence of postoperative scars and abdominal injuries, heavy physical exertion, an abdominal cough, etc. In addition, the risk of developing a hernia increases in pregnant women as a result of stretching the umbilical ring, a decrease in tissue resistance to increased intra-abdominal pressure, tissue atrophy …

Why is an umbilical hernia dangerous?

Of the complications, inflammation of the elements of the hernial sac and coprostasis is most often recorded. If the protrusion does not correspond to the diameter of the umbilical ring, there is a risk of infringement, while there is a sharp pain, nausea and vomiting, gas flow stops, and fecal stagnation develops, which can lead to intestinal obstruction, peritonitis. In addition, compression of displaced organs is accompanied by impaired blood circulation in them, as a result of which necrosis is possible.In these cases, urgent medical attention is needed.

Diagnosis of an umbilical hernia

When characteristic signs appear, you should make an appointment with a surgeon. During the visit, palpation can reveal a defect in the abdominal wall. To confirm the diagnosis, herniography, ultrasound of the hernial protrusion and organs of the peritoneal cavity are prescribed, X-ray of the stomach and EGD are also recommended. Differential diagnosis is necessary to exclude a hernia of the white line of the abdomen, extragenital endometriosis of the umbilicus in women, as well as metastasis in the oncological process.

Umbilical hernia treatment

In children under 5 years of age, physiotherapy exercises, massage are prescribed, at an older age and in adults, the only effective method of treatment is surgical intervention – hernioplasty using the body’s own tissues or a mesh implant. In the first case, after the operation, a prolonged restriction of physical activity will be required, and there is also a risk of relapse. With hernioplasty using a mesh implant, recovery is reduced to a month, and the number of relapses does not exceed 1%.The operation can be performed both openly and using laparoscopy. In traditional plastic surgery, an incision is made in the sub-umbilical fold, after which the hernial sac is opened, the contents of which are adjusted into the peritoneal cavity. Then a duplicate aponeurosis is formed in the transverse or vertical direction. In patients with excessive fatty apron, abdominoplasty is also possible. With laparoscopy, all manipulations are performed through small punctures of the anterior abdominal wall.

Prevention of an umbilical hernia

To prevent hernia in children, situations that lead to straining should be excluded: crying, constipation, bloating, etc. Abdominal massage and gymnastics, the purpose of which is to strengthen the abdominal wall, have a good effect. Adults should avoid heavy lifting, obese patients need weight correction, and attention should be paid to digestion, focusing efforts on preventing constipation. Pregnant women should wear a special bandage for prevention.

Removal of a hernia in Chelyabinsk – Hernioplasty

A hernia of the abdomen is a disease during which an organ from the abdominal cavity through an opening or through a weakened part of the abdominal wall goes under the skin.

Abdominal hernia is a disease during which an organ from the abdominal cavity through an opening or through a weakened abdominal wall goes under the skin. Most often, the omentum or part of the intestine acts as such an organ.

Hernias can be congenital and acquired. Congenital hernias occur due to a congenital defect in the development of the tissues of the anterior abdominal wall.

The following factors contribute to the occurrence of acquired hernias:

• Prolonged or abruptly appeared jump in intra-abdominal pressure, which can occur as a result of intense physical exertion, heavy lifting, prolonged constipation, severe coughing, pregnancy, difficulty urinating, obesity, crying in young children.
• Weakness of the muscle layer of the abdominal wall due to age-related changes, trauma, surgery, severe exhaustion.
• Complicated heredity.

By localization, the following most common hernias can be distinguished: inguinal, femoral, umbilical, white line of the abdomen, spigel line, etc.

To diagnose a hernia, an examination in a standing and lying position is sufficient.In some cases, an abdominal ultrasound and x-ray may be necessary to determine the urgency of the operation and to identify potential complications.

If you have a hernia of the anterior abdominal wall, the surgeon’s main recommendation is to operate on while it is small and easily reducible. The development of complications significantly complicates the surgical intervention and worsens the results of treatment.

Infringement of a hernia of the abdomen is considered the most frequent and most dangerous complication that can occur with this pathology, since it leads to ischemia of the restrained organ with the subsequent development of necrosis (necrosis).The main clinical sign of a sudden infringement of a hernia is the appearance of acute pain at the site of its exit. The situation requires immediate surgical resolution.

An unreducible is called a hernia, the contents of which are not adjusted back into the abdominal cavity. This problem arises as a result of the formation of connective tissue adhesions between the walls of the hernial sac and the internal organs that have emerged into its lumen. It can be complicated by coprostasis and partial intestinal obstruction.Hernia repair is carried out in a planned manner, however, if an infringement is suspected, an urgent operation is indicated.

Coprostasis , or, in other words, fecal stasis in the hernial sac develops as a result of weakening of intestinal motility and is usually observed in the elderly and old people suffering from a tendency to constipation. Such patients are conducted conservatively, prescribing a light massage of the hernial protrusion, enemas with vaseline oil or glycerin. Laxatives are contraindicated due to the fact that, due to the overflow of the adductor loop, they contribute to the transition of coprostasis into the so-called fecal form of infringement.

Inflammation of the hernia of the abdomen occurs against the background of infection of the hernial sac and its contents. Inflammation of a hernia usually proceeds in an acute form as serous, serous-fibrinous, purulent or putrefactive. Treatment of inflammation of a ventral hernia, if infection from the hernial contents has led to it, involves performing urgent surgical intervention with the removal of the source of infection. If the cause is inflammation of the skin, the tactics are conservative.

The operation to remove a hernia is called – Hernioplasty (hernia repair) .

How is a hernia removed

There are several techniques for performing planned hernioplasty, and the essence of such an operation is quite simple:

• Isolation of the hernial sac
• dissection of the hernial orifice
• opening the hernial sac
• revision and reduction of hernial contents
• Suturing of the hernial sac
• plastic of hernia orifice
• wound closure, aseptic dressing.

According to the indications, after the hernia has been repaired, the anterior abdominal wall can be strengthened with a mesh endoprosthesis, which guarantees the prevention of hernia recurrence in the future, avoids excessive tissue tension during the operation and, accordingly, significantly shortens the time until complete recovery. A mesh endoprosthesis (prolene mesh) is a strong, elastic mesh made of synthetic material, which closes the hernial orifice. Removal of hernias by the tension-free method using a prolene mesh is the most modern method of hernioplasty, both in our country and abroad.

The indication for hernia repair is:

• the presence of a hernia.

Contraindications to routine hernia surgery are:

• severe diseases of the heart, liver, kidneys;

90,026 diseases in which there is a constant increase in intra-abdominal pressure – chronic lung diseases with cough, prostate adenoma, chronic constipation;

• as well as inflammatory skin diseases in the area of ​​hernial protrusion.

Removal of abdominal hernia in Moscow

A hernia of the abdomen is a protrusion of internal organs outside the abdominal cavity. A hernia appears as a swelling that can be painful. Infringement of a hernia, in which the blood supply to the restrained organs is disrupted, is extremely dangerous.

With thinning or the appearance of holes in the muscle wall, adipose tissue, intestinal loops, and other internal organs can come out through it.This leads to discomfort, intense pain, and massive complications. A hernia of the abdomen does not go away on its own – over time, it only increases in size. Hernia treatment is only surgical. Surgery to remove a hernia is called hernia repair or hernia repair.

The more the development of pathology, the higher the risk of an emergency. If, for example, “run” a hernia of the white line of the abdomen, it will become irreducible. If the operation is not performed, the patient is in danger of entrapment with swelling, rapid infection and tissue death.

The risk zone for hernias, which are treated only by surgery, includes people:

• with a chronic cough – for example, smokers have a higher risk of hernias;

• often lifting weights — with such work it is necessary to be regularly examined;

• have given birth to a child – during pregnancy, a hernia of the abdominal wall may develop;

• overweight, allergic with frequent sneezing, difficulty in defecation, etc.etc.

The doctor issues a referral for the operation after a comprehensive examination of the patient. In addition to mandatory palpation and examination, ultrasound of the abdominal organs, laboratory tests are prescribed. It is worth contacting a doctor when the first symptoms appear.

Symptoms and signs of the need for hernioplasty

With the appearance of weakness, the divergence of the muscles of the abdominal wall, a hernial sac is formed. The process may be asymptomatic, but more often the patient feels itching, burning in the area where the hernia has formed.When entering the bag of the intestinal loop, swelling appears – where the white line passes or in another area. Sometimes, if the patient lies on his back, the visual defect disappears.

Each hernia is individual, and its symptoms are manifested in the same way and an operation is performed. Painful sensations range from discomfort to tearing. The indications for removal may be:

• feeling of pressure, burning in the groin, scrotum, abdomen;

• bulges and bumps in the abdomen, groin areas, which become visually more noticeable when coughing;

• pain when coughing, lifting weights, etc.etc.

In case of irreducible infringement, the operation is performed as soon as possible. Delay is fraught with the appearance of vomiting, blood in the stool, intense and growing pain in the scrotum, groin. With these symptoms, you should immediately call an ambulance or go to the emergency department.

How is operation

going

During the intervention, the hernial contents are immersed through the hernial orifice back into the abdominal cavity, after which the plastic of the hernial orifice is performed.During operations, the area of ​​the hernial orifice is strengthened either by the body’s own tissues or by implants (polymer meshes). Hernioplasty can be performed laparoscopically (through small incisions under visual control using special equipment).

If you are looking for where to have a hernia removed in Moscow, contact the Family Doctor. In the “Family Doctor”, a hernia repair is performed for various abdominal hernias. If possible, laparoscopic hernioplasty is preferred.You can check the cost of surgery for hernias of various localization below.

Inguinal hernia in questions and answers

• Doctors
• Treatment
• Diagnostics
• Article updated: June 18, 2020

Inguinal hernia – a small bulge on the right or left of the pubis – is a widespread problem to get rid of from which people are ready to use a variety of means, including rather exotic ones.

About why “traditional medicine” cannot cope with an inguinal hernia, and most importantly, about how to defeat this ailment, we will talk today.

What is important to know about an inguinal hernia?

Inguinal hernias are more common in men than in women. One of the main reasons for their appearance is a hereditary predisposition. Other causes include strenuous exercise, heavy lifting, persistent coughing, being overweight, difficulty urinating due to prostate adenoma in men, and pregnancy and childbirth in women.

What are the symptoms of an inguinal hernia?

In the process of forming an inguinal hernia, symptoms such as discomfort when walking and playing sports appear, pulling pains in the lower abdomen appear, which are aggravated by lifting weights. Large hernias can cause constipation, bloating, and urinary disorders. In some cases, the hernia develops without symptoms, and the patient experiences little or no pain. However, a hernial protrusion is always formed – a swelling of a round or oval shape in the groin area, which appears if a person is in an upright position, and disappears as soon as he lies down.

Why is an inguinal hernia dangerous?

As long as the hernia can be repaired, the situation is not critical. But when it is infringed, the organ that has emerged from the abdominal cavity is, as it were, in a “trap”: the blood supply in it sharply deteriorates, which ultimately can lead to tissue necrosis and rupture of the wall. If the person is not helped in the next few hours, the case can be fatal. Infringement of a hernia can occur after lifting weights, overworking in the gym, severe coughing, straining with constipation.

Expert Opinion

Chernookov Alexander Ivanovich Professor, Head of the Department of Hospital Surgery No. 2 of the First Moscow State Medical University. THEM. Sechenov:

If the hernia has formed, then it will not disappear on its own, no “folk remedies” will help. The only way to get rid of her is to have surgery. And the sooner the patient goes to the surgeon, the higher the chance that the treatment will be successful and less traumatic.

A modern and effective method of treating inguinal hernia is the use of mesh implants during the operation. The use of these materials allows for rapid patient rehabilitation. And the likelihood of a recurrence of a hernia after a competently performed surgical intervention does not exceed 2%.

References

• Duggan EM., Patel VP., Blakely ML. Inguinal hernia repair in premature infants: more questions than answers. // Arch Dis Child Fetal Neonatal Ed – 2015 – Vol100 – N4 – p.F286-8; PMID: 25710179

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Umbilical hernia – surgery to remove it in St. Petersburg, price of treatment

The presence of an umbilical hernia is dangerous, since various complications can develop. Effective conservative methods of correction have not been developed, therefore, for adults, the umbilical hernia is removed surgically.

Surgeons of the Tauras-Med medical center successfully perform operations to remove an umbilical hernia. The order of treatment is selected individually for each patient.In their practice, specialists use advanced surgical techniques, as well as modern equipment for minimally invasive interventions. The presence of expert-class diagnostic equipment simplifies diagnostics and allows you to start effective treatment in the shortest possible time.

Why do navel hernias appear?

Umbilical hernias are considered one of the most common types of abdominal hernias. The disease is often diagnosed in babies. At the initial stages of treatment, they resort to conservative methods.If the problem is not resolved after the child reaches 5 years of age, it is eliminated with the help of surgery. Among the adult population, umbilical hernias are more common in women. Moreover, the pathology manifests itself closer to 40 years.

In adults, the main provoking factor for the appearance of a hernia is the weakening of the fascia of the abdomen. The displacement of internal organs occurs with an increase in intra-abdominal pressure, which is observed against the background of the following conditions:

• intense cough;
• persistent constipation;
• serious physical activity;
• ascites;
• abdominal injuries.

The predisposition of women to this condition is explained by anatomical features (wider and thinner white line), as well as additional loads on the anterior abdominal wall in the process of carrying a child. Stretching of muscles and tendons during pregnancy, as well as diastasis of the muscles after childbirth, adversely affect the condition of the connective tissue. In the distant future, this can lead to the formation of an abdominal hernia.

How does a hernia manifest?

A harbinger of hernia formation is a change in the surface of the abdomen in the umbilical region.The patient may notice the periodic appearance of a rounded bulge. Education is usually found against the background of coughing, sneezing, laughing, straining, lifting heavy objects, and also during physical exertion. In the absence of stress or in the supine position, the hernia disappears. Sometimes, to correct the hernia, you need to lightly press on it with your fingers.

The progression of the disease is accompanied by an increase in hernia size, the formation of adhesions between the subcutaneous tissues and the hernial sac. In this case, the bulge is constantly present in the navel area, does not adjust and causes discomfort.Moderate painful sensations after eating and physical exertion are possible. Often, the displacement of the abdominal organs causes constipation, nausea, and weakness.

If you have any questions, call us by phone: +7 812 603-44-71
Administrators of the Tauras-Med medical center are always ready to advise you.

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Complications

If a hernia is detected, you should immediately seek help from a doctor. In the early stages of development, the disease is easier to treat.As the hernia grows, the risk of complications increases.

The condition may be complicated by the infringement of the hernial sac. This happens with an increase in intra-abdominal pressure and muscle spasm that form the hernial orifice. Infringement leads to circulatory disorders inside the sac, the development of necrotic changes, which is fraught with peritonitis and death. The complication is manifested by a sharp pain in the abdomen, nausea, redness and hardness of the hernia, fever and requires immediate attention from a surgeon.

In some cases, a hernia is complicated by inflammation of the contents of the hernial sac. Symptoms can be pain in the area of ​​protrusion, redness, tissue edema, signs of general intoxication of the body (weakness, moderate fever).

With prolonged hernia, some patients may develop coprostasis, or intestinal obstruction. This happens when a part of the intestine is blocked, which is in the hernial sac. The condition is manifested by vomiting, nausea, stool retention and is corrected through surgery.

How to treat patients with umbilical hernia

If you suspect an umbilical hernia, you should consult a surgeon. At the initial appointment, the doctor conducts an examination, details the complaints and anamnesis. To clarify the diagnosis, an examination is prescribed:

• X-ray of the stomach and intestines;
• herniography;
• Ultrasound of the hernial sac and abdominal organs;
• MRI or CT.

Based on the information received, it is determined which organs form the hernial contents, whether adhesions have formed with the skin, what are the sizes and location of the hernial orifices.This information is used to select the optimal technique for performing hernioplasty of an umbilical hernia (removing the protrusion and strengthening the weakened abdominal wall).

Preoperative examination includes consultations with a therapist, anesthesiologist and other narrow specialists (if necessary). Instrumental examination involves an ECG and fluorography. As part of a laboratory examination, blood and urine tests, a study for the group and Rh-affiliation, screening for infections, a coagulogram are taken.

Preparing for surgery

Diet should be followed 2-3 days before surgery. You should give up fatty foods, sausages, sweets, alcohol. You can eat cereals, vegetable dishes, lean meat and fish, eggs. On the eve of the intervention, an early light dinner is organized, after which a hunger pause should be sustained. It is allowed to drink only clean water. The operation is usually scheduled in the morning. You can drink some water 3 hours before the intervention.

How to remove hernia in the navel

Small formations are removed by means of tension hernioplasty. The operation involves dissection of the skin and aponeurosis, removal of the hernial sac and gate, and repositioning of organs. Then the umbilical ring is plasticized using the patient’s own tissues. Simply put, the hernia exit site is sutured. Within the framework of tension hernioplasty of an umbilical hernia, the methods of Mayo, Lexer, Sapezhko are used. Such operations are used to correct small hernial formations.

The method of obstructive, or tension-free, hernioplasty is indicated for the elimination of hernias of any size. It involves repositioning the organs in place, excising the hernial sac, and closing the hernial opening with a mesh implant. Over time, the mesh grows with connective tissue and strengthens the anterior abdominal wall well, preventing repeated displacement of organs. Tension-free hernia repair is used to correct large and recurrent hernias.

Removal of an umbilical hernia is performed laparoscopically or in the course of a classic “open” operation, which depends on the characteristics of the patient’s condition and the procedure for performing the intervention.The classical method is more often used in emergency cases to treat complications of a hernia. When carrying out operations to remove an umbilical hernia in a planned manner, laparoscopy is preferred as a more gentle and safe technique.

Rehabilitation

After laparoscopic hernioplasty, the patient is discharged the next day after surgery. Home mode is recommended for 3-7 days. Physical activity is possible after 2-3 months.

After open operations, inpatient observation is carried out for 2-3 days, regular dressings, drug treatment to eliminate pain and prevent complications.At the stage of patient activation, it is recommended to use a bandage.

After complete healing of tissues, exercise therapy is selected individually to strengthen the muscles of the back and abdomen. The general rehabilitation period is 6-12 months, which depends on the characteristics of the surgical treatment and the patient’s state of health.

Where can an umbilical hernia be removed?

An umbilical hernia can be removed at an optimal cost in the Tauras-Med medical center. Surgical treatment is carried out by experienced surgeons using advanced technologies, the safest and most effective techniques.For each patient, a personal treatment program is drawn up from the moment of seeking help until complete recovery.

How much will the operation to remove an umbilical hernia cost

The cost of removing an umbilical hernia is determined by the surgical procedure. Actual prices can be found by phone or in the “Price” section on the center’s website. The exact cost is announced by the doctor after consultation and examination.

It’s time to get rid of the umbilical hernia and avoid complications.Sign up for a consultation with the surgeons of the Tauras-Med center right now!

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