Hernia or hernia is a condition that occurs when an organ in the body presses and sticks out through weak muscle tissue or surrounding connective tissue. The body's connective tissue should be strong enough to hold the organs in it in place. However, some things cause the connective tissue to weaken so that it can't hold the organs inside and result in a hernia.
Types of Hernias
Hernias consist of several types, namely:
- inguinal hernia, It occurs when a portion of the intestine or fatty tissue in the abdominal cavity sticks out into the groin. Inguinal hernia is the most common type of hernia and men have a higher risk of developing it.
- femoral hernia, It occurs when fatty tissue or part of the intestine sticks out into the inner upper thigh. The risk of women suffering from this type of hernia is higher, especially women who are pregnant or are overweight (obese).
- umbilical hernia, It occurs when a portion of the intestine or fatty tissue pushes and sticks out of the abdominal wall, specifically at the belly button. Umbilical hernias are usually experienced by infants and children under the age of 6 months due to the umbilical cord hole not closing completely after the baby is born.
- hiatus hernia, occurs when part of the stomach sticks out into the chest cavity through the diaphragm (the partition between the chest cavity and the abdominal cavity). This type of hernia generally occurs in the elderly (> 50 years). If a child has a hiatal hernia, the condition is caused by a congenital abnormality.
- incisional hernia, occurs when bowel or tissue sticks out through a surgical scar in the abdomen or pelvis. An incisional hernia can occur when the surgical wound in the abdomen does not close completely.
- epigastric hernia, It occurs when fatty tissue sticks out through the upper abdominal wall, from the gut to the navel.
- spigelian hernia, occurs when a portion of the intestine pushes against the connective tissue (Spigelian fascia) which is located on the outer side of the rectus abdominus muscle, which is a muscle that stretches from the ribs to the pelvis with a characteristic bulge known as 'six pack'. Spigelian hernias most often occur in the area of the Spigelian belt, which is the area of the navel downwards.
- diaphragmatic hernia, It occurs when a portion of the stomach's organs protrudes into the chest cavity through the diaphragm. This type of hernia can also be experienced by babies when the formation of the diaphragm is less than perfect.
- muscle hernia, It occurs when a portion of the muscle sticks out through the abdominal wall. This type of hernia can also occur in the leg muscles as a result of an injury during exercise.
Causes of Hernia
Hernias are caused by a combination of pulled and weakened muscles. There are several things that cause the body's muscles to weaken, namely:
- Age.
- Chronic cough.
- Congenital birth, especially in the navel and diaphragm.
- Injury or complications from surgery on the abdomen.
In addition, there are a number of factors that are thought to increase a person's risk of developing a hernia, especially when the muscles of the body begin to weaken. Among others are:
- Lifting heavy weights too often.
- Constipation that causes sufferers to have to strain during bowel movements.
- Pregnancy causes increased pressure in the abdominal wall.
- Accumulation of fluid in the abdominal cavity.
- Weight gain suddenly.
- Sneezing that lasts a long time.
Diseases likecystic fibrosis, can also indirectly increase the risk of hernia. This condition causes disruption of lung function so that it triggers a chronic cough.
Hernia Symptoms
Symptoms of a hernia vary, depending on its location and severity. Hernias in the abdomen or groin are characterized by the appearance of a lump or bulge that may disappear when lying down. However, the lump can reappear when the sufferer laughs, coughs, or strains. Other hernia symptoms are:
- Pain in the area of the lump, especially when lifting or carrying heavy objects.
- Heaviness and discomfort in the stomach, especially when bending over.
- Constipation.
- The size of the lump gets bigger over time.
- Lump in groin.
A hiatal hernia is also characterized by symptoms of chest pain, difficulty swallowing (dysphagia), and heartburn. Immediately consult a doctor, especially if you experience symptoms of severe pain and appear suddenly, vomiting, difficulty defecating, and hard lumps, painful to the touch, and difficult to push in.
Hernia Diagnosis
The diagnosis of a hernia is made through a physical examination. The doctor will feel the patient's abdomen or groin to feel a lump or bulge that can be seen when the patient stands or coughs.
For a hiatal hernia, the doctor will perform a barium edema examination and endoscopy in the process of diagnosis. Barium edema is an X-ray examination using the help of swallowed barium fluid to produce detailed images of the inside of the digestive tract. This type of examination is also used to detect intestinal obstruction.
Imaging tests are also done to confirm the diagnosis and detect other disorders that may be caused by the hernia, such as:
- ultrasound, to obtain a picture of the inside of the abdominal and pelvic organs.
- CT scan, to examine the internal organs of the abdominal cavity.
- MRI, to detect a tear in the abdominal muscles, even if there is no visible bulge.
Hernia Treatment
Before determining the treatment step, there are a number of factors that can influence the doctor's decision in determining the surgical procedure, namely:
- The patient's overall health condition.
- Symptoms that arise and their impact on the patient's life. The doctor will recommend surgery if the symptoms are getting worse or have interfered with the patient's daily activities.
- The type and location of the hernia.
- Contents of the hernia. For example a muscle or part of the intestine that causes intestinal obstruction or disruption of blood circulation to organs
Based on these considerations, there are several methods of treatment that doctors can do, namely:
- Drug therapy. For patients with a hiatal hernia, the doctor will prescribe medication to lower stomach acid to relieve symptoms and discomfort. Several types of drugs may be given, namely antacids, H-2 receptor antagonists, and proton pump inhibitors (PPI).
- Operation. Surgery is the main step taken by doctors in treating hernias. There are two operating methods that can be performed, namely:
- open operation, consists of several choices of actions that the doctor may perform during the descending surgery. Among others are:
- Herniotomy. The doctor will make an incision in the abdominal wall, then push the hernia back into the abdominal cavity and remove the hernia sac.
- Hernioraphy. Almost similar to a herniotomy, but the doctor will sew the area where the hernia came out to strengthen the abdominal wall.
- Hernioplasty. This action is done when the hole where the hernia comes out is quite large. The doctor will use a synthetic net (mesh) to close and strengthen the hole, so the hernia does not recur.
- Laparoscopy (keyhole surgery), is a hernia surgery procedure performed by making a small incision in the abdominal wall. The surgeon will use a laparoscope and other surgical support tools in this procedure. A laparoscope is a thin tube-shaped instrument equipped with a camera and a light at the end.
- open operation, consists of several choices of actions that the doctor may perform during the descending surgery. Among others are:
However, there are types of hernias that do not require surgery, namely umbilical hernias, which usually heal on their own and hiatal hernias, which can sometimes be treated with medication.
Hernia Prevention
There are several things you can do to prevent hernias. Among others are:
- Quit smoking, because smoking triggers a chronic cough that can increase the risk of hernia.
- Maintain an ideal body weight by exercising regularly.
- Eat foods high in fiber, such as fruit, vegetables, and whole grains to avoid constipation.
- Avoid lifting weights that are excessive or beyond your ability.
- Consult a doctor if you experience persistent coughing or sneezing.
Hernia Complications
If not treated immediately, the hernia will get bigger and put more pressure on the surrounding tissue or organs. This condition can cause complications that can be experienced by hernia patients. These complications include:
- Incarcerated hernia (obstructive hernia), which is a condition when the intestine gets stuck in the abdominal wall or in the hernia sac (ingual canal), thus interfering with the work of the intestines.
- Strangulated hernia, which is a condition when the intestine or tissue is pinched, so that the flow or supply of blood is blocked. If not treated immediately, this condition can be life-threatening for the sufferer. Strangulated hernias usually occur when herniated obstruction is not treated promptly. Surgery must be performed immediately to prevent tissue death.
Postoperative complications are also possible in the patient. Among others are:
- Recurrent hernias.
- Infection.
- Long term pain.
- Bladder injury.