When a piece of tissue or an organ protrudes from its normal position, the condition is called a hernia. An abdominal hernia occurs when a piece of bowel protrudes through a weak area of the abdominal walls. Muscle and tissue layers form the abdominal walls. Weak spots may arise from these layers, enabling the contents of the abdominal cavity to herniate and protrude. The usual types of hernia occur in the groin and the diaphragm. They are called inguinal hernia and hiatal hernia respectively. Hernias may also be congenital (present at birth) or acquired.
The Common Types of Abdominal Hernias
1. Hernias of the Pelvic Floor and Abdominal Walls
- Inguinal hernia - this type of hernia is the most common of all. It usually happens when the fat contents of the abdomen or small intestines protrude via a weak region in the abdominal wall (lower region). This lower area of the abdominal wall is the inguinal region.
- Femoral hernia - normally happens through the entrance of the abdominal walls where the veins and the femoral artery find their way to the leg. It is most commonly seen among women because they have a wider bone structure.
- Obturator hernia - is an anterior hernia of the pelvic floor. However, its cases are rare. This condition is frequently seen in women who have had several pregnancies or those who lost some weight. It happens through the obturator canal, which links the cavity of the abdomen to the leg. This canal has the obturator vein, artery, and nerve.
2. Hernias of the Anterior Abdominal Wall
The muscles of the abdominal walls are mirror images of each other. These abdominal muscles include:
- rectus abdominis
- internal and external obliques
- transversalis fascia
Hernias of the anterior abdominal wall include epigastric hernias, umbilical hernias, and Spigelian hernia.
An epigastric hernia is most commonly observed in men than women. Epigastric hernias will occur due to a fault in the abdominal wall, usually in the midline, where the rectus abdominis muscles join. However, in some cases, the weakness becomes evident only later in the adult life. This type of hernia develops into a bulge in the upper part of the abdomen.
An umbilical hernia typically causes abnormal protrusions in the belly button. They are usually seen in newborns. Treatment of such condition is unnecessary unless complications arise. However, some may grow big, thereby requiring repair. The umbilicus (belly button) is the place in the abdomen where the fetus is attached to the parent enabling the circulation of blood.
The other form of a hernia, the Spigelian hernia occur on the edges of the abdominal muscles, particularly the rectus abdominis muscles. However, this type of hernia is rare.
When an incision is made in the abdominal muscles to allow your doctor to operate on the abdominal cavity, sometimes, complications may arise. When it happens, it is known as an incisional hernia. The reason is that the areas where the cuts were made become weak spots, allowing the abdominal organs to bulge through the incisions.
Hernias of the Diaphragm
They are of three types: hiatal hernias, traumatic diaphragmatic hernias, and congenital diaphragmatic hernias.
When part of the stomach moves through an entrance in the diaphragm, where the food pipe (esophagus) migrates from the chest into the abdomen, hiatal hernias occurs. Two types of hiatal hernias are: sliding and paraesophageal. When the lower esophagus and parts of the stomach gently slide into the diaphragm, the former happens. However, when only the stomach herniates together with the esophagus into the chest, the latter happens. Paraesophageal hernias may lead to severe risks of obstruction or volvulus (twisting of the stomach).
When a blunt trauma is experienced during injury, the diaphragm muscles may become weakened or torn, suddenly allowing herniation. Abdominal organs will be herniated into the chest cavity. In some cases, a delayed herniation can also occur. This type of herniation is referred to as a traumatic diaphragmatic herniation.
Lastly, a congenital diaphragmatic herniation will result from the failure of the diaphragm to completely develop during the fetus' formation. When it happens, the lungs will also fail to develop. Furthermore, a decrease in the lung function will be experienced when the abdominal organs move to the chest.
Abdominal Hernia Symptoms
A bulge will be felt in the groin region where an inguinal hernia forms. You can also feel pain due to the inflammation of the inguinal nerve. The pain will also be felt around the groin region. The tearing of the muscles can also be felt if a hernia that occurred was as a result of weightlifting. Nevertheless, people will not have complaints except having a full feeling in the region of the inguinal canal.
In some cases, bowel portions may become trapped in the hernial sac causing a complication. Similarly, a bowel may find its way into the hernial sac and gets trapped. When it swells, a surgical emergency will be required due to the loss of blood supply causing strangulation of the bowels. Pain results from the situation coupled with vomiting and nausea. When fever is experienced, it will signal you of a dead bowel as a result of the strangulation.
However, another type of a hernia called as the Richter's hernia causes only a portion of the intestines being trapped in the hernial sac. Thus, an obstruction will not occur, as there will be a throughway in the intestines allowing the movement of bowel contents. Only the portion of the bowel, which got trapped, will die from strangulation.
Umbilical hernias can easily be identified in adults. They usually bulge out without any abdominal pressure. Complications resulting from umbilical hernias will also include strangulation and trapping.
The symptoms for obturator and femoral hernias are similar to those of inguinal hernias. However, due to their location, the lumps or the feeling of fullness will not be easy to identify.
Symptoms of a hiatal hernia are very rare. However, large hiatal hernias will cause symptoms that usually include:
- difficulties in swallowing
- abdominal or chest pains
- feeling full after meals
- vomiting blood
Make sure that you contact your physician if any of the abovementioned symptoms persist.
Diagnosis of an Abdominal Hernia
To effectively diagnose the disease, you doctor will examine you after knowing about your symptoms. Your medical history will also be crucial for the diagnosis. Your abdomen will be examined while you stand up and when you lie down. You will be required to cough as the doctor places a finger over a hernia, to check for changes in swelling. Depending on the symptoms, an ultrasound scan is usually recommended to confirm the diagnosis.
Abdominal Hernia Surgery
In young children, umbilical hernias normally get better on its own. However, in adults, their hernias become bigger and will require surgery. The most common is the inguinal hernias repair among adults. The operation may be carried out through a laparoscopy or herniorrhaphy. In both surgeries, the hernia is repaired via an incision in the abdominal wall. The process to be used will, however, depend on the clinical situation and how urgent is the surgery.
Other abdominal wall hernias can also be repaired through surgery to reduce the risk of bowel trapping and strangulation. Having a healthy lifestyle, taking medications, and maintaining a healthy weight will eliminate the need for an operation. The individuals whose groin areas have been exposed to radiation treatments may heal poorly and are vulnerable to the reoccurrence of a hernia.