Hernia: Classification and presentation
In general terms, a hernia is defined as the
protrusion of an organ or a part through a defect in the
wall of the body cavity (usually the abdominal cavity)
in which it normally lies. There are several different
types of abdominal hernias, which can be classified
depending on the location where they occur (inguinal,
umbilical, femoral, etc), as well as on the age at which
they occur.
Congenital hernias are present at birth, while acquired
hernias develop in adulthood and may be due to blunt or
surgical trauma, or to a weakening from any cause in the
muscle wall of the abdominal cavity. It is important to
note that a defect or a muscle weakness in the abdominal
wall is only a predisposing factor for the development
of an abdominal hernia, but it doesn’t necessarily cause
it. However, provided that a defect or a muscle weakness
in the abdominal wall is present, any condition or event
leading to increased abdominal pressure (including
obesity, pregnancy, constipation, persistent coughing or
sneezing and lifting heavy object) can greatly increase
the risk of hernia.
Regardless of the type of hernia, the classic
sing of herniation is a swelling or a bulge under the
skin where herniation has occurred. This bulge or
swelling varies in size and consistency depending on the
size and nature of the protruding abdominal contents
(called hernial contents), and in most cases does not
cause pain on palpation, unless there are some
complications.
When hernial contents are freely movable and can
easily manipulated back into their natural position, the
hernia is said to be reducible. However sometimes it
happens that hernial contents remain fixed in the
abnormal location through adhesions with the surrounding
tissues. In the last case hernia is said to be
incarcerated or irreducible and can lead to serious
complications, such as obstruction of the herniated
portion of the intestine or necrosis (tissue death) of
the herniated contents which causes severe pain and
require immediate medical attention.
Hernia: when surgery is necessary
Hernias are always treated surgically, although
not all hernias need to be repaired and treatment is
usually required only when hernias cause symptoms,
become larger or are incarcerated. The outcome of hernia
surgery is most often good.
When hernias are triggered by increased abdominal
pressure, their worsening or recurrence can be prevented
by simply avoiding the triggering factors. Some
effective measures include losing weight or staying at a
healthy weight, eating a high-fiber diet to avoid
constipation, treating any condition causing persistent
coughing, quitting smoking, and finally lifting heavy
objects carefully.