A hernia is a condition in which the intestine protrudes in and out through a weak opening in the abdominal muscle wall. If the hernia protrudes and cannot be pushed back in, it becomes an incarcerated hernia. If not treated promptly, serious complications may occur. Therefore, you should regularly observe yourself and see a doctor as soon as possible.
What is a hernia?
Hernia (Hernia) is a disease in which part of an organ within the abdominal cavity moves out of its normal position through an opening or pushes through the abdominal wall. Normally, the abdomen has openings through which the intestine can protrude about 3–4 sites; however, where a hernia occurs depends on each individual. In young people, hernias most commonly occur in the groin area, while in women a hernia may be found below the groin, for example.
How many types of hernias are there?
Hernias are classified into several types according to the location where the organ moves and the cause. Most treatments usually require surgery. Common types of hernias include:
- Inguinal hernia The most common type in both men and women. It is divided into:
- A groin hernia caused by a lax abdominal wall, allowing the intestine to protrude near the pubic area (Direct Inguinal Hernia)
- A hernia that protrudes through an opening in the groin (Indirect Inguinal Hernia). This opening used to be the passageway for blood vessels supplying the testicles when the baby was in the womb and normally closes on its own. If it does not close naturally, it indicates an abnormality that may allow the intestine to move into the scrotum.
- Umbilical hernia or a protruding navel. It is commonly found in newborns when the abdominal wall under the skin does not close completely after birth, allowing part of the intestine to protrude beneath the navel and push it outward. The more premature the baby, the higher the likelihood. It can also occur in adults or the elderly, and is found more often in women than in men.
- Hiatal hernia Caused by laxity of the diaphragmatic sphincter muscle, allowing part of the stomach or esophagus to move through a weakened opening in the diaphragm into the chest cavity or other areas. Symptoms are similar to gastroesophageal reflux disease (GERD). You should see a doctor promptly.
- Femoral hernia Mostly found in women. It occurs when the intestine moves to below the groin and forms a bulge. Although relatively uncommon, you should always watch for abnormalities.
- Obturator hernia Rare but very severe because it can cause intestinal obstruction. It is mostly found in thin, elderly women.
- Incisional hernia Found in people who have had abdominal surgery or whose surgical wound has not fully healed, because high intra-abdominal pressure causes tissue to protrude through the abdominal wall, forming a bulge that cannot return to its original position.
What are the symptoms of a hernia?
In the early stage, a hernia often has no symptoms. If it persists for a long time, symptoms may appear and you should see a doctor immediately for evaluation and differential diagnosis, including:
- A dull ache, as if something is slipping out at the hernia site
- Pain at the lump; the lump often comes in and out and disappears when lying down
- Abdominal bloating, no bowel movement
- Nausea, vomiting
What are hernia complications?
Although a hernia is not usually life-threatening, it can cause complications that affect quality of life, including:
- Compression of surrounding tissue and nerves, causing groin pain, testicular pain, thigh pain, and it may extend to the scrotum
- Incarcerated hernia: the hernia progresses until it cannot be pushed back to its original position, causing intestinal obstruction. If left for more than 6 hours, the incarcerated bowel segment may swell and lose blood supply, which may lead to bowel necrosis, perforation or rupture, bloodstream infection, and can be life-threatening.
- Strangulated hernia: the intestine or tissue becomes trapped or squeezed, with inadequate blood supply. This is life-threatening and requires immediate surgery.
Risk factors for hernia
Risk factors for hernia often come from behaviors that increase intra-abdominal pressure or weakness of the abdominal wall, including:
- Abdominal strength Weak abdominal muscles increase the risk of hernia
- Intra-abdominal pressure High abdominal pressure weakens the abdominal wall
- Age As age increases, the abdominal muscles weaken with age
- Sex Men are more likely to have inguinal hernias than women
- Congenital abnormalities Premature birth, low birth weight
- Chronic cough or sneezing From emphysema, chronic bronchitis, smoking
- Chronic constipation Regular straining during bowel movements or urination
- Pregnancy Higher-than-normal intra-abdominal pressure, weak abdominal muscles
- History of hernia or hernia surgery There is a chance of recurrence
- Heavy exertion exercise Such as lifting heavy objects frequently
- Family history of hernia The abdominal wall muscles may be weak
How is a hernia diagnosed?
Diagnosis of a hernia primarily depends on the location. In some cases, other special diagnostic tools may be necessary, depending on the specialist. It includes:
- Physical examination by palpating the bulge and observing with coughing or sneezing
- CT scan
- Abdominal ultrasound (Ultrasound)
- Magnetic resonance imaging (Magnetic Resonance Imaging – MRI)
Hernia treatment approaches
Hernia treatment depends on the type and symptoms. If the hernia enlarges or cannot be pushed back into its original position, or if there is abdominal pain, it should not be left untreated. Treatment should be received as soon as possible to prevent complications. There are 3 treatment methods:
- Open hernia repair (traditional) The doctor pushes the protruding tissue back into place and closes it with a special mesh to prevent recurrence. An advantage is that it can be performed under local anesthesia, making it suitable for patients with underlying diseases who cannot undergo general anesthesia or spinal anesthesia.
- Minimally invasive hernia repair (Minimally Invasive Surgery: MIS) The doctor makes three small incisions in the abdominal wall to return the intestine to its original position and strengthen the weak point that allows the hernia to protrude using synthetic mesh. Placing the mesh from inside the abdominal cavity helps reduce the recurrence rate. The postoperative incisions are small (5–10 mm), postoperative pain is less, and recovery is faster.
- Robot-assisted hernia repair (da Vinci Xi) The doctor inserts a small scope to display the surgical site in detail on the screen, then controls robotic arms and instruments from the console to repair the hernia precisely even in complex areas. Small incisions, less pain, faster recovery, a short convalescence period, and a quicker return to normal life.
How to take care of yourself after hernia treatment
- Be careful not to get the wound wet until stitch removal; do not pick or scratch the wound area.
- If you cough or sneeze, support the wound.
- Prevent constipation; avoid straining during bowel movements or urination.
- Consume clear liquids to prevent dehydration after surgery.
- Do not lift heavy objects, do strenuous exercise, or do abdominal muscle exercises during the first month after surgery.
- Lose weight to an appropriate range.
- You may take pain relievers to ease wound pain.
Can a hernia heal on its own?
A hernia cannot heal on its own and cannot be treated by taking medication. If left until severe, the hernia cannot return to its original position and may cause intestinal obstruction or intestinal necrosis from lack of blood supply. Therefore, you should see a specialist as soon as possible for hernia surgery.
Can a hernia recur?
A hernia can recur if the postoperative wound has not fully healed even after many years, because intra-abdominal pressure is too high and the protruding tissue cannot return to its original position. In addition, in people with higher body weight, the abdominal wall tissue may not be strong, leading to recurrence.
Hernia symptoms that require immediate medical attention
- Pain at the hernia site
- A bulge that cannot be pushed back in
- No bowel movement, unable to pass gas
- Abdominal bloating, vomiting
How to prevent a hernia
- Avoid lifting heavy objects
- Eat high-fiber foods such as vegetables and fruits to prevent constipation
- Maintain weight within the normal range
- Exercise regularly
- Avoid dust, smoke, pollution
- Do not smoke
Hospitals specializing in hernia treatment hernia
Surgery Center, Bangkok Hospital is ready to provide hernia care and treatment with a team of highly experienced specialist physicians and a multidisciplinary team ready to provide close consultation, along with modern instruments and technology for hernia surgery, such as mesh to strengthen the abdominal wall muscles and the use of high-definition 4k Ultra High Defenition imaging to enhance surgical efficiency and prevent recurrence, so you can return to daily life with confidence.
Doctors specializing in hernia treatment
Dr. Chanin Pundee Specialist surgeon in abdominal surgery using laparoscopy and robot-assisted surgery; treats hernias, gallbladder stones, and the colon, Bangkok Hospital
Prof. Dr. Suthep Udomsawaengsup Specialist surgeon in abdominal surgery, Surgery Center, Bangkok Hospital
