In this condition factsheet:
The Facts on Hernia
A hernia occurs when a portion of tissue in your body bulges into or penetrates a weakened muscle area. Theoretically, hernias can happen anywhere in your body, but most occur in the abdomen between the rib cage and the groin.
There are several types of hernias:
- Hiatus or diaphragmatic hernias occur when a piece of your stomach protrudes through the diaphragm (the muscle that separates the chest region from the abdominal area) via the opening through which the esophagus (food tube) passes into the stomach. Approximately 10% of all Canadians and 30% of those over 60 years of age have hiatus hernias. Hernias may also occur in infancy because of a weakness in the abdominal wall. They occur in about 5% of full-term infants and up to 30% of premature babies.
- Inguinal or groin hernias occur when part of the abdominal contents (usually part of the intestine or a piece of bowel) protrudes into the groin area. They affect 3% to 8% of Canadians, and men are 10 times as likely as women to get them. They often occur after age 50 (on one side of the groin or both) and account for approximately 10% of all hospital admissions for surgery.
- Umbilical hernias are similar to inguinal hernias but are found in the area of the umbilicus (the navel or belly button area).
- Incisional hernias occur when a piece of intestine protrudes through a weakness in the abdominal wall in an area where surgery has been performed.
- Femoral hernias occur when a piece of intestine protrudes though the passage that is normally used by large blood vessels as they pass between the abdomen and leg.
- Paraesophageal hernias are very rare, but can be life threatening because in some cases they can cause the entire stomach to slip into the chest cavity.
Causes of Hernia
The cause of some hernias cannot be pinpointed, but many result from increased pressure within the abdomen, a weak spot in the abdominal wall, or a combination of the two.
In adults, hiatus hernias commonly develop in pregnant women and overweight people due to the increased pressure on the abdominal wall.
In men, an inguinal hernia will commonly develop in the groin, specifically in a region called the inguinal canal. This is where the spermatic cord and blood vessels to the testicles pass out of the abdominal cavity and into the scrotum. A weakness in the abdominal tissues at this point can allow a loop of bowel to pass out of the abdomen by following the path of the spermatic cord (indirect inguinal hernia) or between the opening into the inguinal canal and the pubic bone (direct inguinal hernia).
In women, inguinal hernias are rare, but can develop where the tissue that binds the uterus exits from the abdomen and joins with the tissue surrounding the vaginal opening.
Umbilical hernias may be present at birth. In adults, they may develop when there is a weakness in the tissue in the umbilical area combined with increased pressure on the abdominal wall.
Symptoms and Complications of Hernia
If you have a hiatus hernia, you usually don't have any symptoms unless the sphincter muscles around the lower end of the esophagus become weak. When this occurs, the valve between the stomach and esophagus (gullet) won't stay closed, and stomach acids will spill into the esophagus. As a result, you may experience heartburn, sharp pain, regurgitation, belching, and sometimes bleeding. At night, you may experience coughing, breathlessness, or a choking sensation.
Signs and symptoms of an inguinal (groin) hernia include discomfort while bending over or during lifting. You may feel a small egg-like lump in your groin that may become more prominent with certain activities such as coughing. It will usually not hurt at first and will disappear when you lie down. If the bulge persists and is accompanied by nausea and vomiting or abdominal pain, this can be a sign that the hernia has become obstructed or strangulated.
Although rare, an untreated hernia that strangulates may result in gangrene (death of tissue), which is a life-threatening condition and requires emergency surgical attention. Symptoms of strangulation include pain, swelling, discoloured bluish or red skin, vomiting, and an inability to urinate.
Children with strangulated inguinal hernias may have fever and vomiting and should be seen immediately by a doctor.
Inguinal hernias may not make themselves known until your abdominal wall is weakened after years of straining during bowel movements or from heavy coughing or lifting. Smokers are prone to such hernias. Physical exertion such as lifting may exacerbate a hernia by suddenly causing the weakened abdominal lining to give way.
Paraesophageal hernias usually have no symptoms, but if symptoms do occur, the most common are pain, indigestion, nausea, and retching.