Abdominal hernias


An abdominal hernia occurs when an organ or other tissue protrudes through a weakening in one of the muscle walls that enclose the abdominal cavity.

If the hernia occurs in the abdominal wall or groin, the penetrating sac that bulges through the weak area may contain a piece of intestine or fatty lining of the colon, the omentum.

A hernia through the diaphragm, ay involve the penetration the stomach.

The abdominal wall is made up of layers of different muscles and tissues, and the development of weak spots in these layers allows contents of the abdominal cavity to protrude or herniate.

Increased pressure within the abdomen may occur with chronic cough, increased fluid within the abdominal cavity, peritoneal dialysis, and tumors or masses in the abdomen, lifting excess weight, straining to have a bowel movement or urinate, or from trauma to the abdomen, chronic constipation, recurrent vomiting, prior abdominal surgeries, and repeatedly moving or lifting heavy objects

Pregnancy or excess abdominal weight and girth are also factors that can lead to a hernia.

The most common abdominal hernias are in the groin known as inguinal hernias, in the diaphragm, known as hiatal hernias, and the umbilicus.

Hernias may be congenital, or they may be acquired.

Inguinal hernias are the most common of the abdominal hernias.

The inguinal canal allows the spermatic cord and testicle to descend from the abdomen into the scrotum as the fetus develops and matures.

Following testicle descent, the inguinal canal opening is supposed to close completely.

Sometimes, however, the muscles that attach to the pelvis leave a weakened area.

Subsequently, a stress placed on that area of weakened tissues can allow a portion of small bowel or omentum to slide through that opening, producing a bulge.

Most patients with inguinal hernias notice a feeling of fullness or a lump in the groin area with pain and burning. Physical examination can usually confirm the diagnosis.

Inguinal hernias are less likely to occur in women, as there is no opening in the inguinal canal.

Inguinal hernia repair is one of the most common surgical procedures, with almost a million operations occurring each year.

A femoral hernia can appear through the opening in the floor of the abdomen in the space for the femoral artery and vein passing from the abdomen into the upper leg.

Femoral hernias tend to occur more frequently in women, because of their wider bone structure.

Obturator hernias are the least common hernia of the pelvic floor, and are mostly found in women who have had multiple pregnancies or who have lost significant weight.

A obturator hernia occurs through the obturator canal, another connection of the abdominal cavity to the leg, and contains the obturator artery, vein, and nerve.

The abdominal wall is made up of two sets muscles: rectus abdominus muscles, the internal obliques, the external obliques, and the transversalis.

A hernia may be congenital and present at birth or it may develop over time in areas of weakness within the abdominal wall.

Increasing the pressure within the abdominal cavity can cause stress at the weak points and allow parts of the abdominal cavity to protrude or herniate.

When epigastric hernias occur in infants, they occur because of a weakness in the midline of the abdominal wall where the two rectus muscles join together.

This weakness later in adult life appears as a bulge in the upper abdomen.

Pieces of bowel, fat, or omentum can become trapped in such abdominal wall hernias.

Hernias are easy to note and adults often emerge with any increase in abdominal pressure.

Surgery to repair a hernia may use a laparoscope or an open procedure called a herniorrhaphy.

Most cases of hiatal hernia are treated with medical therapy as medication, diet, lifestyle changes, and weight loss may help control symptoms and minimize the need for surgery.

Sliding hiatal hernias may be treated surgically to place the stomach back into the abdominal cavity and to strengthen the gastroesophageal junction.

Paraesophageal hernia repair is done to prevent the complication of strangulation or volvulus.

Small, asymptomatic inguinal or umbilical hernias may be watched.

If such hernias grow or if there is concern about potential incarceration, then surgery may be recommended.

Trusses, corsets, or binders can hold hernias in place by placing pressure on the skin and abdominal wall.

Such devices are temporary and potentially cause skin damage, breakdown, and infection.

Umbilical hernias in children tend to resolve on their own by 1 year of age.

Surgery is considered for umbilical hernia if still present at age 3 or 4, or if the defect is large.

For hiatal hernias treatment is aimed at decreasing acid production in the stomach and preventing acid from entering the esophagus.

The major complications of a hernia: incarceration, and strangulation.

Incisional hernias may recur up to 10% of the time.

Factors to prevent abdominal hernias:

Congenital hernias cannot be prevented.

Avoiding an increase in pressure within the abdomen that could stress the weak areas in the abdominal wall.

Maintaining a healthy weight.

Eating a healthy diet and exercise to minimize the risk of constipation and straining to have a bowel movement.

Use proper lifting techniques especially when trying to lift heavy objects.

No smoking to decrease recurrent coughing.

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