PATIENT INFORMATION

Hernia
Epigastric Incisional Umbilical Defect Abdominal wall

Inguinal

Sac Skin

Femoral Inguinal in scrotum

Parts of a hernia

Types of hernia
What is a hernia and what causes it? A hernia is a bulge or protrusion of soft tissue through the muscles of the abdominal wall where there tends to be a weak spot. The inside of the abdomen tends to be a highpressure area, especially with lifting and straining, and this may cause a blind sac or pouch (rather like a sock) to bulge out through one of these weak spots. This bulge may be present at birth or develop in adult life. What are the common types of external hernia? Inguinal hernia the most common; found in the groin, especially in males, and associated with the development of the testes Femoral hernia also in the groin Incisional hernia develops in operation wounds Epigastric hernia occurs in the midline between the breastbone and the navel Umbilical hernia develops in and around the navel (umbilicus) What are the symptoms? The main symptom is a bulge or swelling. It can usually be pushed back into place (a reducible hernia) with gentle pressure or may simply disappear on lying down. The lump gurgles when it is pushed back. In men, swelling of the scrotum can also be a sign of hernia. Mild discomfort or transient pain can occur but hernias are usually painless. Loops of intestine can get into the hernia and the gurgling noise of the bowel can be felt or heard. What makes people more likely to develop a hernia? Premature infants Increasing age: adults over 60 Obesity Chronic cough: eg, chronic bronchitis Pregnancy Straining: eg, chronic constipation Heavy lifting Difficult urination: eg, enlarged prostate What are the risks of hernias? The main risk is obstruction of a loop of intestine in the sac of the hernia. This will cause abdominal pain, nausea and vomiting. A more serious risk is strangulation in which the blood supply is cut off to the intestine. The strangulated hernia becomes swollen, red and extremely painful. These complications require urgent attention. What is the treatment? A persistent bulge or swelling requires a medical opinion. The best treatment even for most non-painful reducible hernias of the groin is surgery. Hernias are repaired by pushing the sac back into the abdomen and then sewing over the weakened muscle opening with strong stitching or inserting a special mesh to seal the gap. Most hernias tend to get slowly worse with time, and therefore surgery to avoid obstruction or strangulation is best. In the elderly, who have a non-painful reducible hernia, a supportive garment or truss may be recommended. General measures before and after surgery: Keep to ideal weight Avoid heavy lifting and straining Adjust diet to avoid constipation Avoid coughing: seek help if necessary

AUTHOR: PROFESSOR JOHN MURTAGH

Copyright of Professor John Murtagh and Australian Doctor. This patient handout may be photocopied or printed out by a doctor free of charge for patient information purposes.