Understanding Hernias: the Basics

I ncisional hernias

The 6 Most Common Types of Hernia

A hernia occurs when a piece of tissue bulges through an area of the body — usually a weak point in a person’s abdominal wall. Some hernias may cause few symptoms. Others can be a medical emergency.

Here, we’ll discuss different areas in the body where hernias can occur, plus guide you to more in-depth information about each hernia type.

The following are some of the most common hernia types.

Epigastric hernia

An epigastric hernia occurs in the epigastric region of the abdomen, which is located above the belly button and below the rib cage. They are caused by a gap between the two sides of the abdominal muscles, which allows fat tissue to push through the abdomen.

About 2 to 3 percent of all abdominal hernias are epigastric hernias. Some babies are born with epigastric hernias. Other hernias develop in adults due to muscle weakness or straining.

If you have an epigastric hernia, you may be able to feel it when there is pressure on the abdominal wall, such as when you:

• cough
• laugh
• bear down to have a bowel movement

You may also have some pain or tenderness around where the hernia is.

Many epigastric hernias are small and don’t cause symptoms. Larger hernias that cause symptoms may require surgery.

Femoral hernia

A femoral hernia occurs when tissue pushes through a weak point in the groin or inner thigh. The hernia may feel like a small- to medium-sized lump in the groin.

An estimated 2 to 4 percent of all hernias that occur in the groin are femoral ones. This type of hernia is rare in children. Women experience femoral hernias more often than men due to the larger width of the female pelvis. They can sometimes be linked to straining during bowel movements or lifting heavy weights.

A femoral hernia can be a cause for concern due to the femoral artery and vein being nearby. It’s possible the hernia could affect these blood vessels and block blood flow to and from the leg. Because of this, doctors almost always try to quickly correct a femoral hernia with surgery.

Hiatal hernia

A hiatal hernia is a condition that occurs when a person’s stomach bulges through a weak point in the diaphragm. This muscle plays an important role in breathing and separates the lungs from the abdominal organs.

If you have a hiatal hernia, symptoms may include heartburn and gastroesophageal reflux disease (GERD).

Doctors aren’t sure what causes hiatal hernias. They’re quite common in older adults and are most often seen in people who are:

• over age 50
• pregnant
• overweight

Hiatal hernias are classified into types — from type I to IV — depending on where they are located.

An estimated 95 percent of hiatal hernias are type I. With these hernias, the stomach remains in position, yet the area where the esophagus meets the stomach slides above the diaphragm.

Most people only need treatment for hiatal hernias if they’re experiencing symptoms. This may involve treatments to reduce heartburn or surgery in more severe cases.

Incisional hernia

An incisional hernia occurs after a person has stomach surgery. It usually involves an incision down the middle of the stomach. If the surgical wound doesn’t heal completely, that person can be more vulnerable to developing a hernia.

About 15 to 20 percent of people who undergo abdominal surgery experience incisional hernias. Risk factors include:

• undergoing emergency surgery
• experiencing complications during or after surgery, including infection
• having certain chronic conditions, including diabetes and kidney failure
• having obesity
• smoking
• taking certain long-term medications, including steroids and immunosuppressants

Some doctors may use the terms “ventral hernia” and “incisional hernia” interchangeably. A ventral hernia refers to any hernia type that occurs along the midline of the stomach. However, not all ventral hernias are incisional hernias.

Doctors may take a watch-and-wait approach with smaller incisional hernias. Larger hernias may require surgery.

Inguinal hernia

An inguinal hernia occurs when a portion of intestine or fat bulges through the lower stomach wall. The bulge usually goes through the inguinal canal, which is located in the groin area.

An inguinal hernia can contain a portion of the small intestine or parts of the female reproductive organs.

According to the National Institute of Diabetes and Digestive and Kidney Diseases , inguinal hernias are a relatively common type of hernia in the groin region, usually on the right side. An estimated 27 percent of men and 3 percent of women will develop an inguinal hernia in their lifetime. They most often occur in children up to age 5 and adults from ages 75 to 80.

Sometimes it’s difficult to tell the difference between a femoral and inguinal hernia. An inguinal hernia can cause a bulge not only in the groin but also in the scrotum.

Inguinal hernias usually need to be repaired with surgery. That’s because there’s a risk that the hernia may contain parts of the small intestine that become stuck outside the abdominal wall. If blood flow is cut off, this can lead to intestinal obstruction and potentially death.

Umbilical hernia

Umbilical hernias are those in which tissues in the body bulge through an area of weakness in the belly button area (umbilicus). This hernia type causes a visible bulge in or around the belly button that’s usually worse when you cough or strain when having a bowel movement.

According to the American College of Surgeons, an estimated 10 percent of all hernias in the abdominal area in adults are umbilical hernias. They usually happen when muscles weaken with age.

Umbilical hernias are especially common in babies under 6 months old, occurring in about 20 percent of infants. It occurs when the muscles surrounding the umbilical cord don’t close after birth. They usually repair themselves by the time a child is 4 to 5 years old.

Most umbilical hernias aren’t painful and don’t cause problems. They may require surgery if they don’t go away on their own or cause symptoms.

Understanding Hernias: the Basics

A hernia happens when an organ or fatty tissue squeezes through a weak spot in a surrounding muscle or connective tissue called fascia. They often occur where the abdominal wall is weaker, such as in the abdomen (belly area) or groin, and can have various causes.

Hernias can be painful. In some cases, they need emergency treatment. Call 911 right away if:

• Your hernia is extremely painful, growing quickly, swollen, or red.
• You vomit or feel nauseous.
• You have constipation or bloating.
• You have a fever.

In a reducible hernia, the lump can be pushed back through the abdominal wall. If not, it’s an irreducible hernia, which is more likely to have serious complications.

A hernia is an emergency if it is “incarcerated.” In an incarcerated hernia, tissue (such as from the bowel) has slipped through the hernia and gotten stuck there. Stool may not be able to get through normally, which can cause pain, nausea, vomiting, and even tear the bowel wall. If an incarcerated hernia becomes “strangulated,” the bowel tissue has started to die and needs emergency surgery.

Hernia Causes

Ultimately, all hernias are caused by a combination of pressure and an opening or weakness of muscle or fascia. The pressure pushes an organ or tissue through the opening or weak spot. Sometimes the muscle weakness is present at birth. But more often, it happens later in life.

Anything that causes an increase in pressure in the abdomen can cause a hernia, including:

• Lifting heavy objects without stabilizing the abdominal muscles
• Diarrhea or constipation
• Persistent coughing or sneezing

In addition, obesity, poor nutrition, and smoking can weaken muscles and make hernias more likely.

Types of Hernias

The most common types of hernia are inguinal (inner groin), incisional (resulting from a surgical cut, or incision), femoral (outer groin), umbilical (belly button), and hiatal (upper stomach).

Groin hernias

About 3 out of every 4 hernias are in the groin. There are two types: inguinal and femoral.

Almost all groin hernias are inguinal. You get them when part of your intestine pushes through a weakness in the lower belly and affects an area of the groin called the inguinal canal.

There are two kinds of this hernia:

• Indirect. The more common type; it enters the inguinal canal.
• Direct. It does not enter the inguinal canal but goes straight through the bowell wall.

They’re much more common in men than women, but they’re not limited to adults.

With an inguinal hernia, you’ll probably see a lump where your thigh and groin come together. It may seem to go away when lying down, but you see it clearly when you cough, stand, or strain.

Generally, these hernias aren’t dangerous. Your doctor may consider watchful waiting, or monitoring the hernia.

Femoral hernias account for only a few out of every 100. They’re more common in older women. They are often mistaken for inguinal hernias .

Femoral hernias bulge into a different area of the groin called the femoral canal. You might see a lump right around the crease of the groin or just into the upper thigh.Your doctor will likely recommend that you get surgery for a femoral hernia instead of watchful waiting, since they are more likely to get stuck without being reducible.

Umbilical hernias

This is the second most common type of hernia. Umbilical hernias happen when fat or part of the intestine pushes through muscle near the belly button. They’re more common in newborns, especially in those born earlier than expected and babies under 6 months old. But adults can get them, too.

Women are more likely than men to get an umbilical hernia. Your chances are also higher if you:

• Are overweight
• Have been pregnant more than once
• Have a lot of belly fluid (a condition called ascites )
• Have a long-term cough
• Have trouble peeing because of an enlarged prostate
• Are constipated for long periods of time
• Vomit repeatedly

What all of these risk factors have in common is increased pressure in the abdomen that pushes the hernia out.

I ncisional hernias

If you have surgery in which a doctor makes an opening through your belly, you might get an incisional hernia later. Tissue can poke through where the skin has been weakened by a scar left after surgery. Like groin hernias, they can lead to more serious problems if they’re not repaired.

Incisional hernias are common in people who have had an operation, especially emergency surgery. You can be more likely to get one if you do any of these things before your incision heals completely:

• Gain a lot of weight
• Exercise too soon or too heavily
• Get pregnant

Your chances are also higher if the wound gets infected or if you:

• Are a man over 60
• Are obese
• Have long-term lung disease
• Have diabetes or kidney failure
• Smoke
• Take long-term medications like steroids or drugs that affect your immune system

These are a little different from the other types of hernias because of where they happen.

Hiatal hernias involve your diaphragm, the sheet of muscle that separates your chest from your belly. Your esophagus runs from your throat to your stomach and passes through an opening in the diaphragm.

With a hiatal hernia, part of the stomach bulges up through this opening and into the chest. You won’t see any lump, but you might get heartburn or chest pain and notice a sour taste in your mouth.

Although they’re the most common hernias seen in pregnant women, this type of hernia is most often found in people over age 50.

Other types of hernias

Less common types of hernias include:

• Epigastric hernia. This is when fat pushes through the belly somewhere between the belly button and lower part of the breastbone. These show up in men more often than women.
• Giant abdominal wall hernia. You might get one of these if you have an incisional hernia or some other kind that’s hard to treat and keeps coming back.
• Spigelian hernia. You get this type when fat tissue pushes through muscle below your belly button along the bottom edge of where your six-pack might be.

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