A hernia is used to describe a condition where a loop of the intestine enters the inguinal canal in the groin region. This creates a bulge through a weakened spot or tear in the abdominal wall. An inguinal hernia is a situation where the hernia occurs near the groin on account of any inherent weakness of the inguinal canal. Obesity, lifting of heavy objects and multiple pregnancies can lead to an inguinal hernia. Inguinal hernia is a common type of hernia that affects thousands each year. It is noticed that men tend to suffer inguinal hernia condition more often than women. This is because of the weakness of the inguinal canal in men that occurs due to descent of the testicles into the scrotum.
In many cases, there are no symptoms of inguinal hernia. But some patients notice a lump in the groin region near the thigh. In rare cases, an inguinal hernia can lead to blockage of the intestine. There might be discomfort in the groin area when bending or lifting. This might be accompanied by swelling or pain in the scrotum. Certain conditions like cystic fibrosis or chronic constipation can lead to an inguinal hernia. Those with a family history of hernias are more susceptible to developing an inguinal hernia. Smoking, obesity and pregnancy can increase your risk of developing a hernia.
Surgical treatment of inguinal hernia involves removal of the protruding part of the intestine and repair of the abdominal wall. In some cases, all potential hernial openings are secured with patches. This surgery is performed either by laparoscopy or conventional abdominal incision. Large hernias cannot be treated with laparoscopy.
Abdominal hernia refers to a tear in the abdominal wall that allows the abdominal organs or fatty tissues to protrude through the cavity holding the organ. The tear occurs due to the weakness of the muscles surrounding the wall and causes a bulge in the affected area. The bulge tends to enlarge with cough or any other activity that puts pressure on the abdominal muscles and the size of the hernia reduces when the patient is rested or made to lie down. Hernias normally occur in males; however infants and women are also prone to this condition.
Abdominal hernia can be classified into reducible hernia and non reducible hernia. In case of reducible hernia, bulge can be pushed back into the sack with mild pressure and surface can be flattened in the affected area. But in few acute cases, hernia cannot be pushed back into the cavity and this condition is known as non reducible hernia. This is a medical emergency as it poses the risk of strangulation. In case of strangulation, blood supply to the herniated tissue will be cut off leading to the death of the tissue. If the intestines get strangulated and eventually lose blood supply, patient may develop gangrene (dead bowel) and this may prove fatal if medical attention is not given immediately.
Different types of abdominal hernia
Inguinal hernia or groin hernia develops in the groin region due to the natural anatomical weakness present in that area. Hernia that develops in the internal ring within the groin area is called indirect inguinal hernia whereas hernia that develops near the groin area is called direct inguinal hernia. It is the most common type of abdominal-wall hernia that occurs mostly in men.
Femoral hernias appear in upper thigh region and these hernias are most common in women than men. Cause is usually the result of pregnancy and childbirth. Incidence rate is highest in middle-aged and elderly women, especially women who have had one or more pregnancies.
Umbilical hernia develops near the naval area. Most common in infants but can affect adults also. Medical attention is mandatory when hernia turns tender, discolored, swollen and/or when the infant seems to be suffering from abdominal pain.
Epigastric hernia occurs at upper abdominal area lying between the chest and naval. Develops in the middle of the upper abdomen between the breastbone and the umbilicus.
Spigelian hernia happens at the side of abdominal wall.
Incisional hernia develops at the place of incision that has occurred during earlier surgery. The place is a weak area usually an incompletely healed surgical wound. Symptoms are bulge or knot beneath the skin near the scar, sharp pains in the abdomen and/or constipation.
Causes of abdominal hernia
Abdominal hernia may be congenital (present at birth) or acquired later in life due to the weakening of abdominal muscles. Some other factors can also contribute to developing an abdominal hernia.
Symptoms and warning signs of abdominal hernia
Mild to intense pain and bulge on the abdomen or groin area are the significant indications of hernia. However, in few cases, patient may not experience any pain or may have only occasional pain and the swelling also may not appear. Almost all hernias swell up and enlarge with cough, continuous sneezing or any other condition that puts pressure on the abdomen. If the hernia involves intestines, patient will suffer from bowel obstruction and may have fever, nausea and vomiting.
Abdominal hernia treatment
Hernia is usually palpable and a surgeon can easily diagnose the condition during the clinical examination. Hernias are normally corrected through surgery as there is always a risk of strangulation associated with hernia. Reducible hernias are not a medical emergency; hence surgery appointments can be fixed according to the convenience of the patient and doctor. Irreducible hernias with painful lumps require immediate medical attention and surgery is performed as an emergency. During surgery the protruded organs are pushed back into the sack and if the intestines are strangulated, they will be removed. Sometimes, a synthetic mesh is placed behind the weakened abdominal muscle which will eventually merge with adjoining tissues and act as a protective wall against future recurrences.
Preventing Abdominal hernia
Some types of abdominal hernia cannot be prevented. Steps can be taken to avoid further complications and to prevent recurrence.
Ovotestis is a hermaphroditic gonad, with both testicular and ovarian tissue. The term Ovotestis is coined up from ovary and testis. While Ovotestis is a normal feature in some animals such as gastropod Helix aspersa, it is an anatomical abnormality in humans associated with gonadal dysgenesis. A hermaphroditic reproductive organ that can produce both sperm and eggs, is found in certain gastropods. Less than 20% of people with true hermaphroditism are diagnosed before 5 years of age and about 75% are diagnosed by age 20. True hermaphroditism is a genetically heterogeneous condition caused by certain phenotypic, gonadal and molecular theoretical factors.
In such gonads the ovaries occupy normal abdominal position although sometimes they may be found at the internal inguinal ring. Many patients with true hermaphroditism have a uterus and internal duct development corresponding to the adjacent gonad. In approximately 50% of Ovotestis, there is evidence of ovulation.
Persons with true hermaphroditism have ambiguous genitalia at birth. The majority are reared as males due to the size of the phallus. However, due to the functioning of normal ovarian tissue, most of them experience breast development at puberty and abnormal menstruation cycles. Apart from these syndromes, there are not many other developmental abnormalities in these patients. The mortality rate is also not that alarming for affected individuals. They usually possess average intelligence.
Such true hermaphroditism is a rare condition and they are less than 10% of intersex cases. More than 400 such cases have been reported worldwide. Interestingly geographical variation have been noted and the highest occurrence of such cases is found in the Southern African population.
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Bibliography / Reference
Collection of Pages - Last revised Date: November 11, 2019