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HERNIAS MADE EASY

A hernia is a condition in which part of the intestine bulges through a tear in muscles in the abdomen. These bulges, or "ruptures,"  occur most commonly where there are natural weaknesses in the abdominal wall - such as where other structures penetrate the muscles of the abdominal wall. Examples of these are the canals (inguinal and femoral) which allow passage of vessels down to the scrotum and the legs, respectively. The umbilical area (navel) is another area of natural weakness where hernias can develop. Another area of potential weakness can be the previous sites of abdominal surgery. With new surgical techniques that are being used increasingly frequently, oftentimes defects in the muscular lining of the abdomen are not accompanied by large skin scars. Discomfort that is linked with hernias of the abdomen comes from the constant pressure of tissue pushing its way through the weakened spot in the body. As bowel protrudes through the weakened area, the feeling of pressure increases. A hernia that develops or worsens quickly can produce a sudden intense pain as it enlarges.

An inguinal hernia occurs in the groin (the area between the abdomen and thigh). It is called "inguinal" because the intestines push through a weak spot in the inguinal canal, which is a triangle-shaped opening between layers of abdominal muscle near the groin. Obesity, pregnancy, heavy lifting, and straining to pass stool can cause the intestine to push against the inguinal canal. As sports such as power lifting become increasingly familiar, hernias in these areas have become more common.  Any activity that leads to increased pressure on the abdomen (straining, or the "Valsalva maneuver,") can lead to hernias.  The presence of a space in the abdominal wall is not typically a problem in and of itself. Instead, problems can result from the ensuing bulge of intestine through the gap. These problems from hernias may range from mildly annoying to life-threatening, depending on the situation.

Symptoms of inguinal hernia may include a lump in the groin near the thigh; pain in the groin; and, in severe cases, partial or complete blockage of the intestine. The doctor diagnoses hernia by doing a physical exam and by taking x-rays and blood tests to check for blockage in the intestine. In complicated cases, CT scan can be of help.

The main treatment for inguinal hernia is surgery to repair the opening in the muscle wall. This surgery is called herniorrhaphy. Sometimes the weak area is reinforced with steel or Gore-tex (R) mesh or metal wire. This operation is called hernioplasty. If the protruding intestine becomes twisted or traps stool, part of the intestine might need to be removed. This surgery is called bowel resection. (Bowel is another word for intestine.)

One point often confused is the difference between the effects of an abdominal wall hernia and a hiatal hernia.  While an abdominal wall hernia typically allows bowel to protrude through as a bulge, a hiatal hernia develops when a larger-than-normal opening in the diaphragm (muscular wall between the chest and the abdomen) that the esophagus, or food-tube, passes through.  This larger opening allows the upper part of the stomach to slip up into the chest; this is often associated with upper digestive symptoms and not typically with any bulges on the outside of the body.  See our hiatal hernia page for more information on this commonly diagnosed condition.