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What is it about ?
A hernia is a protrusion of tissue protruding from the body cavity that usually contains it. The best known examples are lumbar disc herniation and cervical disc herniation. The contents of the intervertebral disc form a protuberance and can therefore compress nearby nerves. This compression triggers severe pain in the back or neck, and can even cause neurological deficit. But hernias can also form in the groin (inguinal hernia), the abdominal wall or the diaphragm. And it is these hernias that we are dealing with in this patient guide. For more information on herniated discs, we refer you to the patient guide on lower back pain.
Inguinal hernia
An inguinal hernia can develop when the abdominal wall is weakened. As a result, the peritoneum will protrude into the groin area, just above the inguinal ligament, causing the organs that are normally located in the abdominal cavity (e.g. the small intestine) to end up partially end up in the groin. There are two types of inguinal hernia: indirect and direct. In the indirect form, the hernia runs along the inguinal canal along the spermatic cord down to the scrotum in men or up to the lips in women. This hernia can grow larger and cause symptoms.
Direct inguinal hernia is seen mainly in older men. The hernia then passes through the bottom of the inguinal canal. This form generally causes few complaints and complications.
Femoral hernia
Femoral hernias are significantly rarer than inguinal hernias. In such a case, the tissues contained in the abdomen also form a protuberance at the level of the groin, but just below the inguinal ligament. Femoral hernias are seen almost exclusively in older women. This hernia is accompanied by a great risk of compression of the contents of the abdomen and therefore always requires treatment.
Abdominal hernias
In this type of hernia, the peritoneum also protrudes through a weak point in the abdominal wall. We distinguish different forms:
- A hernia at the level of a scar after an operation (incisional hernia);
- A hernia at the level of the navel (umbilical hernia);
- A hernia in the midline of the upper abdomen (epigastric hernia).
Diaphragmatic hernia
A diaphragmatic hernia is a hernia in the diaphragm (also known as a “hiatus hernia”). The diaphragm is a flat muscle that separates the chest cavity from the abdominal cavity. There is an opening for the esophagus and a few large blood vessels in the diaphragm. In diaphragmatic hernia, this orifice is enlarged and part of the stomach passes into the chest cavity. A diaphragmatic hernia is often detected during an examination of the stomach (gastroscopy) or an x-ray requested due to discomfort in the upper abdomen. We also distinguish different forms:
- In sliding hernia, the last part of the esophagus and part of the upper part of the stomach slide into the chest cavity. This is usually a chance discovery, causing few symptoms and complications.
- In a paraesophageal hernia, the upper part of the stomach slides upwards and comes to rest along the esophagus. This hernia can cause symptoms.
- Hernias can also form in other places of the diaphragm. These hernias may be congenital or the result of significant pressure on the abdomen (eg a punch in the stomach).
Age, pregnancy and being overweight can lead to distension of the abdominal muscles. It is not, however, a hernia.
What is their frequency?
Inguinal hernia mainly affects men (95%). In men, the risk of having an inguinal hernia during their lifetime is 27%, while it is only 3% in women.
Femoral hernia almost exclusively affects older women.
Diaphragmatic hernia is common, especially in people over the age of 60.
How to recognize them?
If you have a protrusion, painful or painless, in the area of the abdominal wall, scrotum or lips, it may be a hernia. The characteristic sign of a hernia is a pronounced swelling when the pressure in the abdomen increases, for example, when coughing, lifting a load or pushing on the toilet. Get it checked out by your doctor.
How is the diagnosis made?
Your doctor will ask you a few questions and perform a physical examination. He will examine you while standing and lying down. You should know that hernias are more visible when standing. As a rule, the volume of swelling decreases on pressure.
If there is a herniation of the inguinal canal along the scrotum, the doctor will try to locate the hernia and push it inward. He will ask you to cough so that he can better feel the protrusion of the hernial sac along the inguinal canal. In the case of a femoral hernia, the protuberance is usually located next to the pubis, just below the ligament in the groin.
An ultrasound is sometimes requested for small abdominal hernias. This exam is less useful for inguinal hernias because it often gives false-positive results, that is, the exam indicates that there is a problem when, in reality, there is none. has not.
If a diaphragmatic hernia is suspected, an examination of the stomach (gastroscopy) will usually be necessary to make the diagnosis.
What can you do ?
If you notice abnormal swelling in the abdominal wall, groin or pubic area, it is advisable to see your doctor. Likewise, if you have persistent symptoms in your upper abdomen, such as regurgitation, see your doctor. These complaints may be related to a diaphragmatic hernia. Also, avoid excess weight and constipation by getting enough physical activity, eating a healthy diet, and drinking enough water. Avoid heavy lifting.
What can your doctor do?
Your doctor or specialist will determine whether it is necessary to have the hernia repaired surgically.
For the inguinal hernias, an intervention is considered when the hernia is painful or large, or when it interferes with your daily life. Likewise, if the doctor fails to push the contents of the hernial sac and the hernia sac into the abdominal cavity, the advice of a surgeon is urgently required. A hernia that is palpable in the scrotum tends to grow and it is best if it is operated on at an early stage. In the case of a minor inguinal hernia causing few or no symptoms, the operation can be safely postponed until the symptoms worsen.
The femoral hernias must always be treated with surgery, as they present a risk of incarceration of the abdominal contents (strangulated hernia). During a procedure for a hernia in the groin area, small incisions are made to insert a small net (“meshgraft” or mesh graft) against the peritoneum and behind the inguinal canal and abdominal muscles. . This intervention usually takes place laparoscopically (exploratory surgery) and allows faster convalescence than after a conventional operation.
In the case of a abdominal hernia, a symptomatic umbilical hernia is considered for an operation. An asymptomatic umbilical hernia does not necessarily have to be operated on. Hernias that form around a scar (incisional hernias) can become very large. Repair operation may therefore be considered, but only if you are in good health. Otherwise, the risk of complications is too great.
A abdominal hernia is also treated by surgery, through the insertion of a net in the abdominal wall. The intervention can be done by laparoscopy or by laparotomy (via an incision).
The sliding hernias Only be operated on in cases where lifestyle adjustment advice and medication do not sufficiently improve symptoms. The intervention can be performed laparoscopically. In recent years, however, this type of intervention has been less frequent, as the symptoms reappear after a time and still require the resumption of drug treatment. If the stomach is located partly along the esophagus in the rib cage (“paraesophageal hernia”) or if there is an additional congenital opening in the diaphragm, surgery is usually necessary.
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