Diagnosing and Treating Hernias

Diagnosing and Treating Hernias

Hernias are often obvious from a simple physical examination in a doctor’s office, and a diagnosis is not usually difficult to make. Hernias appear as a bulge in the groin, upper thigh or umbilical regions and are called inguinal hernias, femoral hernias or umbilical hernias, respectively, based on their location. These three types of hernias have similar treatments, as will be discussed later on in this article. In some cases, an ultrasound may be used to visualize a hernia, especially a femoral hernia, that may not bulge out as much. In addition, abdominal X-rays can be used to reveal an obstructed bowel, which is a potentially serious hernia complication.

One type of hernia is more easy to overlook: the hiatal hernia. A hiatal hernia is completely internal and occurs when part of the stomach protrudes through the hole in the diaphragm that the esophagus passes through. This type of hernia is not visible from the outside, so it is usually discovered when a person gets an upper endoscopy or an abdominal X-ray with barium for another medical condition or when they go in to see a doctor to find out what is causing their symptoms of heartburn.

Most hiatal hernias do not require surgical treatment. If a person is experiencing symptoms of heartburn, they may be prescribed acid reflux medications, such as proton pump inhibitors or H-2-receptor blockers. Antacids purchased over the counter may help provide quick relief from symptoms of heartburn, but they are not the best treatment of choice for frequent and recurrent heartburn because they do not help prevent acid damage to the esophagus. Surgical treatment may be used for a hiatal hernia if medications are not effective, or if there is an emergency situation. Hiatal hernia surgery varies depending on the presentation of the case. The best surgical course of action may be to relocate the stomach to its proper place and close up the hole in the diaphragm or to remove the herniated portion of the stomach. The incision for hiatal hernia surgery can be made in the chest cavity or upper abdomen, or, if a laproscope is used, multiple small incisions are made in the upper abdomen and a camera is used to aid the surgical procedure.

Treatment for inguinal hernias, femoral hernias and umbilical hernias is very similar. If the hernia is causing someone pain or discomfort, they may be instructed to take over-the-counter pain medication or given prescription pain relievers. The only direct treatment for a hernia is surgical repair. Umbilical hernias are often not treated in babies because they may heal themselves eventually, but if a baby has a large umbilical hernia or an umbilical hernia occurs in an adult, surgery may be necessary. Depending on the severity of the hernia, a person may have the choice to delay surgical treatment. Even if a person has a completely asymptomatic hernia, however, they should monitor the hernia in case it becomes trapped and strangulated. A strangulated hernia is a serious medical emergency because the lack of blood flow to the tissue can lead to tissue death and other problems such as gangrene. Femoral hernias are more likely to become strangulated than inguinal hernias and umbilical hernias, so someone with a femoral hernia may want to consider hernia repair surgery to prevent this.

Hernia surgery can be performed in a traditional manner or with a laproscope. Both types of hernia surgery require anesthesia and have the goal of putting the protruding abdominal contents back where they belong and close up the hole in the abdominal wall with synthetic biologically-inactive mesh. Laproscopic surgery uses a small camera device that allows a surgeon to perform surgery with smaller incisions. Laproscopic surgery is becoming the method of choice because it is a little less invasive, but it is not for everyone; people with large hernias and people with previous surgeries in the area tend to do better with traditional hernia surgery. A person who has had hernia surgery may have to stay in the hospital overnight, but sometimes they can go home on the same day as the procedure. Pain medication is usually prescribed to take after the surgical procedure. A person may recover from the surgery in a few days, but certain activities are restricted for several weeks after the procedure, such as heavy exercise and lifting heavy objects.

Although it is not common for a hernia to reappear after hernia repair surgery, it does happen in less than three percent of cases. People who have undergone hernia repair surgery should be careful and conscious of the ways to reduce the risk of developing another hernia. Hernia prevention will be discussed in further detail in an upcoming Pain.com article.

References:

  • http://www.webmd.com/digestive-disorders/understanding-hernia-treatment
  • http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001956/
  • http://www.mayoclinic.com/health/hiatal-hernia/DS00099/
  • http://digestive.niddk.nih.gov/ddiseases/pubs/inguinalhernia/#treatment
  • http://www.surgeryencyclopedia.com/Ce-Fi/Femoral-Hernia-Repair.html
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