Types of Hernias and Risk Factors
What is a Hernia?
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A hernia is a hole in the abdominal fascia, the strong connective tissue that your muscles sit on. Hernias develop at areas of weakness in the abdominal fascia. Major areas prone to hernia formation are:
- Certain areas of the abdominal wall. These areas include where fascia is not covered with overlying muscle such as the mid-line of your abdomen.
- Areas where the fascia had been previously weakened by surgery.
- Areas where structures, such as the cord for the male testicle, pass through the abdominal wall.
How Serious Are Hernias?
Often, a part of the intestine pushes through this tear in the abdominal wall and a soft bulge is seen underneath the skin where the hernia has occurred. The risk is that this bowel can get stuck in the hernia, leading to an incarcerated hernia. This can cause the blood supply to be cut off and the hernia can quickly, within the space of 6 hours, go from an incarcerated hernia to a strangulated hernia. This strangulation of the blood supply leads to necrosis (death) of this piece of bowel and spillage of the bowel contents, which can lead to sepsis and even death. This is why hernias are usually surgically repaired on an elective basis to avoid these complications.
A small hernia is amenable to a minimally invasive outpatient surgical repair. Large hernia defects may require a full abdominal wall reconstruction to give you back a functional abdominal wall. Our expertise in understanding, evaluating, and surgically treating complex conditions means you’re in the most experienced hands.
Risk Factors for Developing Hernias
Anything that strains the abdominal wall can predispose a person to a hernia.
- Heavy lifting can increase intra-abdominal pressure and cause a hernia. Chronic coughing leads to increased strain on the abdominal wall and hernia formation.
- Abdominal weight gain leads to stretching of the abdominal wall and the formation of hernias.
- During pregnancy, the body releases hormones to allow the abdominal wall to stretch but the hormones don’t completely counteract the strain on the abdominal wall and hernias can develop.
- Any surgical procedure on the abdominal wall weakens it and can lead to hernia. The risk is greatly increased if a surgical site infection occurs as this inhibits normal healing of the fascia.
- Some people are genetically more prone to hernia development. They have connective tissue/fascia that is inherently weaker than the general population.
What Types of Hernias Exist?
Hernias come in different shapes and sizes, and are located in many different parts of the abdominal wall.
- Inguinal Hernia
This is the most common type of hernia in both men and women. However, it is three times more likely to occur in men. In males, it happens when an opening in the abdominal wall from the passage of the testicle into the scrotum does not close normally before birth, or reopens later in life. In women, this canal contains the round ligament (a suspensory ligament for the uterus) and is much smaller but still exists and can reopen later in life.
- Femoral Hernia
Appears as a bulge near the groin or thigh. This type of hernia is not common, usually occurs in elderly thin females. It is due to an enlargement of the small hole in the abdominal fascia needed for the major blood vessels of your leg. Less than 5% of all hernias are femoral hernias.
- Umbilical Hernia
As an unborn baby develops during pregnancy, there is a small opening in the abdominal wall, where the umbilical cord passes from the unborn baby to the mother and provides all of the nutrients for life. After birth, this opening closes but is an area of weakness in the abdominal wall. Over time and with strain this area of weakness can reopen. A loop of intestine can then move into the opening, causing an umbilical hernia.
- Incisional Hernia
Usually occurs months, or years, after surgery in the area overlying the scar. The size of this type of hernia depends on the initial surgery.
- Epigastric Hernia
Normally present in the middle of the belly between the breastbone and the belly button. In the mid-line, the fascia is not covered with muscle and is a natural area of weakness. Fat or intestine can push through a weak spot in the abdominal wall.
- Hiatal Hernia
Is the most common form of a diaphragm hernia. The diaphragm is a large flat muscle that separates the chest from the abdomen. A normal communication between the chest and the abdomen is present to allow the esophagus to enter into the abdomen and connect to the stomach. Over time, this area can stretch and part of the stomach can bulge up through the diaphragm and into the chest. Many people don’t feel symptoms; however, heartburn can be a common symptom.
- Spigelian Hernia
A hernia located at the lateral edge of the rectus muscle (6-pack muscle). The lateral edge of the rectus muscle is called the semilunar line. Where the semilunar line intersects with the arcuate line is where Spigelian hernias occur. The arcuate line is usually about 2cm below the belly button and runs transversely. It represents where the posterior rectus fascia ends. This is an area of weakness as it is a location where fascia meet and is not covered by muscle. Spigelian hernias are rare hernias that are sometimes harder to diagnose with a physical exam alone as they don’t always give a normal bulge as you get with most hernias.
- Lumbar Hernias
Posterior abdominal wall hernias that present with bulge laterally. These hernias are the result of trauma, prior surgery or sometimes congenital.
- Obturator Hernia
Is a rare hernia of the pelvic floor. Abdominal contents herniate into the obturator canal. These types of hernias can be difficult to diagnose on physical exam and require a high degree of suspicion on the part of the clinician. They often require a CT scan of the pelvis to correctly diagnose.