Posted: April 25, 2007

Sportsmedicine: Hernia

Types, Treatment and Prevention

Hernia is a general term referring to a condition which can appear in various parts of the body. The most common hernias develop somewhere in the abdomen. They are caused by a weakness in the abdominal wall which allows a hole to develop. Adipose tissue, or abdominal organs covered with peritoneum (a membranous lining covering the abdominal cavity and internal organs), may protrude through this opening. Hernias contain an orifice through which the organ or tissue herniates, the hernial sac, and its contents.

Occurrence of hernia may produce localized pain, a visible or palpable lump, or less obvious symptoms due to pressure on an organ from the hernia. In more severe instances, organ dysfunction may result. Many conditions can increase intra-abdominal pressure leading to hernia, including various diseases, overstrain from lifting activities or pregnancy. Alternately, the abdominal area may have been weakened by age, injury or through previous surgical incision

Areas of the abdominal wall prone to herniation include the inguinal and femoral canals, which permit passage of vessels downward to the scrotum and the legs. The umbilical region or navel is another area of natural weakness vulnerable to hernia. Congenital susceptibility to hernia exists and the affliction is known to run in families.

Previous abdominal surgery can also leave areas of the abdominal wall weakened and at risk for developing hernia. Excessive strain is the cause of many abdominal hernias. In sports, weight lifters are at particular risk. Complications of untreated hernia include strangulation of an intestine, a condition causing severe pain and requiring emergency surgical intervention

What is a hernia?
Hernias occur when the contents of a body cavity bulge outward from their normal location. Such contents may include portions of intestine or abdominal fatty tissue enclosed in a membranous lining. Many structures of the body (including the brain) are vulnerable to herniation though hernia most often refers to bulges in the lower torso involving the abdominal wall. While hernias are often relatively harmless, they all carry risk of complications, particularly, should the blood supply to the contents of the hernial sac be cut off - a so-called strangulated hernia.

Types of Hernia and the Anatomy Involved
Inguinal hernia: This condition comes in two forms, direct and indirect. Inguinal hernias comprise 75% of all hernias involving the abdominal wall. Such hernias are far more prevalent in men than in women. Both forms of inguinal hernia occur at inguinal crease, the area where the skin creases at the top of the thigh joining the torso.

An indirect inguinal hernia involves the pathway that the testicles create during embryonic development. This pathway descends from the abdomen into the scrotum, normally closing before birth but remaining a vulnerable site for hernia. Occasionally, the hernial sac may protrude into the scrotum. Such hernias sometimes occur in infancy but also can result later from the aging process.

The direct inguinal hernia occurs in a slightly different place, (to the inside of the indirect inguinal) in a thinner area of the abdominal wall. Such hernias rarely protrude into the scrotum. They also differ from indirect inguinal hernias in being largely restricted to middle aged and elderly patients, whose abdominal walls have weakened with age.

Femoral hernia: This condition produces a bulge below the inguinal crease in roughly the middle of the thigh. Such hernias are rare and largely restricted to women. Femoral hernias also run a higher risk of becoming irreducible and strangulated. The femoral canal is the site into which abdominal contents, usually intestine, protrude. (The femoral canal allows the femoral artery, vein, and nerve to enter the thigh after exiting the abdominal cavity.)

Umbilical hernia: This form of hernia is fairly common, accounting for 10-30% of all hernias. Often, it is detected at birth and becomes visible as a protrusion at the bellybutton or umbilicus. This is the result of incomplete closure of an abdominal wall opening after birth. Depending on the size of the umbilical hernia, it may gradually close by the age of 2 or (if larger that three quarters of an inch) may require surgery at age 2-4 years. The condition can recur later in life, due to original weakening of the abdominal wall coupled with the effects of age. Women in middle age who have had children can suffer umbilical hernias, as can the elderly of both sexes.

Incisional hernia: Following abdominal surgery, the wall of the abdomen may become weakened and vulnerable to hernia. Such incisional hernias occur in about 2-10% of all abdominal surgeries, and may occur months or years after surgery. Incisional hernias recur following correction in about 20-45% of cases.

Additional, less common forms of abdominal hernia include the Spigelian hernia Obturator hernia and Epigastric hernia.

What causes hernia?
While an umbilical hernia may be present at birth, other forms of abdominal hernia occur later in life. Areas of weakness in the fetal pathways of the abdomen, existing abdominal wall openings or other sites of abdominal wall weakness can lead to hernia. Further, conditions which increase the pressure of the abdominal cavity may contribute to producing a hernia (or worsening an existing hernia). Some of these include:

• Obesity
• Heavy lifting or any other intense straining of the abdomen
• Coughing, particularly chronic (as with smokers)
• Straining during a bowel movement or urination
• Chronic lung disease
• Pregnancy
• Fluid in the abdominal cavity
• Family history of hernias

Signs and Symptoms?
In some cases, hernias are asymptomatic, while in others, extreme pain results. A swollen protrusion of tissue, particularly one causing pain, may indicate a strangulated hernia, a serious condition requiring immediate medical care. General signs and symptoms of hernia include:

• A lump in the groin or other abdominal region, sometimes preceded by aching or pain
• Pain increasing during coughing
• Bowel obstruction, nausea and vomiting
• Reddish, tender area of the abdomen
• Burning sensation in the abdominal or scrotal region
• Increased pain from long periods of standing up

Subscribe to the Runner's Web Weekly Digest