Is it a hernia? This month’s column examines the diagnosis, symptoms and causes of the different types.
Lots of people have heard of hernias, and know they can relate to “having a lump”. So, what is a hernia? All of our internal organs are kept in place by muscles and tissue. A hernia happens when, due to a weakness in the muscle or tissue, part of an internal organ can push through the structures that normally keep it in place. This might be the lump that you can feel. Sometimes the lump can disappear when lying down and be more prominent when you are standing up, coughing or straining. Often you can push them and they disappear too – this is called a “reducible hernia”.
Hernias most commonly happen between the chest and the hips. There are several different types including inguinal hernia (most common), femoral hernia, umbilical hernia and incisional hernia to name a few. There are other types of hernia too, but these happen less commonly. This article will cover the common hernias which may present as a lump you can feel in the groin or around the tummy.
Inguinal hernias occur most commonly in men. They present often with a painless or mildly uncomfortable lump in the groin. This is caused by a muscle weakness allowing a small part of the bowel to poke through. The lump may come and go. It is related to getting older and activity related to straining (straining increases the pressure on the inside of the body and makes the hernia pop out more).
Femoral hernias are more commonly seen in women. They are similar to inguinal hernias in terms of cause. They also occur in the groin but in a slightly different position to inguinal hernias.
Umbilical hernias occur around the belly button. These are often seen in babies and are due to the tummy muscles not fully closing over yet, which allows bowel or fatty tissue to protrude. They often get better with time. Adults can also develop these due to repeated straining.
Incisional hernias can occur at the site of an operation if the muscles or tissues to not fully heal. This weak point allows a hernia to form.
So, are hernias a cause for concern? In some situations they can be. As mentioned before, many hernias can often be pushed back into place or reduced. This is a good sign. If a hernia cannot be pushed back at all, there is potential the tissue or bowel can get stuck, cutting off its blood supply or causing a blockage. This is an emergency. The signs to look out for in this case would be:
- The hernia getting bigger, being discoloured, firm or tender and unable to be reduced
- Sudden onset, severe pain
- Vomiting
- Difficultly in passing wind or a bowel motion
If you have a hernia and any of these symptoms it is important to seek medical help ASAP as an operation is often needed to help relieve blockage.
If you think you have a hernia or discover a new lump you should see your GP. The GP will be able to examine you to find out what the lump is. Some hernias need to be referred for investigation – normally an ultrasound scan – and may need to be fixed through a minor operation via either keyhole or open surgery. Not all hernias are suitable for fixing, and not all require an operation. The type of hernia and its impact, along with the general health of the person who has it, will influence who is offered surgery. It is perfectly possible to have a hernia without it causing any problems long term.
For further information on hernias from the NHS visit https://www.nhs.uk/conditions/hernia/
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