A hernia is the leakage of intestines through a gap in the tissue, usually in the abdominal cavity. Depending on the location of the hernia, parts of the intestine, organ parts or fatty tissue, for example, can protrude under the skin and become visible as a bulge or protrusion.
This is often, but not always, associated with pain. This can usually be remedied by surgery. Around 80 percent of all hernias occur in the groin area; they are referred to as inguinal hernias. Hernias are widespread and can affect children as well as adults. In Switzerland, around 18,000 patients with hernias are treated in hospitals every year – that is one in five hundred of the population.
Hernia means “hernia”. This does not mean a fracture, i.e. a broken bone, but the penetration or breakthrough of tissue through a gap. When we talk about a hernia in medicine, we are almost always talking about a hernia. This means that a gap is created in the abdominal wall through which intestines or organs penetrate and protrude. This is possible because of a weak point in the abdominal cavity wall. It is either congenital, often in the form of connective tissue weakness, or acquired later in life.
The protrusion is called the hernial sac and the gap through which the hernial sac emerges is the hernial orifice. There are two types of hernia: If the hernia sac penetrates outwards towards the skin, it is an external hernia. If, on the other hand, the protrusion extends inside the body, it is referred to as an internal hernia.
The term “hernia” is often equated with a hernia. Strictly speaking, however, this is too narrow a definition, as there are a large number of different hernias. This also includes hernias that occur outside the abdominal cavity. There are even brain hernias (cerebral hernias) in which parts of the brain are displaced. Herniated discs also belong to the category of hernias.
The most common hernia is the inguinal hernia. Around 25 percent of all men will develop such a hernia in the groin in the course of their lives. Newborn babies, on the other hand, are at high risk of an umbilical hernia because the tissue around their navel is not yet firm: up to ten percent of all babies suffer an umbilical hernia. Incisional hernias are also relatively common; incisional hernias occur in around 20 percent of patients after abdominal surgery.
All these hernias are external hernias. The most common internal hernia is the diaphragmatic hernia, but this is rather rare compared to external hernias.
Here is a brief overview of the most common hernias, their various names and their special features:
An inguinal hernia is also called an inguinal hernia. It occurs in the groin area, between the lower abdomen and thigh. If a gap forms here at a weak point in the wall of the inguinal canal, parts of the intestines – for example parts of the bowel – can penetrate through the abdominal wall to the outside like a sac. The protrusion (the hernial sac) is usually clearly visible and can be easily felt.
Inguinal hernias are very common: Every year, around one in two hundred people suffer such a hernia. Men are affected in around 90 percent of cases. A male inguinal hernia is far more common than a female inguinal hernia because the female inguinal canal is narrower than the male. As the connective tissue weakens with age, it is mainly older men who suffer a hernia. In rare cases, however, newborn babies can also be affected.
An umbilical hernia is caused by a weak point in the navel. The tissue that penetrates through the fracture site bulges outwards in a spherical shape. Unlike in adults, an umbilical hernia in babies is usually harmless and often resolves itself. However, this hernia can become painful and problematic if organ parts are trapped in the hernia site. In any case, parents should seek medical advice if their child has an umbilical hernia.
An umbilical hernia is relatively common in infants and young children: around ten percent of all babies suffer an umbilical hernia. Adults, on the other hand, are rarely affected.
An incisional hernia always occurs as a result of abdominal surgery or abdominal injury. If the connective tissue and muscle layers of the abdominal wall are severed during the operation and later heal, a weak spot may form at the scar. If the pressure is too high, there is a risk of an incisional hernia appearing. This late consequence of surgery usually occurs within the first twelve months after the operation.
Incisional hernias are not uncommon: after abdominal surgery, up to 20 percent of one hundred patients suffer such a hernia.
An abdominal wall hernia is also known as an abdominal wall hernia, upper abdominal hernia, abdominal wall hernia or epigastric hernia. This hernia occurs in the middle of the abdomen when viewed from left to right and from bottom to top between the belly button and the beginning of the breastbone. The protrusion is usually easy to recognize and feel. The hernia sac often contains connective tissue and fatty tissue, and more rarely parts of the small intestine.
Abdominal wall hernias are rather rare compared to other hernias.
A femoral hernia is also called a femoral hernia. It occurs when the hernial orifice forms below the groin. Here, parts of the viscera penetrate the inside of the thigh. As the hernia site in a femoral hernia is very narrow, organs can easily become trapped. This can lead to severe pain, which is aggravated by movements of the thigh.
Thigh fractures often affect older women, especially patients who are overweight.
A diaphragmatic hernia is also called a hiatal hernia. The diaphragm is a structure consisting of muscles and tendons that separates the abdominal cavity from the chest cavity. A diaphragmatic hernia occurs when a weak point in the diaphragm causes parts of the stomach to slide upwards and enter the chest cavity. Gastric juice often flows into the esophagus, causing so-called reflux symptoms. They can manifest themselves as belching, difficulty swallowing and heartburn. However, a diaphragmatic hernia can also occur without any symptoms because the actual hernia is usually not felt.
The risk of a diaphragmatic hernia increases with age. Men are more frequently affected than women.
An intervertebral disc hernia is also known as a slipped disc, disc hernia or disc prolapse. Intervertebral discs act as a soft buffer between the hard vertebral bodies of the spine. If an intervertebral disc is damaged, its core can bulge and press on the spinal cord and the nerve canal there. This can lead to severe, stabbing pain. Typical locations for a slipped disc are in the lumbar spine and the cervical spine. If a herniated disc pinches a nerve that supplies the arms or legs, it can lead to symptoms of paralysis.
A painful slipped disc is not uncommon. In Switzerland, around 13,000 people are affected by this type of disc hernia every year. Most of them are around 40 to 50 years old.
The prerequisite for a hernia is a weak point in the tissue, for example in the abdominal tissue. It can be congenital or occur later in life, although any age is possible. Congenital hernias are usually caused by a weakness in the connective tissue that was already present at birth. Later acquired hernias are favored by various events and risk factors. These include, for example:
These processes lead to increased pressure in the abdominal cavity and strain the connective tissue there until it can no longer withstand the pressure and tears.
Other risk factors for hernias:
Hernias are usually recognizable by a noticeable protrusion of the abdominal cavity. It mainly manifests itself when standing and less when lying down. A hernia is often accompanied by a feeling of pressure, a pulling sensation or pain. Coughing, sneezing or pressing can intensify these sensations. Incisional hernias are usually less obvious at first. Sometimes they become noticeable through pulling pain in the scar area, a protrusion is often only visible later. Herniated discs are not visible, but are often very painful.
Hernias do not always cause pain. But even in this case you should seek medical advice. In the case of an inguinal hernia, for example, your doctor may not be able to push the bulge back into the abdomen by hand. In this case it is an irreducible hernia. He has to be operated on quickly.
The University Hospital Zurich offers a general visceral surgery consultation for hernias.
Although there is no guarantee that a hernia can be safely avoided, you can reduce the risk. Pay particular attention to the following points:
There is no causally effective treatment with medication for hernias; in most cases they have to be operated on sooner or later. Only in the case of a slipped disc can physiotherapeutic treatment help permanently, and in the case of a hiatal hernia at least the symptoms (e.g. heartburn) can be treated with medication. In babies, umbilical hernias often disappear on their own. If this is not the case in the first two years of life, they must also be operated on.
Hernia surgery is performed either conventionally as an open procedure or minimally invasively. The hernia suture is usually sutured shut or closed with a mesh made of synthetic fibers. To minimize the risk of complications, you should contact a hospital that has many years of experience with hernias and such procedures.