All you need to know about: Hernias

Inguinal hernia, femoral hernia, umbilical hernia and hiatal hernia are among the most common types. Photograph used for representational purposes only
| Photo Credit: Getty Images/iStockphoto

A hernia occurs when an internal organ or tissue pushes through a weak spot in the surrounding muscle or tissue wall. Hernias can occur in the abdomen, upper thigh and groin areas. Inguinal hernia, femoral hernia, umbilical hernia and hiatal hernia are among the most common types. A previous surgical incision site is also a common site for a hernia to develop.

According to the ‘Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease (GBD) Study 2019’ published in The Lancet, inguinal, femoral, and abdominal hernia comprise disorders in which portions of the digestive tract protrude through defects in the walls of the abdominal cavity. These occasionally lead to life threatening acute complications, but more commonly are asymptomatic, or cause chronic or intermittent pain. Symptomatic hernia is surgically repaired.

Studies have indicated a surge in the global prevalence of hernia cases. While one analysis of data from the 2019 GBD Study found that the global prevalence of hernia cases rose by 36% from 1990 to 2019 (‘Global, regional, and national burden of inguinal, femoral, and abdominal hernias: a systematic analysis of prevalence, incidence, deaths, and DALYs with projections to 2030’ published in the International Journal of Surgery), another analysis found that males, older adults, and low-income and middle-income countries such as India and China, had heavy hernia burdens (‘The global, regional, and national burden and its trends of inguinal, femoral, and abdominal hernia from 1990 to 2019: findings from the 2019 Global Burden of Disease Study – a cross-sectional study’).

What are the symptoms of hernia?

One of the most common and recognisable symptoms of hernia is a visible bulge or lump in the affected area. Most commonly, hernias occur in the abdomen, groin and pelvic floor. Very often, it can appear when a person strains or lifts objects or coughs.

An inguinal hernia is characterised by a bulge in the groin area – for instance, a part of the intestine can protrude through a weak spot in the abdominal wall cavity appearing at the groin. Discomfort or pain, especially while coughing, bending over or lifting objects are some of the symptoms.

According to the European Hernia Society, an abdominal wall hernia is defined as a protrusion of the contents of the abdomen through a defect in its wall. Primary ventral hernias are commonest in the midline of the abdomen. These are called umbilical or epigastric hernias, depending on their location. While an umbilical hernia is a hernia in the umbilicus (tummy button), and epigastric hernia is any other hernia in the middle of the tummy. Umbilical hernias, though common in babies, can also occur in adults.

The American College of Surgeons says that about 10% of abdominal hernias are umbilical hernias. Among the common symptoms are a visible bulge on the abdomen, especially when coughing or straining; pain or pressure at the hernia site, increasing sharp abdominal pain and vomiting can mean that the hernia is strangulated. If strangulated, this is a surgical emergency and immediate treatment is needed, it said.

How are hernias diagnosed and treated?

Doctors can diagnose hernias through a physical examination. During the examination, they may check for bulges or protrusions when a patient stands or coughs. Imaging tests such as ultrasounds may also be used to confirm the diagnosis. Treatment options for hernias include surgical procedures – open and laparoscopic repairs. Other options include watchful waiting and lifestyle changes. In open hernia repair, the surgeon makes an incision in the groin and pushes the protruding/herniated tissue back into the abdomen. The weakened wall is repaired and usually a surgical mesh is reinforced, to reduce the chances of recurrence.

What is the way forward?

The study in the International Journal of Surgery made an observation that predictions until 2030 indicate an increase in hernia prevalence, particularly among males, with a simultaneous expected decrease in hernia-related death rates and disability-adjusted life years.

It emphasised that considering the ongoing global burden of hernias, the need for continuous monitoring and adaptive health strategies is evident. “Effective reduction in hernia impact will require persistent research and proactive healthcare approaches,” it said.