Hernia

A hernia in the stomach or groin can produce a noticeable lump or bulge that can be pushed back in. Laughing, crying, coughing, straining during a bowel movement, or physical activity may make the lump reappear.

In most cases, hernias are felt or seen as bulges and do not cause symptoms. However, they can lead to:

• Pain
• Burning
• A feeling of pressure
• A pulling sensation, especially during physical strain

Some other hernia symptoms include:

• Swelling or bulge in the groin or the scrotum
• Pain at the site of the bulge that increases while lifting
• Dull aching pain around the bulge
• Increase in the bulge size over time
• Bloating
• Bowel obstruction

In the case of hiatus hernia, there may not be bulges on the outside of the body. Instead, the symptoms may include:

• Chest pain
• Indigestion
• Difficulty in swallowing
• Frequent regurgitation of food
• Heartburn

Suffering from heartburn? Understand what medications to take to tackle this problem.

Hernia can develop quickly or over a period of time due to a combination of muscle weakness and strain. Research shows that there are numerous risk factors that can contribute to the development of a hernia:

• Age
• Obesity
• Chronic cough
• Heavy lifting
• Genetic predisposition
• Previous surgical incisions

There are several risk factors that can increase your chances of developing a hernia. They include:

• Congenital conditions: Birth defects in which there is a hole in the diaphragm can increase the risk of the bowel, stomach, or even the liver moving into the chest cavity. This gap can form in the womb during fetal development.
• Family history of hernias: Studies suggest that patients with a family history experience primary hernias and their recurrence at a younger age than those without a family history.
• Age: Inguinal hernias are more frequent in older individuals than in young adults due to the loss of strength in the stomach wall and conditions that increase pressure on the stomach.
• Sex: Men are significantly more likely to develop inguinal hernias than women, due to the location of the inguinal canal. Abdominal wall and umbilical hernias are also more common in pregnant women.
• Pregnancy: The intra-abdominal pressure is typically higher during pregnancy, increasing the chances of herniation or its recurrence. The incidence of umbilical hernia among pregnancies is approximately 0.08%.
• Injury or surgery: Incisional hernias occur when the surgical cut in the stomach wall does not close properly after surgery.
• Lifting weights: Strenuous sports and physical activities, particularly weight lifting, can lead to an inguinal hernia due to excessive strain on the muscles. Note: Strenuous sports can also cause a condition known as sports hernia, which has similar symptoms but is not actually a hernia.
• Premature birth or low birth weight: Infants born prematurely are at an increased risk of inguinal hernia. Those with very low birth weight have a threefold greater risk of requiring an emergency procedure than heavier infants.
• Chronic cough: A repetitive cough over an extended period increases pressure and strain on the stomach walls, leading to a hernia.
• Constipation: This condition can increase straining during bowel movements, contributing to the emergence of an abdominal hernia.
• Ascites: This condition involves fluid buildup in the stomach. Studies show that ascites can be a major etiological factor, as umbilical hernias occur almost exclusively in patients with persistent ascites who undergo surgery for liver cirrhosis.
• Obesity: Being obese or overweight increases the strain and pressure on the muscles of the stomach, making them weaker and more prone to developing hernias.
• Lung diseases: Risk factors for hernias include chronic lung infections, collagen disorders, and cystic fibrosis. For a diaphragmatic hernia, weakness of the diaphragmatic muscles can be the cause.
• Smoking: Smoking weakens connective tissue. Studies have shown that smoking is a known risk factor for the development of a hernia and can also increase the risk of recurrence.

Diagnosing a hernia can be straightforward and mainly consists of a physical examination. Your doctor will first observe you while standing, asking you to tense your stomach muscles and cough. Then, you may be asked to lie down, and the doctor will assess the size of the hernia sac and determine whether it can be pushed back into the abdomen. A stethoscope may be used to evaluate bowel sounds in the hernia sac.

Additional methods to diagnose a hernia may include:

• Imaging Techniques: A more definitive diagnosis of a hidden hernia often requires imaging as part of the workup to confirm clinical suspicion. This may include:
• Ultrasound: Groin pain from a hidden hernia can be a challenging clinical diagnosis; however, studies demonstrate that it is easier to detect through ultrasound.
• Computed Tomography (CT): A pelvic CT scan may be helpful in diagnosing inguinal hernias.
• Magnetic Resonance Imaging (MRI): MRI has shown a sensitivity of up to 94.5% in diagnosing inguinal hernias.

Preventing a hernia can be tricky. Here are a few things to keep in mind that can reduce the pressure on your abdomen, thus preventing your chances of developing a hernia:

• Maintain an ideal body weight: Being overweight can put stress and pressure on your stomach due to excess fat. Shedding some extra kilos will help greatly reduce your risk of developing a hernia.
• Add fiber to your diet: Fiber-rich, low-acid foods like apples, pears, carrots, sweet potatoes, and leafy greens are good dietary choices. They help prevent constipation, thus reducing the risk of a hernia.
• Do not lift heavy objects: Be careful and use the correct form when lifting weights or heavy objects. Avoid over-exerting yourself.
• Take care of your wounds: Avoid any activities that put pressure on your wounds, and always use gel to promote wound healing. Limit sexual activity until your wound has healed completely. Note: Do not get pregnant within six months of any surgery, as it can lead to an umbilical hernia.
• Treat your cough: Heavy coughing puts stress on your stomach, which may cause a hernia. Call your doctor if your cough doesn't go away after a few weeks.
• Say no to smoking: Smoking is a known risk factor and can lead to a persistent cough, increasing your chances of developing a hernia.

Hernia repairs are very common. While surgery is the only treatment that can repair hernias, watchful waiting is also an option for people who do not have complications or symptoms with their hernias. Surgical options include:

• Mesh for hernia repair: Surgical mesh is a medical device used to provide additional support to weakened or damaged tissue. It helps strengthen the hernia and reduce the risk of recurrence.
• Laparoscopic surgery: Laparoscopy is a minimally invasive surgical procedure that allows a surgeon to access the inside of the stomach and pelvis through multiple small incisions, typically no more than 1 centimeter in length. A mesh may or may not be required for the repair.
• Open procedures: This type of surgery uses a single incision to open the abdomen and access the hernia, after which the hernia is repaired using mesh. Open procedures are ideally suited for patients with large or multiple hernias and can be performed with or without surgical mesh.
• Reconstructive surgery: Abdominal wall reconstruction repairs defects in the walls of the stomach while reducing tension and providing structural support.

Note: Your doctor may prescribe medications for pain management, and in most cases, the pain will lessen during the first week, making additional drugs unnecessary. Read more about types of painkillers and when they should be taken.

If you are diagnosed with a hernia, you can try these home remedies that can help you manage the symptoms:

• Castor oil (Arandi ka tel): This oil helps to inhibit inflammation inside the stomach and promote proper digestion.
• Aloe vera juice: Aloe vera has anti-inflammatory properties with soothing effects, and consuming the juice before meals can be beneficial for easing some of the symptoms of hernia.
• Ginger (Adrak): Studies suggest that ginger can be useful in treating various gastric ailments like constipation, bloating, indigestion, nausea, and vomiting.
• Black pepper (kali mirch): Black pepper is more than just an added flavor. It stimulates healing and can also suppress acid reflux, which may help to alleviate the swollen region of a hernia.
• Buttermilk (Chhachh): It is loaded with beneficial bacteria and is considered a safe option for people with hiatal hernia as it can reduce acids in the stomach.
• Turmeric (Haldi): It contains an active ingredient called curcumin and is believed to strengthen muscles, potentially preventing the formation of hernias.

If the contents of the hernia get entrapped in the weak point in the stomach wall, the contents can block the bowel, leading to the following complications:

• Severe or sudden pain
• Nausea and vomiting
• Peritonitis (inflammation of the tissue that covers the lining of the stomach)
• Intestinal strangulation (if the trapped section of the intestines does not receive enough blood)

The only treatment for a hernia is surgery, but certain alternative therapies have shown promising results in alleviating the symptoms of hernia. They include:

• Yoga: Studies show that yoga therapy with selected asanas is effective in the treatment of reversible inguinal hernias. It is important to choose the right yoga poses to relieve pressure on the stomach, strengthen the stomach muscles, and close the inguinal canal.
• Acupuncture: This has been shown to be an effective treatment for several health issues, including hiatal hernia. Studies demonstrate that anesthesia through acupuncture is a feasible anesthetic option as it reduces the amount of local anesthetic required, thus decreasing complications. It is effective in pain relief and inhibiting gastrointestinal upset, leading to rapid postoperative recovery, which is usually complication-free.
• Traditional Chinese Medicine (TCM): Traditional Chinese medicine effectively treats hernia by using herbs that clear away heat and toxic materials, promote qi circulation to relieve pain, diminish swelling, and remove stasis, demonstrating a good curative effect.

Large, clearly visible hernias are very unpleasant and can be quite distressing. While a hernia cannot heal itself, it can almost always be treated effectively with surgery. The good news is that most hernias can be repaired with minimally invasive surgery, which has a low complication rate, allowing most patients to return to their normal routine quickly.

Certain tips to keep in mind if you have been diagnosed with a hernia:

• Be active, the right way: Being physically active in certain ways has been shown to help prevent hernias, but other types of exercise can put too much pressure on your abdomen. Beneficial exercises may include:
• Cycling: Light cycling may be considered safe for people with smaller hernias and may also strengthen your muscles.
• Walking: Walking is one of the most beneficial and simple exercises to perform and comes with many health benefits.
• Swimming: Swimming can relieve a lot of pressure, strain, and pain.

Note: Any type of exercise that involves very high levels of exertion can also increase your hernia risk. Speak with your doctor to find out whether these exercises are appropriate for you.

• Eat fiber-rich foods in smaller quantities: Incorporating high-fiber foods into your diet can prevent constipation and strain during bowel movements. Smaller meals can also help decrease symptoms associated with hernias. Foods that may help include:
• Fruits
• Vegetables
• Whole grains
• Nuts and seeds
• Dried beans and peas

Note: Laxatives, like mineral oil, milk of magnesia (magnesium hydroxide), or MiraLAX (polyethylene glycol), can also help with constipation.

• Stay hydrated: It is important to maintain optimum hydration if you have a hiatal hernia. Drinking water outside meal times can help dilute digestive juices and aid in proper digestion, preventing constipation.
• Avoid heavy lifting: If you have to lift a heavy object, bend down with your knees instead of your waist. Use your legs rather than your torso to do most of the lifting effort. If an object is too heavy for you to lift comfortably, know your limits and don’t do it.
• Use ice packs: An ice pack on the hernia can act as a quick inflammation reliever when discomfort arises. Always cover the ice with a soft cloth and do not leave it on for long periods.
• Check if your prostate is enlarged: An enlarged prostate can increase pressure on the stomach by causing strain during urination. Most men develop an enlarged prostate as they age. Avoid straining during bowel movements or while urinating to decrease your chances of a hernia. Enlargement of the prostate gland can be diagnosed by prostate-specific antigen. To know if you have this condition, book your test now.