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The Different Types of Hernias

Author: Benjamin C. Wedro, MD, FAEEM
Editor: Melissa Conrad Stöppler, MD

No matter what you make or build, it's the seams that are the hardest part to get right. On a piece of clothing, a loose seam will be prone to tear; make it too tight and it will restrict movement. On a house, that loose board will cause the roof to leak, and if there isn't enough room for expansion, stuff will start to buckle.

As it turns out, the body has numerous seams that need to be made just right so that they don't pull apart and let body parts slide into places they don't belong. The abdomen is surrounded by numerous muscles to keep the stomach, small intestine, and colon where they belong, but if one of these organs starts to slip though a weakness or a hole in the muscles, it's called a hernia. To be fair, many other parts of the body can have organ herniation. By definition, a hernia is a bulge or protrusion of an organ through a muscle or other structure that normally serves to keep it contained. But when people talk about hernias, they are usually talking about the abdomen. And while there are many types of abdominal hernias (hiatal, umbilical, or incisional), mentioning a hernia usually means they are talking about one in about the groin.

The male anatomy is built with three bands of muscles and their thick fascia covering coming together in the groin, or inguinal area, to form a narrow ring that allows the testicle and spermatic cord to descend into the scrotum. If all goes well in the building process for the male body, this area remains solid with a lifetime guarantee. But sometimes, the area is a little weaker, and if intra-abdominal pressure increases repeatedly, the fascia starts to give way and the ring tears.

This is not a big deal, unless a piece of intestine herniates and is able to slide into the opening and starts to descend into the scrotum. At this stage, all is relatively easily fixable if a surgeon is able to tighten the ring and return things to where they belong. Often this is an elective procedure. The patient notices a lump in the groin, sees their doctor and pretty soon, the hernia is fixed. Sometimes though, it can be an emergency. If the herniated intestine gets stuck, or incarcerated, there is an urgent need to have it repaired because the consequence is a disaster. An incarcerated hernia may swell, lose its blood supply, and become strangulated so that the tissue dies. Dead bowel is bad. It is associated with massive infection, causing patients to become severely ill, requiring emergency surgery.

Women are not immune to inguinal hernias but they are much less common than in men. With a woman's different anatomy, femoral hernias are more common, in which the bowel slides into the opening that allows the femoral artery, vein, and nerve to enter the leg. The risks of incarceration and strangulation are the same, but the diagnosis may be a little harder to make because of the rarity of the situation.

Sometimes hernias happen "just because," but many times they are a complication of what we do and who we are. Risk factors for developing a hernia include family history, premature birth, chronic cough or constipation, lifting heavy weights, being overweight, and pregnancy. When the abdominal wall is stretched or if it has to endure increasingly frequent stresses, the fascia of the inguinal ring can weaken and fail.

The body is intricately put together, but as with any other building project, the quality is in the details and in this case, the quality is in the seams.

Reference:

Townsend CM, et al.. Sabiston's Textbook of Surgery. 17th edition. Saunders, WB and Co. 2007


Last Editorial Review: 8/24/2009




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