Hernia

A hernia occurs when the contents of a body cavity bulge out of the area where they are normally contained. These contents, usually portions of intestine or abdominal fatty tissue, are often enclosed in the thin membrane that naturally lines the inside of the cavity.

Symptoms of Hernia

Symptoms of hernias vary, depending on the cause and the structures involved. Most begin as small, hardly noticeable breakthroughs. At first, they may be soft lumps under the skin, a little larger than a marble; there usually is no pain. Gradually, the pressure of the internal contents against the weak wall increases, and the size of the lump increases.

Early on, the hernia may be reducible - the protruding structures can be pushed back gently into their normal places. If those structures, however, cannot be returned to their normal locations through manipulation, the hernia is said to be irreducible, or incarcerated.

Causes of Hernia

Umbilical hernias can be present from birth, but most happen later due to pressure on openings or weaknesses in the abdominal cavity or wall. Hernias tend to run in families, and can be caused by such things as coughing, straining during elimination, lifting heavy objects, accumulation of fluid in the abdominal cavity, and obesity. Chronic lung disease can also cause a hernia

Treatment

All femoral hernias need to be treated surgically as they have a high risk of becoming strangulated.

A femoral hernia repair is routinely performed as a day case, without the need for an overnight stay in hospital. The type of anaesthesia will depend on the exact operation and the preferences of the surgeon and patient. Femoral hernia repairs are routinely carried out under general or regional anaesthesia (where just the area being treated is anaesthetised). For more information, please see the separate BUPA factsheet, Anaesthesia.

The operation

The surgery is generally performed through an incision about 10cm long either over the hernia itself or on the lower abdomen. The procedure involves opening up the femoral canal, returning the loop of intestine or intestinal covering back to the abdomen, and then patching up the canal to repair the defect that let the hernia through in the first place. The top of the femoral canal may be reinforced by a mesh made of a synthetic material that does not irritate the body.

Laparoscopic surgery, also known as "keyhole" or "minimally invasive" surgery, may be used. For further information, please see the separate BUPA factsheet, Laparoscopy.

If the hernia has become strangulated, and part of the intestine damaged, the affected segment of intestine may need to be removed and the two ends of healthy intestine connected. This is more complex surgery and requires a longer stay in hospital.