Hernia

A hernia is a gap in the abdominal wall through which organs or tissues protrude.

This gap is caused by a weakness in the tissue (muscles, connective tissue, tendons and scar tissue) and is called a hernial orifice. Since hernias usually occur in the abdominal wall, hernias are also referred to as abdominal wall hernias. Hernias can also occur in the groin, diaphragm, pelvic floor, abdominal cavity or back muscles.

About 80 % of hernias occur in the groin area. The so-called inguinal hernia occurs mainly in men. Women are only affected in 10% of cases.

Hernias can be congenital or result from a genetically determined connective tissue or muscle weakness. A disorder in the collagen metabolism is often one of the main causes of hernias, as the lack of collagen makes the connective tissue unstable. Consequently, if there is a lack of collagen, the scar tissue is also less stable and weak points in the tissue can develop along scars or after operations. Pregnancy and obesity also increase the risk of hernias. In many cases, however, no clear cause can be identified for the occurrence of the hernia.

Hernial orifice: The gap usually runs through different tissue layers (muscles, tendons, connective tissue, etc. ) and is called a hernial orifice. The hernia is named according to where the hernial orifice is located. e.g. umbilical hernia, diaphragmatic hernia, inguinal hernia, etc.

Hernia sac: The peritoneum is turned outwards through the hernial orifice. The outer covering of the hernia sac consists mostly of subcutaneous fatty tissue and the skin.

Hernia contents: In most cases, the hernia sac is filled with parts of the peritoneum, sometimes also with organs such as intestinal loops or parts of the stomach, which protrude through the hernial orifice. Mostly there is also a portion of hernial fluid in the hernial sac, which keeps the hernial contents slippery. However, it is also possible that the hernia sac is completely empty.

A noticeable bulge in the abdominal wall is usually the first symptom of a hernia. The spherical swelling appears when standing. When you lie down, the hernia often slides back into the abdominal cavity and disappears for the time you lie down.

Particularly during physical exertion, sensations of discomfort, pain, burning, pressure or pulling may occur. These are intensified when coughing and pressing.
Sometimes pain or discomfort can occur before the hernia is even visible.

A hernia cannot heal by itself. As long as it does not bother you and does not cause pain, it does not need to be operated on immediately. Usually it enlarges slowly and the discomfort increases steadily. In the end, however, surgical closure of the gap is the only treatment option. We will be happy to advise you on what the best options are in your case.

Emergency – incarcerated hernia (incarceration)

If the hernia sac becomes trapped in the hernial orifice, this is called incarceration. This can lead to blood stasis and the entry of fluid into the tissue (oedema). The tissue swells so much that the intestines in the hernia sac are cut off from the blood circulation and can die without timely surgery. Consequently, intestinal obstruction, peritonitis or infection of the abdominal cavity may occur. The patient notices an incarceration by severe pain in the area of the hernia. Often a pressure-sensitive, bulging, elastic lump develops at the hernial orifice. This cannot be pushed back into the abdominal cavity even when the patient is lying relaxed. Sometimes fever, nausea and vomiting also occur.

If this happens to you, call us immediately or go straight to the emergency ward of the nearest hospital!