What are the different types of hernias?

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1. Inguinal hernia 

 

Abdominal wall hernias are common, with a prevalence of 1.7% for all ages and 4% for those aged over 45 years. Inguinal hernias are the most common and represent 75% of abdominal wall hernias, with a lifetime risk of 27% in men and 3% in women.

 

Repair of inguinal hernia is one of the most common operations in general surgery, with rates of approximately 28 per 100 000 people in the United States.  It is much more common in males over females (>90% men and 40% women).

 

95% per cent of patients that are diagnosed by their primary care doctor are male, and in men the incidence of inguinal hernia rises from 11 per 10 000 men aged 16-24 years to 200 per 10 000 men aged 75 years or above.

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An inguinal hernia is defect or hole in the inguinal (groin) region, and is usually noted as a bulge, lump or swelling near the inner part of the upper thigh. The bulge is caused by a protrusion of intra-abdominal contents such as fat, intestine, or other organs through the defect to outside of the abdomen. There are two types of inguinal hernias: 

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• Indirect inguinal hernia: (54% Men and 33% Women). An indirect inguinal hernia occurs through a natural opening in the abdominal wall called the inguinal (groin) canal. The inguinal canal is where the attachments of the testicle (arteries, veins, nerves, and vas deferens) travel from the abdomen in men, and where a ligament (round ligament) travels and attaches from the labia to the uterus in women. The abdominal opening to the canal should close down around those structures mentioned before or sometimes shortly after birth. If this opening does not close, or doesn't completely close, there is a tendency for tissue (usually fat) from inside to herniate (protrude) through the opening and later develop into a hernia. Over time, the tissue from the inside dilates the hole until it is big enough for large amounts of fat or even intestine to protrude, and then it becomes noticeable. If large enough, the abdominal contents can then protrude into the scrotum of men, following the pathway of the testicle in development. These types of hernias can occur at any age (from birth to old age). In women, sometimes these hernias can protrude to the opening of the vagina, following the pathway of the round ligament. As you may have learned in the "What causes a hernia?" section, any activity that increases intra-abdominal pressure can cause these hernias to become evident, and can certainly make them worse (lifting, coughing, sneezing, straining to have a bowl movement, sports, etc.).

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• Direct inguinal hernia: (27% Men and 2% Women). A direct inguinal hernia usually develops when there is a weakness or tear in the fibers of tendon that attaches the abdominal wall muscles to the pubic bone. This area is typically weak in all humans, and especially as we get older. Lifting, coughing, sneezing, or straining can result in the formation of a hernia or contribute to making a hernia in this area worse over time. People who are heavy lifters (construction, movers, warehouse workers), obese people, pregnant people, or people who have chronic coughing, sneezing, or constipation are at higher risk to develop a direct inguinal hernia.

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• Combined: (8% Men and 3% Women) You guessed it! A combined hernia results from BOTH an indirect and a direct hernia. It may therefore have the signs and symptoms either or both.

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2. Femoral hernia 

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• Incidence is 3% Men and 11% Women. Very similar to inguinal hernia above, but it occurs when the same type of tissues protrude into the groin near the top of the inner thigh but through the canal where the "Femoral" blood vessels (artery and vein) pass through the abdominal wall. Femoral hernias are much less common overall than inguinal hernias. Conversely however, femoral hernias are much more common in women, and predominantly affect older women, who tend to have weaker pelvic floor anatomy. These types of hernias also tend to be much more dangerous and often need emergency repair when initially noted.

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3. Umbilical hernia

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• The incidence is 2% in the adult population and is more common in females with a ratio of 3:1. Umbilical hernias occur when fat from inside or intestine can protrude through the abdominal wall near the umbilicus (belly button). This type of hernia also typically occurs through a natural hole where the umbilical cord once came through the abdominal wall as a newborn. In most children, this hole will close in the first 4-5 years of life. An umbilical hernia results when this hole does not close or does not completely close. So, if a protrusion is noted in the belly button anytime past the age of 5 years, then it needs to be repaired as it will only get worse.

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4. Incisional hernia 

 

A common complication after abdominal surgery, especially open surgery (as opposed to laparoscopic or minimally invasive surgery). Incisional hernias occur when intra-abdominal fat, intestine, or other organs protrude through the abdominal wall at a site where the patient has a scar from a previous abdominal surgery. The incidence of incisional hernia ranges from 2% to 20% after abdominal surgery, and depends heavily on the type of surgery, the anatomic location of the surgery, and the health status of the patient at the time of surgery, or their overall health status in general. As you might imagine, an incisional hernia is noted as a bulge, lump, or swelling at the site of a scar from previous surgery. It most commonly has no associated symptoms, but like most hernias, it can cause pain or discomfort. Also, like most hernias, it is more evident when you are standing, and/or when you lift, cough, sneeze, strain, bend over, strain to have a bowel movement, or otherwise do any activity that tightens your core muscles and therefore increases the internal pressure of your abdomen. And like most other hernias, they often disappear when you lay down, but come right back when you stand up or strain. Incisional hernias are almost guaranteed to occur in smokers, diabetics, steroid users, and people that had previous surgery for an infectious etiology or had emergency surgery.

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5. Epigastric hernia 

 

Similar to an umbilical hernia, but typically occurs from a hole where the abdominal wall did not complete fuse in the midline during development. These hernias can be tiny holes and occur anywhere in the midline of the abdomen along a line from the umbilicus (belly button) and the sternum (breastbone). They are often noted as a bulge, lump, or swelling in the midline, above the belly button and tend to come and go like other hernias. They become more noticeable and made worse over time by the same activity factors noted previously.

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So what do I do if I think I may have one of these types of hernias?

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If you can see or feel a bulge, lump, or swelling in any of these areas mentioned, please make an appointment with your doctor or a hernia surgeon like us to be evaluated for a hernia.

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If you notice a bulge, lump, or swelling in any of these areas and are also experiencing pain, especially if you cannot push the hernia contents back inside, then you should make an appointment with a HERNIA SURGEON as soon as possible. A hernia causing pain can quickly, and unexpectedly, develop into an emergency. A hernia that has intestine or other organs protruding can cause the blood supply to that intestine or other organs to be compromised, therefore depriving those tissues of oxygen. Without oxygen, intestine or other organs will die, and this situation can lead to perforation or sepsis, or both. This condition is called "Strangulation," and can absolutely be life-threatening without immediate surgical intervention.

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IF YOU ARE EXPERIENCING SEVERE PAIN, IF YOU NOTE ANY CHANGE IN THE SKIN COLOR (RED OR PURPLE) OVER THE HERNIA, AND ESPECIALLY IF YOU ARE ALSO EXPERIENCING ANY OF THE FOLLOWING, ABDOMINAL BLOATING, NAUSEA, VOMITING, ABDOMINAL PAIN, FEVER OR CHILLS, YOU NEED TO CALL 911 OR GO TO THE NEAREST EMERGENCY ROOM IMMEDIATELY. YOU CAN DIE IF YOU DO NOT RECEIVE EMERGENCY SURGERY. 

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Take the Next Step:

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What are you waiting for? Come and see us at Advanced Hernia Specialists.  We have the most experience and are considered experts in the field of hernia surgery. We perform hernia repairs almost every day. We are committed to delivering excellent care and the best patient outcomes possible, with a less than 1% recurrence rate (chance of coming back) for most hernias, which is much lower than that of most other surgeons. We offer the most cost-effective options, as well as the most advanced laparoscopic, minimally invasive, and robotic surgical techniques for hernia repair.

 

If you think you may have a hernia, please schedule an appointment with us by calling 904-808-5658, emailing us, using our online Contact Form, or Book Online. 

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