What Are The Common Types & Causes of Hernias?
There are several types of hernias, the most common ones being:
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1.
Inguinal Hernia
- Consisting 70% of all hernia cases, an inguinal hernia affects the groin or scrotum where it manifests as a round lump. Some may only feel it as a vague muscle ache without any noticeable swelling.
- It usually occurs when the fat in the abdomen or intestine bulges through the abdominal muscle or inguinal canal and into the groin.
- Men in particular are 8 times more likely to get an inguinal hernia than women.
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2.
Hiatal Hernia
- This occurs when the upper part of the stomach protrudes from the abdominal cavity through an opening in the diaphragm (a muscle that lies between the abdomen and chest) and into the chest.
- Hiatal hernias commonly result in acid reflux, since the muscles preventing reflux of acid are no longer in the correct position to work.
- This mostly occurs in people who are over 50 years old.
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3.
Umbilical Hernia
- Commonly found in babies under 6 months, umbilical hernias develop when a portion of the intestine protrudes through the abdominal wall near the navel (belly button).
- The umbilical cord connects mother and foetus during pregnancy, with the cord passing through a small opening between the baby’s abdominal wall muscles (where the navel is).
- When the baby’s abdominal wall layers don’t join completely after birth, a loop of the intestine can squeeze through the weak spot, causing a hernia.
- 20% of babies are born with an umbilical hernia and 90% of these hernias will naturally close by the time the child is 5 years old.
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4.
Paraumbilical Hernia
- While umbilical hernias are found in babies, paraumbilical hernias are found in adults. In adults with paraumbilical hernia, the umbilicus looks a bit asymmetrical.
- This occurs when weakness in the muscles or ligaments around the navel allow abdominal tissues to protrude through.
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5.
Femoral Hernia
- Femoral hernias occur in the groin when abdominal tissue protrudes through a weakness in the abdominal wall and moves into the femoral canal in the upper thigh, which is a narrow passage next to the blood vessels going to the leg.
- Unlike inguinal hernias, femoral hernias affect women more than men—particularly those who are pregnant or obese.
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6.
Incisional Hernia
- Incisional hernias result from a weakened abdominal muscle due to a past surgical incision.
- In these cases, abdominal tissue, such as the intestines, may push through the abdominal walls at the site of a previous surgery.
What Are The Symptoms & Diagnosis of Hernias?
When a hernia first occurs, you may experience slight pain in the area, similar to that of a muscle ache. More obviously, you will notice a lump in your abdomen or groin which may become more prominent when you cough or stand.
Your hernia doctor will usually be able to identify a hernia simply by examining the affected area. In some cases, imaging tests may be conducted to confirm the diagnosis or assess the severity of the problem.
Possible imaging tests include :
- Ultrasound: This is the simplest and most common method used to assess hernias. It uses sound waves to create images of the abdominal muscles, to see any defects and to assess the contents that are protruding out. It is also dynamic, in that the patient will be asked to strain during the test, to see how much more the hernia is bulging under pressure.
- CT Scans: This method uses X-rays to create images of the abdomen and its organs, and may be used if your doctor thinks that the pain may be due to other internal problems and not from the hernia.
- MRI Scans: This method utilises radio waves and a magnetic field to create images of abdominal organs and other structures. An MRI scan gives the best images in looking at the details of the muscles.
Once the diagnosis is confirmed, a personalized treatment plan will be determined.
Most Cases of Hernia Require a Surgical Repair—What Methods are there?
Hernias may often be painless, or only cause mild discomfort; but apart from umbilical hernias, most hernias do not go away on their own, and may result in serious complications if left untreated.
Inguinal and femoral Hernias
The traditional way to repair inguinal hernia is herniorrhapy. This is done via open surgery where an incision is made over the hernia. The hernia contents are pushed back and the sac is removed. The defect in the muscle is then stitched closed.
The more common method of repair nowadays is hernioplasty. Hernioplasty means putting a mesh (like a netting) over the defect in the muscle, which allows new tissue to grow into it.
Hernioplasty may be done via open surgery, with the same cut as in herniorrhapy, but putting a mesh over the defect instead of stitching it close. It is believed that by not creating any tension in pulling the muscles together, the risk of the hernia recurring is lower.
Hernioplasty may also be done laparoscopically, via 3 small cuts of 0.5 to 1cm away from the groin. The mesh is then placed under the muscle layer to cover the defect.
Most inguinal hernia surgery are done as day procedure. For some patients with other health issue, they may have to stay overnight in hospital after the surgery for monitoring.
Risks of Hernia Repair Surgery
As a routine and established procedure, complications are rare. However, as with all surgeries, there are risks, which include:
- Post-operative bleeding
- Infection of the mesh
- Infection of the wound
- Chronic pain
- Damage to the vas deferens (the tube which carries sperm from the testes)
- Recurrence of the hernia
Paraumbilical Hernia
This may be done either via laparoscopic or open surgery.
This is usually a small hernia protruding from one edge of the umbilicus. Even for open surgery, only a very small cut is made (typically 2-3cm). The defect in the muscle is then sewn together or closed with a mesh.
Some surgeons prefer laparoscopic repair. This requires putting a few small 0.5 to 1 cm incision away from the umbilicus. A mesh is then placed below the defect, and held in place by tacks. Some patients may feel more pain after surgery because of the tacks in the muscles.
Risks of paraumbilical hernia repair includes bleeding, wound infection, mesh infection and pain.
As paraumbilical hernia usually only have fat protruding into the hernia, the risk of intestines getting caught inside and strangulating is very low.
Incisional Hernias
This may also be done under open or laparoscopic surgery.
For smaller incisional hernias, I personally prefer open surgery and making an incision through the old scar (hence no additional scar). The hernia may be repaired by stitching the two edges together, or by stitching a mesh over the defect. Open surgery saves on the unnecessary costs of laparoscopic repair and also avoid having to put tacks into the muscles to hold the mesh in place.
For larger incisional hernias where having a long cut through the old scar may be more painful, it can be done laparoscopically. This is done by making a few small cuts at the side of the abdomen, putting in a mesh to cover the defect in the muscles, then holding it in place with tacks through the mesh into the muscles.
Most incisional hernias have relatively wide defects, so the chances of strangulation is also quite low.
What is the Mesh in a Hernia Repair Used For?
What is a Hernia Mesh?
During a hernia surgery in Singapore, the surgeon will insert a hernia mesh to reinforce damaged or weakened muscle wall.
What are the Benefits of Using a Mesh in Hernia Surgery?
The use of mesh in hernia repair surgery reduces the risk of hernia recurrence. Furthermore, as hernia repair with a mesh can be done with minimally invasive techniques, it requires smaller incisions compared to traditional open surgeries. This means that eligible patients can enjoy shorter recovery times and less post-operative discomfort and scarring.
HOW SHOULD I CARE FOR MYSELF AFTER THE HERNIA REPAIR SURGERY?
Shortly after the procedure, pain and swelling are normal and should subside within a week.
In some cases, the patient may be asked to wear an abdominal binder or bandage to support the abdomen and hips. Light exercises may be resumed after a week or two, though strenuous activities and heavy lifting should be avoided until at least four weeks post-surgery.
In the unlikely event that you experience excessive pain or bleeding, please seek medical attention immediately.
How Can I Reduce My Chances of Recurrence?
Unfortunately, you cannot always prevent the muscle weakness that leads to a hernia; but you can definitely reduce the amount of strain that you place on your body. Some methods include:
- Quitting smoking
- Getting treated for chronic cough
- Maintaining a healthy body weight
- Avoiding straining during bowel movements
- Avoiding lifting excessively heavy weights
IS IT EVER SAFE TO DELAY HERNIA SURGERY?
Most hernias do not require URGENT or IMMEDIATE surgery
The greatest danger from a hernia is strangulation. This occurs when the intestines protrude through the hernia opening and the opening is so tight that the intestines cannot return back in even when lying down. The blood supply to the intestines then become compromised, the intestines die and the bowel contents leak out and cause severe infection and possibly death. Hence, it is very important that patients with untreated hernia be aware of this possibility, and to seek medical help immediately if the hernia area is swollen and painful.
The risk of hernia strangulation varies between different types of hernias. It is usually very low for paraumbilical hernia, moderate for inguinal hernia and higher for femoral hernia.
For hernias that are small and asymptomatic, it is quite common for patients to observe to see if it gets bigger or start causing symptoms. It is not infrequent that some prefer to wait, but eventually decide for surgery after a few years.
The benefits of hernia surgery should be weighed against the risks if one is in general poor health. If the underlying medical conditions makes the surgery very risky (eg high risk of heart attack after surgery), just watching for symptoms or wearing a support may be a better option.
For more information regarding this medical condition, visit Dr Ho Kok Sun's dedicated page for Hernia Surgery.
FAQ on Hernia Surgery in Singapore
How Much is the Cost of Hernia Surgery?
The cost of hernia surgery in Singapore depends on a number of factors, including the type and complexity of the hernia, the chosen medical facility, the surgeon’s fees, and the patient’s medical insurance coverage.
What is the Recovery Time for Hernia Surgery?
Depending on the type of hernia repair surgery, patients can expect to recover within two to six weeks following surgery. During this time, they should refrain from engaging in strenuous activities or heavy lifting to allow proper healing.
How Painful is Hernia Repair Surgery?
After undergoing a hernia repair in Singapore, patients may experience pain, discomfort, and sensations of pulling or tingling in the surgical site for several weeks. These post-operative symptoms can be managed with prescribed pain medication and sufficient rest.
Can I Repair My Hernia Without Surgery?
In cases where a hernia is small or asymptomatic, and the doctor may recommend watchful waiting, as hernias do not go away on their own. However, if the hernia is large or causing discomfort, surgery is the only definitive option to correct the hernia and prevent complications from occurring, such bowel obstruction and intestinal strangulation.