Hernia: Is There More than One Type?

Hernia is a condition which can develop in both men and women. It can be classified into various types depending on its anatomical location. Following are the most common types of hernias that you must know about.

1) Inguinal Hernia

This is the most common type of hernia which affects about 2% of the men in the US. It is located in the lower abdomen, right above the leg crease near or adjoining the pubic area. They might even occur on both sides of the pubic area.

It occurs when the intestine protrudes through a weaker area or pushes into the inguinal canal in the groin. This condition is more frequently seen in men than women.

In men, inguinal canal is the area that lets the spermatic cord pass to the scrotum from the abdomen. The testicles of the men descend through the inguinal canal soon after birth and after the testicle descends, the opening should close completely. However, sometimes the canal does not close tightly and leaves a weak area making the person prone to inguinal hernia. Inguinal hernia is divided further into two types - direct and indirect.

Indirect inguinal hernia: it is caused by a weakness in the internal inguinal ring.

Direct hernia: it is caused due to a weakness in the floor of inguinal canal.

The technique used in repairing inguinal hernia is called tension repair and the chances of recurrence is 15%. Other methods used for treating hernia are tension free repair and laparoscopic tension free. These methods have a low ratio of occurrence.

 

2) Hiatal Hernia

In hiatal hernia, the stomach's upper part squeezes through the diaphragm where the esophagus moves from the chest into the abdominal area. 

Hiatal hernia is most commonly reported in elderly people aged 50 or more. If a child is affected by this condition, it is characteristically caused by a congenital defect. Hiatal hernia is divided further into two types - sliding and paraesophageal. Sliding hiatal hernia is a more common type of hernia in which the stomach and a part of the esophagus that joins the stomach pushes up into the chest through the diaphragm opening called hiatus. The paraesophageal hernia occurs when a part of the stomach pushes up through the hiatus and stays next to the esophagus while stomach and the esophagus remain in their normal positions. Though it is less common, it is potentially fatal because it can cause the “strangling” of stomach or shut off its blood supply.

It is slightly different from other types of hernia because they are caused due to weakness in the diaphragm. Hiatal hernia causes reflux of acids in the stomach into esophagus resulting in indigestion, pain and erosion of esophagus. It is treated with surgery due to the complication aroused.

3) Umbilical Hernia

In umbilical hernia, the small intestine squeezes through the abdominal wall near the belly button or umbilicus (the area where the umbilical cord attaches the fetus to the mother). Umbilical hernia is caused when the abdominal wall opening which usually closes before birth is not closed completely.

It is most commonly reported in children and newborns under 6 months. However, they are also known to affect elderly people, obese women or those women who have given birth to many children. Umbilical hernia often vanishes on its own when the patient turns 2 years of age, but sometimes surgery is required for repairing large hernias when complications occur.

4) Incisional Hernia

Incisional hernia occurs when the intestine protrudes through the abdominal wall. It commonly occurs in elderly or obese people who have undergone an abdominal surgery in the past and are inactive since then. The abdominal surgery creates an area of weakness in the abdomen that must heal on its own, but when it does not happen, the intestines may push through that weakened tissue causing hernia.

Incisional hernia is also known as ventral hernia and can appear after weeks, months or even years of surgery. It varies in size from small to large and might be really complex.

5) Femoral Hernia

The femoral canal is where the main blood vessels (femoral artery, vein and nerve) leave the abdominal cavity to enter the thigh. Femoral hernia occurs when part of the intestine squeezes through the femoral canal and bulges at the top of the thigh. 

Femoral hernias are more common in women than in men. Although this type of hernia is rare, it is at more risk of becoming irreducible and strangulated which creates several complications and becomes a medical emergency.

They appear just below the groin crease and generally occur after childbirth.

6) Obturator Hernia

Obturator hernia is a rare type of hernia in which pelvic or part of the intestine protrudes through the opening created by the ischium and pubis bones. There is no bulge, but it can cause bowel obstruction, nausea and vomiting. Since there is no visible sign, this type of hernia is often hard to diagnose by the healthcare provider.

It is most commonly reported in women who have lost significant amount of weight the last few days or who have had multiple pregnancies.

Hernias are also classified on the basis of when they are transpired. Hernias can develop due to daily activities or a person might be born with it.

Acquired Hernia: It is caused by wear and tear of the tissues during childbirth, weight gain or muscle strain.

Congenital Hernia: They are present at the birth and are caused due to weak abdominal wall. Hernias in children are always congenital.

Hernias are also classified on the basis of their bulge depending on whether they are flat or not.

Reducible Hernia: It has a bulge which flattens when lying or when it is gently pushed. It does not cause any immediate effect to the health but can be painful or worsen if it is not treated on time.

Non Reducible Hernia: It occurs when a loop of intestine is trapped and the bulge cannot be flattened. This type of hernia is very painful and requires immediate medical attention as it may cause gangrene. It may also lead to strangulation of intestine or tissues because of the lack of blood supply.