FAQ - Hernia


What is Hernia ?

Most of the people are unaware about the hernia occurring in newborn & adult male or female. Apart from this most of the time hernia in primary stage is asymptomatic, so many of them realize hernia when it becomes complicated. “When any body organ gets displaced from its original position & protrudes outside, it is called hernia”. From this definition of hernia, it is difficult to get complete explanation. So we will discuss in brief about hernia.


Most of the times, hernia is related to abdominal cavity. Abdomen is called magician’s box as many organs are enclosed within it. It contains stomach, small intestine, large intestine, layer of fat, liver, gall bladder, spleen, kidney, urinary bladder and in females uterus & other genital organs. The covering which keeps these organs in their respective places is a thin layer called peritoneum. Along with it muscles, fat & skin forms the external layer of abdomen. Weakness of this thin layer leads to descent of abdominal organs leading to bogginess below skin. It is called hernia from abdomen.

Why hernia occurs ?

One or more of the following can be reasons for hernia :- (1) Congenital abnormality in body structure. (2) Increased pressure inside the abdomen e.g. straining on micturition, constipation, chronic cough etc. (3) Weakness of abdominal musculature e.g. obesity, increased age, recurrent pregnancy, ascites etc. (4) Injury to abdomen e.g. accident, Surgery etc.

What is inside of the hernial swelling ?

Hernial sac is made up of many layers. The sac is formed by layer of intra-abdominal fat (peritoneum), muscles, fat & skin. In the sac there is either skin or organ. Generally, in hernia there is first layer of fat & after that comes small intestine. Sometimes other organs also come in hernial sac. e.g. large intestine, appendix, bladder etc.

What will happen if hernia remains untreated ?

Hernia will increase in size. Hernia will increase in the following sequence :-

(1) Reducible hernia – In this hernia, swelling will appear only on standing or on coughing when organ comes in hernial sac. But on lying in supine position or on pressing with hand intestine again goes to its place in the abdomen. In this case patient does not have any complaints. This stage lasts for few days to many years. But size of hernia increases slowly.

(2) External irreducible hernia – In this, part of intestine gets attached to hernial sac. Hernia doesn’t reduce on lying down or on pressing with hand. Patient doesn’t get much pain other than mild discomfort. As intestine is not obstructed in this hernia, intestinal functions of secretion & digestion are going on smoothly.

(3) Complicated or obstructed hernia – In this case, part of intestine in the hernial sac gets rotated or obstructed & leads to two complications (a) obstruction to passage of food (b) blockage of blood supply of intestine. Because of this, patient gets severe pain & vomiting. This can occur in any type of hernia at any time & if patient is untreated for more than 5-6 hr., It can be a life threatening condition. Patient has to undergo emergency surgery.

How will you diagnose hernia ?

It is very easy to diagnose. On asking patient to cough, hernial swelling appears. Depending on the site from which hernia appears, different types can be easily identified. Also depending on symptoms state of hernia can also be identified. For diagnosis of hernia there is no need for pathological tests or x-rays. But before surgery some investigations have to be done.

Can hernia be cured by medicines ?

Hernia is not a disease, it is a localised, limited weakness. So no medicine can cure hernia. Experts of allopathy, homeopathy & ayurveda all agree on this fact.

Can surgery for hernia be prevented by using truss ?

By using truss, surgery is not prevented but it is postponed. Also with truss, muscles in that area become more weakened so that when operation has to be performed it becomes difficult & complicated. For that truss has to be used to postpone surgery for limited days e.g. In patient who had heart attack, operation has to be postponed for atleast 3 months.

When surgery for hernia is done ?

Best treatment is to do operation as soon as hernia is diagnosed. It is wrong to wait for operation as size of hernia is small. Because in this case there is no guarantee of when obstruction will occur & also as size increases time consumed for operation also gets prolonged.’ Exception for this is congenital umbilical or congenital inguinal hernia. In these hernias, it is wise to wait till child is 1 yr. old as sometimes in this period hernia gets corrected of its own.

What pre-operative preparation has to be done before hernia surgery ?

Before surgery, treatment for the cause & aggravating factors of hernia & other diseases has to be done with great effort Eg, treatment for cough, treatment for breathlessness, to stop smoking, treating constipation with diet or medicines, in old patients because of enlargement of prostate there is obstruction to passage of urine, this has to be treated by doing endoscopic surgery & other diseases like diabetes, hypertension, leukemia etc. should be brought under control.

Which type of anaesthesia is used for hernia surgery ?

Generally, abdomen & legs are anesthetized by using injection in lower back, it is called spinal anaesthesia. Sometimes general anaesthesia or local anaesthesia can be used. Because of safe advanced techniques & recent medicines in anaesthesia, hernia surgery can be performed safely in any age & along with any disease.

How is hernia surgery performed ?

Simple hernia surgery takes 1/2 to 1 hr.. Blood transfusion to patient is usually not required. But patient is kept fasting for half of the day & is given glucose saline. During surgery, intestine & other organs in hernial sac are pushed back to their original places & empty sac is cut. Then the gap in muscles is closed by suturing muscles with each other. If the muscle is atrophied or is incapable of suturing with each other or if the gap is very big then mesh made of plastic or mesh woven with steel threads, of appropriate size is put on this gap & gap is closed. In obstructed hernia, operation takes more than one hour & depending on that blood & glucose or saline is required. In this, first by opening sac, intestine is untwisted & obstruction is relieved. If the intestine is healthy it is pushed in the abdominal cavity. But if it is atrophied or gangrenous, then the diseased intestine is cut & healthy ends are sutured with each other. Afterward gap in the muscles is closed.

After hernia surgery, for how many days patient has to stay in the hospital ?

This depends on patient’s age, size of hernia & type of hernia e.g. ln congenital hernia of less than 5 yr. old child, stay is for 1 day. For healthy adult patient with simple hernia stay is for 2-4 days, for old patient or for obstructed hernia case or hernia with previous operation site i.e. incisional hernia stay is 5-8 days.

What precautions have to be taken after hernia surgery ?

Complete bed rest for a week (or till stitches are removed). Diet should be easily digestible. For preventing cough oily & sour food should be avoided. For preventing constipation fruits & green vegetables should be eaten. Heavy weights (more than 10 kg.) should not be lifted for atleast 1 month. Driving should be avoided. Travelling for long distance should be avoided. Exercises or sports which will cause stress on that site should not be played.

After surgery, can hernia recur? What are its causes & its treatment?

In 5% patients hernia can recur after hernia surgery at that site.

It has many causes, such as :- a) Causes before surgery - Constipation, cough, obstruction to micturition, diabetes, leukemia etc., if these- causes remain untreated. b) Causes during surgery - Blood loss or infection, jack of proper diagnosis & skill. c) Causes after surgery- Infection not immediately treated or patient has not taken adequate rest. Most of the times for recurrent hernias mesh is applied with the help of endoscope. Mesh can be put from inside of the abdominal wall but as this technique is new, it is not used frequently.


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