3 Mount Elizabeth, #14-15, Mount Elizabeth Medical Centre, Singapore 228510

Hernia

Hernia

What is hernia?

A hernia occurs when an organ or fatty tissue squeezes through a weak spot in a surrounding muscle or connective tissue called fascia. Hernias can occur in various parts of the body, each named for its location or cause. Here are some of the most common types of hernias:
Type of Hernia Description Specification
Inguinal Hernia Occurs when tissue, such as part of the intestine, protrudes through a weak spot in the abdominal muscles. Often appears in the inguinal canal in the groin area. Most common type, constituting about 70% of all hernias; more common in men.
Femoral Hernia In femoral hernia, tissue bulges out near the femoral artery in the upper thigh. Less common than inguinal hernias; frequent in women, especially those who are pregnant or obese.
Umbilical Hernia In an umbilical hernia, part of the small intestine pushes through the abdominal wall near the site of the belly button. Common in newborns, obese women, or after pregnancy; can cause discomfort.
Incisional Hernia Incisional hernia occurs when tissue protrudes through the abdominal wall at the site of a previous surgery. Can occur after surgery, especially post-abdominal surgery or C-section; can require surgery or conservative care.
Epigastric Hernia This type of hernia, part of the stomach pushes up through the diaphragm into the chest. Common in individuals aged over 50; associated with GERD (acid reflux).
Hiatal Hernia In this type of hernia, part of the stomach pushes up through the diaphragm into the chest. Typically results in pain or heartburn.
Diaphragmatic Hernia Occurs when the diaphragm, the muscle that separates the chest from the abdomen, fails to fully form, allowing abdominal organs to move into the chest cavity. Can be congenital or acquired; requires medical attention, especially if it causes respiratory issues.
Muscle Hernia Attacks that bulge through an opening in the muscle, connective tissue surrounding the muscle. Commonly seen in the lower extremities; often asymptomatic but may cause an noticeable bulging.
Spigelian Hernia Occurs along the Spigelian fascia, near the edge of the rectus abdominis muscle below the navel. Rare; develops through a slit-like opening; often diagnosed due to deep location.

What causes hernia?

Hernia involves the protrusion of an organ or tissue through a weakened spot in the surrounding muscle or connective tissue. This typically occurs when increased intra-abdominal pressure—due to activities like lifting, straining, or coughing—exerts force on a weakened area of the abdominal wall or groin.

The weakened spot can be a result of congenital defects, previous surgical incisions, or natural openings that have not properly healed or have become further weakened by strain or age-related muscle degeneration. This combination of pressure and weakness allows parts of organs or fatty tissue to push through, forming a hernia.
A hernia forms when an organ or tissue pushes through a weakened area in the surrounding muscle or connective tissue, often due to increased intra-abdominal pressure.

What are the symptoms of hernia?

The symptoms of a hernia can vary depending on the type and location, but common signs include:

Visible bulge:

One of the most noticeable signs of a hernia is a bulge or lump in the affected area. This bulge may become more apparent when you stand up, bend over, or lift heavy objects and might disappear when lying down.

Feeling of heaviness:

Some people with a hernia experience a feeling of heaviness or pressure in the abdomen.

Swelling around the testicles:

In the case of inguinal hernias, men might notice swelling or a bulge around the testicular area.

Pain or discomfort:

Pain at the site of the hernia is common, especially when bending over, coughing, or lifting. The pain may be sharp and immediate or a dull ache that worsens throughout the day.

Other symptoms:

Depending on the type, hernias can cause other symptoms such as acid reflux, chest pain, and difficulty swallowing in cases of hiatal hernias. Symptoms can be mild initially but may worsen over time as the hernia grows.
If a hernia becomes trapped or strangulated (where the blood supply to the herniated tissue is cut off), it can lead to severe symptoms including intense pain, nausea, vomiting, and even fever. This is a medical emergency and requires immediate attention.

Is hernia a painful condition?

Yes, hernias can be painful, but the intensity and nature of the pain can vary. Some hernias might be relatively painless and only noticeable as a bulge, while others can cause significant discomfort. The pain is often associated with activities that increase pressure within the abdomen, such as lifting heavy objects, coughing, or bending. This pain might be sharp during such activities and subside when resting.
In more severe cases, especially with strangulated hernias where the blood supply to the herniated tissue is cut off, the pain can be intense and constant. The level of pain can also depend on the hernia’s size, location, and whether it's being compressed or trapped within the muscle wall.
Pain levels in different types of hernias can vary, ranging from mild discomfort to severe pain, especially during physical activities that increase abdominal pressure.

Who is at risk of developing hernia in Singapore?

These factors can influence the development of hernias by weakening the abdominal wall or increasing intra-abdominal pressure.
Pregnancy increases the risk of hernias due to added abdominal pressure and hormonal changes that can weaken connective tissues.
Certain factors increase the likelihood of developing a hernia. These include:
These risk factors increase the pressure and strain on the anus, which can cause tears in the lining, resulting in an anal fissure.
  • Gender: men are generally more susceptible to inguinal hernias due to the natural weakness in the inguinal canal, which is less common in women.
  • Age: older individuals are at higher risk because muscles weaken with age.
  • History of hernias: people who have had one hernia are more likely to develop another hernia, possibly in a different location.
  • Chronic coughing: conditions that cause chronic coughing, such as chronic obstructive pulmonary disease (COPD), can increase the risk of developing a hernia due to the repeated strain on abdominal muscles.
  • Pregnancy: pregnant women experience increased pressure on the abdomen, which can lead to hernias.
  • Obesity: excessive body weight increases pressure on abdominal tissues, which can contribute to hernia formation.
  • Heavy lifting: regularly lifting heavy objects without proper technique can strain muscles and increase the risk of hernias.
  • Previous abdominal surgeries: surgical cuts can weaken the abdominal wall, which creates a potential site for hernias.
  • Premature birth and low birth weight: these are risk factors for hernias in infants, particularly umbilical hernias.
  • Physical exertion: high levels of physical activity or jobs that require hard physical labour can put extra stress on the abdominal wall.
  • Smoking: smoking may weaken connective tissues and contribute to the development of hernias.

How is hernia diagnosed?

Hernias are mainly diagnosed through a combination of physical examinations and medical imaging. Here’s how the treatment procedure works:

Physical examination:

The primary method for diagnosing a hernia is a physical examination. The doctor will look for a bulge in the abdominal or groin area, which may become more apparent when the patient stands up, coughs, or strains. The doctor might feel the area to check for tenderness or the size of the hernia.

Medical history:

The doctor will ask about symptoms, such as pain or discomfort, and any activities that might exacerbate the hernia, such as lifting heavy objects. They will also inquire about any previous surgeries, which can be relevant for incisional hernias.

Herniography:

In rare cases where other diagnostic methods are inconclusive, a herniography might be performed. This involves the injection of a contrast dye into the abdominal cavity, which can help highlight a hernia on X-ray images.

Imaging tests:

If the diagnosis is not clear from the physical exam, or to get more detailed information, the doctor might opt for imaging tests, such as:
  • Ultrasound: commonly used for suspected hernias in the groin or abdominal wall, an ultrasound can visualise soft tissue and organs, which helps confirm the presence and position of a hernia.
  • CT Scan: a CT scan provides a detailed image of the abdomen, which can be helpful in diagnosing hernias that are difficult to detect during a physical examination.
  • MRI: an MRI might be used to visualise soft tissues and structures within the abdomen or groin more clearly, particularly in complex cases.
  • These diagnostic methods help in determining the presence, type, and size of the hernia, which facilitates the healthcare professional in determining appropriate treatment decisions.

    What are the treatment options for hernia in Singapore?

    Treatment options for hernias vary based on the type, size, symptoms, and overall health of the patient. Here are the most common approaches used for treating hernias:

    Monitoring for small, asymptomatic hernia:

    For small, asymptomatic hernias (particularly inguinal hernias), the doctor may recommend waiting and monitoring the hernia for any changes or symptoms over time without immediate surgery, especially if it poses no discomfort or risk.

    Lifestyle changes:

    Adjustments such as losing weight, avoiding heavy lifting, and treating constipation can help reduce the symptoms of a hernia and prevent it from worsening.

    Medication:

    While medications cannot repair a hernia, they can be used to alleviate symptoms such as acid reflux in the case of hiatal hernias.

    Emergency surgery:

    For strangulated hernias, where the blood supply to the herniated tissue is cut off, emergency surgery is required to prevent serious complications.

    Surgery:

    This is the only way to effectively repair a hernia. Surgery can be done using different methods:
    Open hernia repair: in this traditional method, a surgeon makes a cut near the hernia, pushes the protruding tissue back into place, and then sews the weakened area, often reinforcing it with a synthetic mesh.
    Laparoscopic surgery: this is a minimally invasive technique (link to service page)where the surgeon makes several small incisions and uses tiny instruments and a camera to repair the hernia with mesh. This method results in quicker recovery and less postoperative pain.
    Robotic surgery: similar to laparoscopic surgery, robotic surgery (link to service page) provides the surgeon with enhanced precision and control. It can be particularly useful for complicated or recurrent hernias.

    The choice of treatment depends on the patient’s lifestyle, the risk of the hernia worsening, and the potential benefits and risks of surgery. The type of surgery is selected based on the hernia’s characteristics and the patient’s overall medical condition.
    If you are suffering from any type of hernia, please schedule  an appointment with CRCS Clinic for proper diagnosis and an appropriate treatment option.

    Frequently Asked Questions

    Yes, hernias can affect individuals of any age, including infants and children. The most common types in children are umbilical and inguinal hernias, often congenital and sometimes resolve themselves as the child grows.

    If you have a hernia, it is advisable to avoid heavy lifting, strenuous exercises, and any activity that significantly strains the abdominal area. Consult your healthcare provider for specific guidance based on the type and severity of your hernia.

    To prevent recurrence, maintain a healthy weight, avoid smoking, manage chronic coughs, and follow proper lifting techniques. You must also adhere to post-surgical care instructions provided by your healthcare provider to avoid any complication or recurrence.

    If you experience sudden, intense pain, nausea, vomiting, fever, or if the hernia bulge becomes red, purple, or dark and cannot be pushed back in, seek immediate medical attention. These could be signs of a strangulated hernia, which is a potentially life-threatening condition.

    Location

    Colorectal Care Specialists (CRCS)

    3 Mount Elizabeth, #14-15, Mount Elizabeth Medical Centre, Singapore 228510

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