สาเหตุ อาการ การักษาโรคไส้เลื่อน (Hernia)

Hernia

A part of the intestine or fatty tissue protrudes through a weakened spot of the muscles or tissues in the abdominal wall or groin area. When it occurs, a lump can be seen or felt.

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A hernia is present when a part of the intestine or fatty tissue protrudes through a weakened spot of the muscles or tissues in the abdominal wall or groin area. When it occurs, a lump can be seen or felt. The condition does not improve or resolve over time and can lead to severe complications.

Types of hernia

  • Inguinal hernia is the most common type of hernia, particularly in men. A part of the intestine or fatty tissue protrudes into the groin.
  • Femoral hernia is more common in older women. The hernia protrudes out of the groin at the top of the inner thigh.
  • Umbilical hernia is when there is a poking lump near the belly button.
  • Hiatal/hiatus hernia occurs when a part of the stomach pokes through the diaphragm into the chest cavity.
  • Incisional hernia happens when the protruding tissue pushes through an abdominal scar from abdominal or pelvic surgery.
  • Epigastric hernia is when the fatty tissue protrudes through the midline in the area between the breastbone and belly button.
  • Spigelian hernia protrudes out at the lateral side of the abdomen, below the navel.

Causes

  • Inguinal and femoral hernias occur due to a weak spot in the surrounding muscle wall from birth, aging, prolonged abdominal straining from regular heavy lifting, chronic coughs, chronic constipation, or urinary straining due to enlarged prostate gland.
  • An umbilical hernia is a result of straining the abdominal area, overweight, persistent coughs, and childbirth.
  • Hiatal hernias are due to weakened muscles of the diaphragm from aging.

Symptoms

  • Lump or bulge in the abdomen, groin, or scrotum which can be pushed back or disappear when you are in the supine position and reappears when coughing, sneezing, screaming, laughing, or straining during a bowel movement.
  • Increase in size of the lump over time.
  • Dull aching sensation which can increase over time.
  • Pain when lifting objects.
  • Feeling of fullness, bloating, or bowel obstruction

Patients with hiatal hernias have no noticeable lump on the body, but they may experience trouble swallowing, heartburn, indigestion, vomiting, and chest pain.

Diagnosis
A physical exam to feel a bulge. For inguinal hernias, the doctor will ask a patient to cough vigorously while the scrotum and groin are being examined. A CT scan or ultrasound may be ordered for further confirmatory diagnosis.

Treatment
Because hernias cannot improve on their own, surgical repair is necessary.

Umbilical hernia surgery is recommended for a child with a large hernia at age 5 or above. An adult with an umbilical hernia should also have surgery as the condition has a heightened risk of complications.

  • Open surgery is a traditional surgery involving skin and tissue incisions over the hernia site. The surgeon has a full view of the structures inside and can push the protruding structure back in, cut out the excess fascial hernia sac, and stitch together the weakened muscle wall. The placement of a synthetic inlay mesh can provide extra support.
  • Laparoscopic surgery: The surgeon inserts a laparoscope and surgical tools through small skin incisions. This method has advantages, including a shorter hospital stay, faster recovery, and less postoperative pain, bleeding, and scarring.

Discuss with your doctor which surgical procedure is most suitable for your condition.

Complications
Only a diminutive umbilical hernia in a baby may disappear on its own, usually by age 5. Other types of hernia usually worsen, and complications may develop if left untreated.

 Inguinal and femoral hernia can lead to the following complications:

  • Incarcerated hernia: Some parts of your intestine are stuck in the inguinal canal, leading to pain in the abdomen, painful groin lump, nausea, and vomiting. An incarcerated hernia can progress to a strangulated hernia.
  • Strangulated hernia: The blood supply to parts of your intestines decreases to the point gangrene develops in the strangulated tissue. The condition is a medical emergency. 

    Prevention

    • Keep your weight within the healthy BMI range.
    • Exercise regularly, at least 30 minutes a day.
    • Add more fruits, vegetables, and whole grains to your daily meal to prevent constipation.
    • Learn a proper position to lift heavy objects.
    • See a doctor if you have persistent sneezing or coughs, which can trigger a hernia.
    • Quit smoking. Smoking can cause coughing, which predisposes to hernia development.

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    Published: 19 Oct 2022

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