fullcortex.net

WHAT IS IT?
A hernia is a bulge of tissue that pushes through the muscles that should contain it. Hernias are also called ruptures. They happen most often in the abdominal wall, the sheet of muscle that covers the stomach, intestines, and kidneys. These are called abdominal hernias. Hiatal hernias, another common type, occur in the diaphragm, the layer of muscle that lies between the chest and the abdomen.Most hernias don’t cause serious problems. A person with an abdominal hernia may simply notice a bulge where the rupture has occurred. Some people with hiatal hernias tend to get heartburn, but many have no symptoms at all. Some hernias can be dangerous, though. If you think you have a hernia, see a doctor promptly for advice.

It’s hard to tell whether a hernia will cause a problem. But if you have an abdominal hernia, you can expect it to slowly get worse. That’s why many people have surgery to repair an abdominal hernia, even if it doesn’t bother them. The operation is simple and effective and can prevent big problems later. Doctors can also repair hiatal hernias, although these hernias are most often harmless.
WHAT IS HAPPENING?
Abdominal hernias
A network of flat muscles that runs from the bottom of the rib cage to your groin holds the stomach, intestines, and neighboring organs in place. This network is called the abdominal wall. It should hold the organs in place, even under great pressure when you’re lifting, coughing, or straining. But sometimes there is a weak spot or tear in the muscle. Then tissue bulges out. The tissue may include fat, part of an internal organ such as an intestine, or other tissues.

By far the most common type of abdominal hernia occurs in the groin. This is called an inguinal hernia. Hernias can also happen at the top of the inner thigh near the groin (femoral) or at the navel (umbilical).

If your hernia is minor, you may be able to make it disappear for a few moments simply by pressing on it. If you can’t push your hernia back into your body, you will need to see a doctor. The bulge may contain a loop of intestine, which can become strangulated. That means muscles in your abdomen clamp down on the trapped tissue, cutting off its blood supply; when this happens to the intestine, the flow of waste is often blocked. Without immediate treatment, the squeezed section of intestine can die.

Hiatal hernias
The esophagus, the tube that connects the mouth to the stomach, passes through an opening in the diaphragm called the hiatus. A hiatal hernia occurs when part of the upper stomach pushes through this opening and moves up into the chest. This can happen at any age, but it’s especially common among older people. More than half of all people over 60 have a hiatal hernia, and most never notice it.

Hiatal hernias are usually harmless. But in some people, the hernia weakens the seal between the stomach and the esophagus. This allows stomach acid to splash into the esophagus, causing heartburn. In severe cases, frequent bouts of heartburn can lead to esophagitis, a painful inflammation of the esophagus. And rarely, a piece of stomach in a hiatal hernia can become twisted, cutting off its blood supply (another kind of strangulation). Like a strangulated intestine, this condition is an emergency.
WHAT CAUSES IT?
Hernias result when a muscle stretches or rips open under strain. Anyone can get a hernia, and most hernias can’t be prevented. Still, there are a few things you can do to reduce your risk.

THINGS YOU CAN’T CHANGE

Birth defects
Some people are born with defects or weaknesses in the muscles most likely to rupture. Often, these defects occur for no obvious reason. But in some cases, genes seem to play a role.

Family history
If a close relative has a hernia, you’re more likely to have the problem, too.

Age
Hernias can happen at any age, but some types are more common in older people. For instance, people born with perfectly sound muscles rarely get inguinal (groin) hernias before age 40. But after decades of wear and tear, the muscle walls can weaken and rupture. Hiatal hernias also grow more common with age.

Gender
Men get about 90 percent of all inguinal hernias. That’s because men have a weak muscle in the abdominal wall where the testicles descend into the scrotum.

Pregnancy and birth
Femoral hernias are most common in pregnant or overweight women. Umbilical hernias are most common in newborns and infants.

Prior surgery
Some people get hernias where a surgeon made a cut through the abdominal wall during surgery for some other reason: for example, to remove an infected appendix.

THINGS YOU CAN CHANGE

Straining yourself
If you lift a lot of heavy objects, you may be especially likely to get an abdominal hernia. A hacking cough, frequent sneezing, or even straining during bowel movements can also cause a rupture. However, it usually takes years of strain, not a single event, to bring on a hernia. You may first notice the pain while moving a heavy item such as a couch, but the problem could have been building for years.

Likewise, frequent coughing, vomiting, and hard exercise can put pressure on the abdomen and cause a hiatal hernia. Again, one moment of straining isn’t likely to cause the problem.

Muscle weakness
Muscles in the abdominal wall can grow weak if they don’t get enough exercise. This means they’re more likely to rupture, especially when you strain.

Being overweight
Extra pounds put more pressure on the abdomen. This raises your chance of getting a hernia.

Smoking
A smoker’s deep cough can cause a muscle to weaken or rupture. It also makes the heartburn that can accompany a hiatal hernia worse.
WHAT YOU CAN DO FOR YOURSELF
Most hernias can’t be prevented. But you may be able to reduce your risk of an abdominal hernia by avoiding unnecessary strains. If you already have a hernia, a few commonsense steps can help keep the problem from getting worse.

Be wary of heavy lifting
If you have an abdominal hernia or are recovering from hernia surgery, you should avoid lifting heavy objects until the hernia is repaired. If you do lift something, bend at the knees, not at the waist, when you pick up the object, and use your legs to support the lift.

Eat well
Eat high-fiber foods such as fruits, vegetables, and whole grains to improve digestion and prevent constipation. Straining during bowel movements puts pressure on muscles in the abdominal wall.

Stay active
Be as active as you can. Everyday movement such as walking or climbing stairs uses the muscles of your trunk, and just moving around makes them stronger. Consider some gentle exercises such as sit-ups that target the muscles in your abdomen. If you already have an abdominal hernia or are recovering from surgery, check with your doctor to make sure your exercises are safe.

Lose weight
If you weigh more than you should, start dropping those extra pounds. Even a loss of a few pounds will help cut your risk of an abdominal or hiatal hernia. Weight loss can also help prevent heart disease, arthritis, and even some cancers.

Taking off weight may sound daunting, but it doesn’t have to be. The best approach? Combine smart eating with exercise.

Extra calories-those you don’t need for energy right away-pack on the pounds. Exercise burns them off. To lose a pound of fat, you need to use 3,500 more calories than you take in. That’s because one pound of fat has 3,500 calories. (A typical fast-food lunch of burger, fries, and a shake is loaded with about 1,700 calories; by contrast, an apple has only 80.)

Here are some tips for a program that works:

Check with your doctor to find out how much you ought to weigh.
Take your time. It’s better to lose weight slowly-no more than 1 percent of your body weight each week. The more gradually you lose weight, the easier it is to keep it off.
Be realistic. Don’t shoot for a weight you can’t maintain.
Keep an eye on your total calories and make a point of cutting down on fats.
Fat-free and low-fat foods can be a trap. They don’t have the fat, but many of them make up for it with sugar, so they’re high in calories.
Stay as active as you can.
Don’t smoke
If you smoke, there are many good reasons to quit, and cutting your risk of getting a hernia is one of them. Deep, heavy coughs such as a “smoker’s hack” strain the muscles most likely to rupture. There are lots of programs that can help you quit, including support groups run by the American Cancer Society.
WHAT YOUR DOCTOR CAN DO FOR YOU
If you think you have a hernia, talk with your doctor about your options. Treatment can ease your symptoms and prevent future problems.

Trusses
If you have an abdominal hernia that you can push back into your body, your doctor may suggest a truss. This special garment can hold the bulging tissue in place and keep the area flat. A truss won’t cure a hernia, but it can help ease some of the pain and discomfort.

Surgery
Surgery is the only cure for a hernia. The operation takes an hour or less. You may get either a local or a general anesthetic.

The surgeon makes a small cut at the site of the hernia, then gently pushes the bulging tissue back inside the abdominal cavity. Next, the surgeon stitches together the split in the muscle wall. Sometimes a plastic mesh or sheet is used to help strengthen the muscle against further injury.

A new version of the surgery uses a laparoscope. This device, like a small telescope, lets doctors see into the abdomen while they operate. The surgery is performed through cuts so small they barely need stitches. This speeds recovery and lowers the risk of infection.

After surgery, your doctor will want you to get up and move around the same day. You’ll be able to return to work in two or three days, though you shouldn’t lift anything for up to eight weeks.