Hernia Treatment in Bhubaneswar
A hernia is a bulge that forms when an internal organ or fatty tissue pushes through a weak spot in the muscle or connective tissue that normally holds it in place. A hernia does not usually resolve on its own, although not every hernia requires immediate surgery. Dr. Kasturi Bharadwaj is a general and laparoscopic surgeon and an Associate Professor at IMS & SUM Hospital. This page explains the types and symptoms of hernias, how they are assessed, when surgery may be recommended, the available repair options, and what recovery can involve.
What is a Hernia?
A hernia develops when part of the intestine or fatty tissue protrudes through a weakness in the abdominal wall. Hernias occur most often in the groin, near the belly button, and at or near the site of an earlier surgical scar. Some stay small and cause little trouble for years, while others slowly enlarge and become uncomfortable. Because the muscle weakness does not mend itself, hernia surgery is the only way to repair the defect, and your surgeon will advise whether and when it is needed in your case.
Causes and risk factors
A hernia appears where the abdominal wall is weak and pressure inside the abdomen is raised. Factors that can contribute include:
- Heavy lifting or repeated straining
- Long-standing cough
- Constipation or straining during bowel movements or urination
- Obesity
- Pregnancy
- Previous abdominal surgery
- Age-related weakening of the muscles
Having a risk factor does not mean you will develop a hernia, and some hernias have no clear cause.
Symptoms of a hernia
Symptoms depend on the type and size of the hernia. Common ones include:
- A visible or palpable lump in the groin, abdomen or near the navel
- A bulge that becomes more noticeable on standing, coughing or straining, and may settle when lying down
- Aching, burning or a feeling of heaviness or pressure at the site
- Discomfort while lifting or during physical activity
Some hernias cause no pain at first, so a painless lump should still be examined.
Seek emergency care urgently if
- The lump becomes hard, tender, red or discoloured
- The hernia cannot be pushed back
- You have severe abdominal pain or repeated vomiting
- You cannot pass stool or gas
These can be signs that the hernia is obstructed or its blood supply is cut off (strangulation), which needs emergency treatment. Do not wait for a routine appointment.
Types of hernia
- Inguinal hernia: This occurs in the groin and is the most common type, and it is more common in men.
- Femoral hernia: It appears just below the groin crease, is more common in women, and has a higher risk of strangulation, so repair is usually not delayed.
- Umbilical hernia: It develops near the belly button and can occur in adults and children. In many young children it closes by itself, so the doctor decides on timing.
- Incisional hernia: It forms through the scar of an earlier operation, and cases of this kind may be discussed in the context of abdominal surgery.
- Epigastric hernia: It occurs in the midline between the breastbone and the belly button.
- Hiatal hernia: Part of the stomach moves up into the chest through the diaphragm, which often causes acid reflux and heartburn, and it is usually treated with lifestyle changes and medicines first.
When is surgery needed?
Surgery is the standard treatment to repair a hernia, but the timing depends on the type, size, symptoms and your health. A small inguinal hernia that causes no symptoms may sometimes be watched under medical supervision, while a hernia that is painful, enlarging, or at risk of complications is usually repaired. A femoral hernia, and any hernia that has become obstructed or strangulated, generally needs prompt treatment. Your surgeon will go through the options with you, including the option of waiting where it is appropriate.
How a hernia is evaluated
At the consultation, the doctor takes your history and examines you, often while you stand and cough. Tests such as ultrasound or CT scan may be advised when the diagnosis is uncertain or when the hernia is complex, and blood tests and a pre-anaesthetic check are done before surgery. Not every patient needs every test.
Hernia repair options
Depending on the type and size of the hernia and your general health, your surgeon may discuss:
- Open repair: The hernia is repaired through a cut over the site.
- Laparoscopic (keyhole) repair: The repair is done through small cuts using a camera, and for suitable hernias this is explained in detail on the page about laparoscopic hernia repair, while the technique in general is described under laparoscopic surgery.
- Mesh repair: A surgical mesh may be used to reinforce the weakened area and is commonly used for many adult hernia repairs. Whether mesh or a tissue-based repair is appropriate depends on the type of hernia, the patient’s circumstances and the surgeon’s assessment. The risk of recurrence varies by case and technique.
Laparoscopic repair is not better for every patient. Previous surgeries, the size and type of the hernia, and your general health can make open repair the safer option, and sometimes the plan changes during the operation
What happens on the day of surgery
Hernia repair may be done under general, spinal or local anaesthesia, depending on the type of hernia and the repair chosen. You are usually asked to fast beforehand, and the anaesthesia team will advise you about regular medicines. The surgeon returns the protruding tissue to its place and reinforces the weak area, and the wound is then closed. After the operation you are watched in a recovery area, and the team decides whether you go home the same day or stay in hospital. The length of the operation varies with the type and complexity of the hernia.
Recovery and aftercare
Recovery varies with the type of hernia, the repair, and your general health. In general:
- Take medicines as prescribed and keep the wound clean and dry
- Walk early, as advised by your surgeon, to help circulation
- Avoid heavy lifting and strenuous work until you are told it is safe
- Use abdominal support if you are advised to
- Prevent constipation with fluids and a balanced diet
- Attend your follow-up visits
- Contact your doctor if you develop fever, increasing pain, wound redness or discharge, swelling at the site, or vomiting
Your surgeon will give you a timeline for returning to work and normal activity that fits your operation, because it differs from one patient to another.
Risks and possible complications
Hernia repair is a commonly performed operation, but like any surgery it carries risks. These can include:
- Bleeding or a collection of blood (haematoma)
- A collection of fluid at the site (seroma)
- Infection, including, rarely, infection of the mesh
- Pain in the groin that continues for a long time
- The hernia coming back
- Injury to nearby structures (uncommon)
- Blood clots
- Reactions to anaesthesia
Your surgeon will explain the risks that apply to you and take your written consent before the operation.
FAQs
itself. However, not every hernia needs immediate surgery. Your surgeon can advise whether monitoring or repair is appropriate. No, a hernia generally does not heal on its own because the weakened area does not repair
No. Many hernias cause only mild symptoms for a long time. Some, however, can become obstructed or strangulated, which is an emergency, so a hernia should always be examined.
Not always. Keyhole repair can mean smaller wounds and, for many patients, a quicker return to routine activity, but open repair is the better choice in some situations. The decision depends on the type and size of the hernia, previous surgeries and your health.
It depends on the type of hernia, its size and the technique used, so your surgeon can give you an estimate for your operation.
Some pain is expected after any operation. Pain relief is planned for each patient, and the amount of discomfort differs between types of repair and between people.
Most patients are encouraged to start walking soon after the operation, but you should follow your surgeon’s instructions for your own case.
It depends on your type of work and the repair done. Desk work can often be resumed earlier than heavy physical work, and your surgeon will tell you when it is safe for you.
A hernia can recur after repair, although the chance depends on the type of hernia, the technique, and factors such as smoking, obesity, and straining. Your surgeon will explain how to reduce the risk.
Avoid heavy lifting, straining, and strenuous exercise until your surgeon approves, and prevent constipation and coughing where possible.
Go to an emergency department if the hernia becomes hard, painful or discoloured, cannot be pushed back, or if you have severe abdominal pain or repeated vomiting.