There are several classifications of hernias. Speaking of any of the varieties of this pathology, they mean protrusion of an internal organ or its fragment through natural or abnormally formed holes. Without treatment, any hernial masses can lead to serious consequences.
Causes of the disease
The formation of a hernia of the abdomen occurs due to weakening of the muscles. Congenital defects in the structure of the body often lead to the appearance of pathology. Various factors can provoke a problem. Most often, a hernia of the abdomen appears:
- after abdominal surgery on the abdominal organs at the sites of scar tissue formation;
- in the postpartum period due to stretching of tissues and weakening of the abdominal muscles in women;
- against the background of diseases of the gastrointestinal tract;
- in case of a sharp change in weight (gain or decrease in body weight);
- with an inactive lifestyle and lack of physical activity;
- due to age-related atrophy of muscle tissue.
Main symptoms
Tissues that protrude beyond the boundaries of their cavity, with time, are deformed and covered with a dense shell, due to which the hernia increases. The most common symptom that indicates the development of this pathology is a visually noticeable protrusion on the abdomen. It can resemble a tubercle, bump, swelling. With pressure and at rest, the formation can completely disappear, and with a minimum load, sneezing, coughing or during the act of defecation - increase in size.
Hernia of the abdomen
The classification of muscle mesh disorders in the form of pathological protrusion of fragments of internal organs is based on various criteria. First of all, formations are distinguished by localization. To date, the most common classification of hernias is known:
- inguinal;
- phrenic;
- umbilical.
Pathologies differ in the type of acquisition. Classification of a hernia of the abdomen implies a formation that is congenital, acquired or arising after surgery. The contents distinguish protrusions of a single-chamber and multi-chamber type. Doctors use other classifications of hernias, which are determined by the nature of the pathology and the frequency of relapses. Also hernia bags are:
- eligible;
- irreparable;
- infringed;
- perforated;
- causing intestinal obstruction.
Another type of hernia classification is based on the width of the hernia gate. This indicator is indicated as follows:
- if the hernia is up to 5 cm - W1;
- if 5-10 cm - W2;
- from 10 to 15 cm - W3;
- more than 15 cm - W4.
In the same way, the Latin letter R denotes relapse of the formation of a hernia, and the numbers next to the letter indicate what the recurrence is.
How to recognize a disease
Regardless of the classification, abdominal hernias in the early stages have one characteristic feature: during palpation of the abdominal wall, protrusion will be felt only when the abdominal muscles are tensioned. In moments when a person is completely relaxed, the formation disappears, but, despite this, the patient still experiences a pulling, aching pain at the site of the formation of the hernial sac.
If the patient suspected a hernia, do not postpone the visit to the surgeon. To confirm the diagnosis, you will have to undergo a medical examination, although an experienced doctor is able to determine the presence or absence of this disease with an accuracy of 99% at the first examination. By palpation, the surgeon probes the abdominal wall. The specialist may ask the patient to cough in order to detect a protrusion. The doctor determines the area of damage by tapping.
If the diagnosis is difficult, the surgeon will prescribe:
- blood tests;
- CT and ultrasound of the abdominal cavity;
- peritoneoentgenography;
- laparoscopy.
Features of umbilical hernia
The classification of hernias of the anterior abdominal wall includes pathological formations that have arisen in the umbilical region. For this disease, protrusion of the umbilical ring is characteristic. Umbilical hernias are congenital, that is, formed in utero, and acquired.
In newborns and babies in their first year of life, this problem is very common. Children, as a rule, are prescribed conservative treatment. The essence of therapy is to regularly carry out manipulations aimed at reducing the hernial sac. If the umbilical protrusion provokes serious complications or an extensive lesion is involved in the umbilical ring, an operation is prescribed.
Surgeons note a separate classification of hernias of the abdominal wall. So, for example, congenital protrusions can be embryonic or germinal. Hernias, which develop in adults, are divided according to the type of damage to the abdominal muscles. They are straight (implies a protrusion in the navel) and oblique, localized below or above the umbilical ring.
What is diaphragmatic hernia
The second name for this disease is a hiatal hernia. This type of disease is characterized by a shift in the abdominal organs (upper stomach, lower esophagus, intestines, spleen, left lobe of the liver, large omentum) to the diaphragm.
The classification of hernias of this type is created taking into account the type of origin. Diaphragmatic formations are traumatic and non-traumatic. In turn, the latter are divided into false ones, which appear when the diaphragmatic septum is underdeveloped, and true ones, which form in areas with low muscular tone. It is worth noting that with false hernias, the gap between the thoracic and abdominal regions does not overgrow, due to which subcutaneous fat or internal organ penetrates from one part to another. Unlike true, false hernias are not accompanied by the appearance of a hernial ring, therefore, cases of their infringement are extremely rare.
Thanks to the detailed classification of hiatal hernia, doctors are able to timely diagnose the patient and choose the right treatment for this hidden disease. Therapy, which is selected for patients with relapses, can vary significantly.
How inguinal hernias are classified
This type of disease, which is characterized by pathological protrusion of the peritoneum into the groin area, is more often found in boys. In adult men, inguinal hernia is not so common. One of the complications that protrusion leads to is damage to the inguinal canal and disorders in the genitourinary area.
All existing classifications of inguinal hernias are built according to a single system. Doctors distinguish oblique, femoral and direct types of protrusion. Depending on the type of hernia in the groin, it can be localized in the upper square of the inguinal region. At the initial stage, the back wall is not damaged. With an increase in the hernial ring, the formation drops lower, sometimes it reaches the scrotum.
What is the danger
In the presence of a hernia, the risk of developing peritonitis and necrosis always increases. This disease negatively affects the general condition, performance and activity of the patient. Inguinal hernia is dangerous for men with impaired reproductive and sexual health. The sooner a pathology is detected, the more likely it is that there will be no need for surgical intervention, and after therapy there will not be a trace of protrusion.
Protrusion after surgery
Any kind of abdominal hernia occurs as a result of a violation of the integrity of the muscle tissue of the abdominal wall. Pathology can develop as a result of abnormal formation of the internal organs of the fetus in the mother’s womb, trauma, damage to the muscle corset, muscle strain due to excessive physical exertion, especially with a sharp increase in weight.
A separate category includes postoperative (ventral) hernias. The classification of pathology, as such, is absent. There are protrusions:
- by localization (in the epigastric, masogastric, hypogastric, as well as mixed);
- by size (subtotal and total).
There is another classification of postoperative hernias. They are right-sided and left-sided, iliac and hypochondrium, pararectal and lateral.
Any abdominal surgery involves an incision in muscle tissue, after which the risk of protrusion increases. To minimize the risk of a hernia, modern medicine offers a lot of minimally invasive surgical methods, eliminating the need for long incisions.
Can there be a hernia after childbirth
If the baby was born naturally, and with the help of a cesarean section, his mother may develop a ventral hernia. The risk of pathology increases after an unplanned surgical intervention in the process of childbirth, involving the dissection of the abdominal muscles.
In order to prevent protrusion on the abdominal wall, all women after cesarean section should observe strict restrictions. In addition to the ban on lifting heavy objects, it is equally important to wear a postoperative bandage.
Conservative treatment
If the formation was detected at an early stage, the patient has good chances of solving the problem without surgery. Patients with large hernias are almost always prescribed surgery. In case of infringement of internal organs, the removal of education is carried out urgently.
As for conservative methods of treatment, they are mainly used to prevent complications, increase the size of the hernia and relieve symptoms. In addition, the intervention of the surgeon may be contraindicated for some patients due to various circumstances (old age, pregnancy, cardiovascular disease, etc.). In such cases, only conservative therapy remains the only treatment option.
Non-surgical methods for the treatment of hernias include:
- taking medication;
- measures aimed at stabilizing intra-abdominal pressure;
- diet correction;
- physical therapy exercises;
- wearing a bandage;
- massage.
Types of operation
None of the conservative methods for the treatment of hernia can get rid of it. Removal of protrusion is carried out surgically. An exception can only be umbilical hernia in a child under 5 years old. This type of pathology often disappears on its own. Other types of hernias per se do not disappear.
To remove a hernia of the abdominal wall or groin, hernioplasty is most often performed. There are three ways to perform such an operation:
- with tension - the hole that appears at the site of the remote protrusion is pulled together with its own tissues;
- without tension - synthetic implants are used to close the hole;
- combined method - implies the use of artificial mesh and patient tissue.
In addition, surgeons remove hernias by open, laparoscopic or endoscopic methods. The first option is considered traditional. An open operation is performed by cutting the peritoneum and removing the hernia. After the manipulation, an implant is inserted and the tissues are sutured. Large incisions are not required for endoscopy and laparoscopy. The surgeon makes only a few small punctures (up to 5 mm in size), and carbon dioxide is supplied to the abdominal cavity to form a working space. The operation is performed using a flashlight and a video camera that displays the image on the monitor.
Rehabilitation period
For full recovery after surgery, the doctor draws up an individual rehabilitation program for the patient. For several months, the patient should limit himself in physical activity and follow a diet. During the first few months, it is advisable to completely abandon sports.
In the first days after surgery, the patient is allowed only liquid and nonfat food: broth, light soup, kissel. As you recover, add eggs, low-fat meats and fish, vegetables, fruits to the menu. All dishes should contain a minimum of salt and spices. Under the strict prohibition of alcoholic beverages, coffee and soda.
If the restoration is normal, the sutures are removed a week after the operation. The patient is recommended to wear a bandage, which will help restore muscle tone of the abdomen. After another 3-4 months, you can gradually enter the minimum physical exertion, massage and breathing exercises into the rehabilitation program.