Hernia

What is a Hernia?

A hernia occurs when tissue, such as fat or part of an intestine, pushes through a weak area in the surrounding muscle or connective tissue. Abdominal wall hernias commonly develop in the groin, around the navel or at the site of a previous surgical incision.

A hernia may be present from birth due to a weakness in the abdominal wall or develop later due to a combination of tissue weakness and increased pressure inside the abdomen. Depending on its location and contents, the bulge may sometimes move back into the abdomen when a person lies down or with gentle pressure.

What are the Types of Hernia?

Hernias are categorised based on their locations and development process. They include:

How Common is a Hernia in India?

The incidence of hernia is very high in India. As per a study, about 1.5 to 2 million people in India suffer from inguinal hernia, and inguinal hernia repair is one of the most commonly performed surgeries in the country. Another study from a rural medical college in central India reported abdominal wall hernias in 10.1% of the surgical outpatient population in the study group. Moreover, groin hernias comprised about 80% of the studied cases.

Ageing can increase the risk of hernias, as tissues may weaken over time. Hence, the elderly population in India is vulnerable to hernias.

What are the Symptoms of a Hernia?

Hernia symptoms vary according to its type, location and whether complications develop. A common sign is a visible or palpable bulge that may become more prominent when coughing, standing or straining and may reduce when lying down.

Symptoms of a hernia may include:

Diseases Similar to Hernia

People can easily mistake a hernia for other illnesses like hydrocele and enlarged lymph nodes, as all these diseases have an observable lump in the groin area. Nonetheless, these diseases have differences in how they are formed, what location they affect, the symptoms that accompany them, and the common treatments they require.

The following table is a comparison that can be useful in differentiating these illnesses:

Hernia vs. Hydrocele vs. Enlarged Lymph Nodes

What Causes Hernia?

A hernia usually develops when there is a weakness in the muscle or connective tissue, combined with increased pressure inside the abdomen. The weakness may be present from birth or develop over time. The common causes of hernia are as follows:

• Abdominal wall weakness: A weak area in the abdominal wall can allow tissue to push through.

• Congenital weakness: Some hernias develop because an opening or weakness present from birth does not close properly.

• Previous abdominal surgery: Surgery can weaken the abdominal wall and lead to an incisional hernia.

• Heavy lifting: Repeated or strenuous lifting can increase pressure inside the abdomen and contribute to hernia formation in a susceptible abdominal wall.

• Chronic coughing: Frequent coughing repeatedly increases pressure inside the abdomen.

• Chronic constipation: Repeated straining during bowel movements can increase abdominal pressure.

• Pregnancy: Pregnancy can place additional pressure on the abdominal wall.

• Obesity: Excess abdominal fat can increase strain on areas of weakness.

• Ageing: Age-related weakening of muscles and connective tissues can increase the risk of hernia.

What are the Risk Factors of Hernia?

Most hernias do not cause serious problems initially. However, a hernia can sometimes become trapped or restrict the blood supply to the tissue inside it. Common risk factors of hernia are as follows:

• Incarceration: The herniated tissue becomes trapped and cannot be pushed back into the abdomen.

• Strangulation: The blood supply to the trapped tissue becomes restricted, making it a medical emergency.

• Intestinal obstruction: A hernia containing part of the intestine can sometimes obstruct the passage of bowel contents.

• Pain: An incarcerated or strangulated hernia may cause severe or sudden pain.

• Tissue damage: Prolonged loss of blood supply can damage the trapped tissue.

• Recurrence: A hernia can recur after surgical repair.

• Post-surgery complications: Hernia repair can occasionally be followed by complications such as infection, bleeding or persistent pain.

When Should I See a Healthcare Provider?

You should schedule a medical check-up if you discover a newly developed lump or swelling in the abdomen, groin, or navel region. Seek immediate medical care in case of:

• Intense or acute pain: The pain caused by the hernia intensifies.

• Rapid swelling: The swelling increases in size.

• Irreducible bulge: If there is an irreducible bulge, this means that the bulge does not reduce its size when you lie down as it used to be.

• Change in skin colour: There is a change in skin colour at the hernia area; this could be redness.

• Nausea/vomiting: There is nausea or vomiting with hernia pain.

• Abdominal distension: You have abdominal distention along with abdominal pain.

• Obstruction/stool and gas: You cannot pass stool or gas.

These signs may indicate obstruction or strangulation of the hernia and require prompt medical assessment.

How is a Hernia Diagnosed?

The tests doctors use to diagnose a hernia are as follows:

Diagnostic Summary Table

How is Hernia Treated and Managed?

Hernia treatment is based on the type and size, associated symptoms, and overall health of the patient. The various treatment methods for managing hernia include:

Common Medicines Used to Treat Hernia

Medicines cannot repair the weakened abdominal wall or make an abdominal wall hernia disappear. They may, however, help manage associated symptoms such as pain, constipation or acid reflux related to a hiatal hernia. Medicines should be used according to medical advice. Common medicines used to treat hernias are:

• Paracetamol: May be used to manage mild pain when considered appropriate by a healthcare professional.

• Laxatives or stool softeners: Medicines such as polyethylene glycol or lactulose may help manage constipation and reduce straining during bowel movements.

• Antacids: Medicines containing compounds such as calcium carbonate or magnesium hydroxide may provide temporary relief from heartburn.

• H2 receptor blockers: Medicines such as famotidine reduce stomach acid and may help manage reflux symptoms associated with a hiatal hernia.

• Proton pump inhibitors (PPIs): Medicines such as omeprazole, pantoprazole, esomeprazole and lansoprazole reduce stomach acid and may be used to manage reflux symptoms.

Note: Hernia is managed based on the type, size, symptoms, and general well-being of the patient. Drugs might assist in managing the symptoms associated with the hernia, but will not cure the problem itself. There is a need to undergo surgical management of the condition when it is symptomatic or complicated.

Living with Hernia: Daily Challenges, Caregiving and Expenses

Living with a hernia can cause discomfort and may affect daily activities, especially when symptoms worsen or surgery is required. Some critical challenges and care points include:

What is the Prognosis for Hernia?

The prognosis for a hernia is generally favourable when it is diagnosed and managed appropriately. Small hernias that do not cause symptoms may sometimes be monitored by a healthcare professional. However, a hernia usually does not repair itself, and some may increase in size or become symptomatic over time.

The outlook depends on the type and location of the hernia, its size, symptoms and whether complications such as incarceration or strangulation develop. Hernias that become trapped or lose their blood supply require urgent medical attention.

How Can I Prevent Hernia?

Not every hernia can be prevented, particularly those related to congenital weaknesses. However, you can reduce some factors that increase abdominal pressure. The common practices that may help prevent hernia are as follows:

• Maintain a healthy weight: Excess abdominal pressure may increase strain on the abdominal wall.

• Prevent constipation: Eat enough fibre and drink adequate fluids to reduce straining.

• Treat chronic cough: Seek medical care for a persistent cough.

• Use proper lifting techniques: Avoid sudden or excessive lifting and use appropriate techniques.

• Avoid unnecessary straining: Do not repeatedly strain during bowel movements or physical activity.

• Stop smoking: Smoking can contribute to chronic coughing, which increases abdominal pressure.

• Follow surgical advice: Follow your healthcare provider's instructions after abdominal surgery.

• Stay physically active: Regular activity can support overall muscle health without excessive strain.

Hernia Disease Treatment Cost in India

The cost of hernia treatment in India varies depending on the type of hernia, procedure used, hospital, city, length of hospital stay and whether complications occur. The overall expense may also vary depending on whether the treatment is paid for through a government health scheme, health insurance or out-of-pocket.

The average cost of umbilical hernia repair is approximately ₹82,132. On the other hand, the average cost of inguino-femoral hernia repair is approximately ₹63,085. Take a look at the cost of various treatment components of hernia in the table below:

Does Health Insurance Cover Hernia?

Yes, health insurance covers the cost of hospitalisation and surgery required to treat a hernia, subject to the terms and conditions of the policy. Depending on the policy, coverage may include:

• In-patient hospitalisation for medically necessary hernia surgery

• Diagnostic tests conducted during covered hospitalisation

• Medicines and medical supplies used during covered hospitalisation

• Pre and post-hospitalisation expenses

• Day care expenses incurred during the hernia procedure

The exact coverage may vary from one policy to another. Besides, outpatient consultations, diagnostic tests and pharmacy will be covered only if the policy has an OPD cover.

A hernia may be subject to a specific waiting period under a health insurance policy that may range from 1 year to 36 months. If a hernia existed before the policy began, it will be considered a pre-existing disease and a pre-existing disease waiting period of up to 3 years will apply.

Make sure to read the policy document carefully to know about the inclusions, exclusions, waiting period, sub-limits, co-payment and other details.

How Much Health Insurance Coverage is Needed for Hernia Treatment?

The requirement for health insurance coverage for the treatment of a hernia will depend on the type of hernia, the treatment process adopted and the hospitals and cities in which you plan to get treated. Health insurance coverage of about ₹5 to 10 lakh may be considered as the average requirement for hospitalisation and surgery for a hernia.

If you have some other ailments, need a more complex surgery or have risks of complications, then a health insurance cover of at least ₹15 to 20 lakh may prove to be useful. You must compare various health insurance policies to pick the right one as per your requirements.