American Medical Association Family Medical Guide - American Medical Association [495]
• A hernia that you cannot push back into place
• A hernia that is very warm, red, and swollen
Incisional Hernia
An incisional hernia can result from abdominal surgery if the cut abdominal wall muscles and fibrous layers do not heal properly, if the incision becomes infected, or if broken stitches cause defects in the abdominal muscle wall. Incisional hernias can range from small to large areas of weakness in the abdominal wall. You are more likely to develop an incisional hernia after abdominal surgery if you are inactive after the surgery, older, overweight, extremely underweight, or weak.
Hernias develop in many parts of the body but are most common in the abdominal wall. If a significant portion of an intestine has squeezed through the weak part of the abdominal wall, the contents of the intestine may be prevented from moving through the intestine, causing an intestinal obstruction (see page 759). If the blood supply to the intestine is cut off, the result is a condition called a strangulated hernia.
Symptoms
Usually the only symptom of a hernia is a bulge or swelling. The bulge usually forms slowly over several weeks, but it can also appear suddenly. Other symptoms include a feeling of heaviness, tenderness, or aching at the site of the hernia. If the hernia has caused an intestinal obstruction, you will have symptoms such as nausea, vomiting, or increasing abdominal pain.
Diagnosis and Treatment
A doctor can usually diagnose a hernia through a physical examination. Most hernias can be treated temporarily by pushing the organ or soft tissue back through the weak point in the muscle wall and wearing a supportive device called a truss to keep the organ in place. However, surgery is usually necessary to treat a hernia permanently. A strangulated hernia or a hernia that causes an intestinal obstruction is a medical emergency and must be treated immediately. A surgeon will push the protruding muscle or tissue back into place and tighten the loose muscles (usually by sewing them together). A thin, meshlike piece of plastic is sometimes used to reinforce a weak muscle or a muscle that has been replaced by scar tissue from previous hernia surgery.
Types of Hernias
Inguinal hernia
In males, the inguinal canal is the opening through which the spermatic cord passes and eventually through which the testicles descend into the scrotum. Normally, it closes completely before birth. In an inguinal hernia, the opening does not close, causing part of the intestine to protrude into the canal.
Inflammatory Bowel Disease
Inflammatory bowel disease refers to disorders that cause recurring inflammation of the intestines. Crohn’s disease and ulcerative colitis are examples of inflammatory bowel disease. Crohn’s disease can occur in any part of the digestive tract but usually occurs in the intestines. Ulcerative colitis usually affects the large intestine and the rectum (but sometimes just the rectum). The cause of inflammatory bowel disease is unknown, but doctors think the inflammation may be an immune system response to a viral or bacterial infection. Neither disorder results from stress or from eating specific foods, although these factors can trigger symptoms in some people who have the disorder.
Inflammatory bowel disease tends to run in families and affects men and women in equal numbers. The inflammation may produce ulcers in the intestine and colon and scar tissue that thickens and narrows the intestinal wall, possibly causing an intestinal obstruction (see page 759). In ulcerative colitis, sores form where inflammation has killed cells in the intestinal lining. About 20 percent of people who have Crohn’s disease develop anal fistulas (abnormal channels from the intestine to the surface of the skin or other organs; see page 779). Fistulas can leak to the skin or other organs and cause peritonitis (see page 759). People who have inflammatory bowel disease, especially ulcerative colitis, have an increased risk of developing cancer of the intestine (see page 775).
Symptoms
The symptoms of