What types of hernia are there?

A hernia occurs when part of the abdominal contents protrude through a weakened area, known as the fascia, or hole in the peritoneum (wall that supports the abdominal muscles). 

This abdominal failure is caused by increased pressure in the area, which affects the strength of the abdominal wall.

When a hernia occurs, organs and tissues are pushed through the hole that forms in the abdominal cavity, leading to the formation of a bulge.

Although hernias can be congenital, appearing at birth, in most cases they are caused by overexertion or health problems.

Normally, all hernias are caused by the same mechanism of action, but they are known by different names, depending on where in the body they develop:

• Inguinal hernia
  • Direct inguinal hernia
  • Indirect inguinal hernia
  • Femoral or inguino-crural hernia
• Ventral hernia or eventrations
  • Umbilical hernia
  • Epigastric hernia
  • Incisional hernia
• Hiatal hernia
• Herniated disc

Inguinal hernia manifests itself as a bulge in the groin area as a result of a failure of the abdominal wall. This type of hernia is more common in people who do heavy work or very intense physical activities.

Inguinal hernia can occur at any age, but is more common in adult men.

The main causes of this groyne condition include: overweight, pregnancy, chronic coughing or sneezing, straining when urinating, especially in men with an enlarged prostate or benign hyperplasia.

Inguinal hernias may be direct or indirect, depending on where they originate:

Direct inguinal hernia

In this case, viscera or abdominal contents enter through the ruptured abdominal wall, bypassing the inguinal canal and moving outwards. This type of hernia is always more common in men over the age of 40, due to ageing or injury.

Direct inguinal hernia is acquired, never congenital.

Indirect inguinal hernia

In this case, the loop of intestine presses against the inguinal canal which, due to a congenital defect, is at an increased risk of rupturing and causing the contents to prolapse, resulting in an inguinal hernia.

Unlike direct inguinal hernia, indirect inguinal hernia is a congenital defect and is as common in men as in women.

Femoral hernia

Femoral hernia, also known as crural hernia or inguino-crural hernia, is a protrusion in the groyne area, arising near the thigh, due to a weakening of the abdominal wall. It occurs in the upper part of the thigh, just below the groyne.

This hernia is susceptible to strangulation of the small intestine, as it is the small intestine that usually forms the protrusion (hernial sac). Surgical operation would therefore be almost obligatory and urgent, to repair the femoral hernia.

Unlike inguinal hernia, crural or femoral hernia is more common in women and can be very painful.

Ventral hernias occur in weakened areas of the abdominal wall, which is why they are also known as abdominal hernias, due to a medical cause, i.e. infection, vascular necrosis, etc. They can also occur as a result of trauma such as a surgical accident, etc.

In this type of hernia the sac is never peritoneal. It is a distended scar that simulates the peritoneum.

Thus, within ventral hernias, we distinguish:

• Umbilical hernia
• Epigastric hernia
• Incisional hernia

Umbilical hernia

Umbilical hernia develops at or near the navel due to congenital weakness. This type of hernia involves the prolapse of part of the protruding intestine through the opening in the abdominal muscles through which the umbilical cord passed before birth.

Although the umbilical cord disappears, leaving only a scar, the muscle area may be weakened. This, over time, can lead to failure of the abdominal wall, leading to the development of the hernia.

This type of hernia is very common and usually presents no risk. Although they can occur in infants, it is more common for them to develop in adulthood in an acquired form, albeit due to defective closure of the umbilical scar.

Infantile umbilical hernias usually close on their own between the first 2 and 5 years of life.

In adults, surgical intervention is more likely to be required to repair it.

Epigastric hernia

Epigastric hernia appears as a bulge in the upper abdomen between the sternum and the umbilicus. It occurs as a result of a weakness of the abdominal wall that allows internal tissues to leak through the wall.

This type of hernia is most common at birth. Although very similar to an umbilical hernia, an epigastric hernia forms between the navel and the chest.

Although the exact cause of an epigastric hernia is unknown, it is certain that it occurs when the tissues in the abdominal wall do not close completely during development. Thus, the increased tension between the epigastric region and the diaphragm would promote its occurrence.

The measures taken to prevent this type of hernia are: eat a healthy diet, avoid exerting yourself beyond your capabilities. In any case, if they arise, the specialist may recommend surgery.

Incisional hernia

Incisional hernia is the protrusion of abdominal contents through a surgical scar, occurring in or near the scar itself.

Incisional hernia occurs in 10-23% of cases after abdominal surgery.

The main cause is due to the failure of some stitches in the suture or nearby tissues. Thus, if the area is subjected to increased tension, or if the suture has become infected, or if you are obese, etc., there is an increased risk of this type of hernia occurring.

First of all, it is important to understand what the hiatus is and where it is located. The hiatus is a small hole in the diaphragm through which the oesophagus (food pipe) passes before it connects with the stomach.

Thus, hiatal hernia arises when there is a bulge of stomach tissue through the hole (hiatus). In cases where the hernia is minimal, symptoms are negligible. In fact, if you have such a hernia, you may not be aware of it unless you have a diagnostic medical check-up.

Conversely, if the hiatal hernia is large, you are likely to have heartburn. In cases where the hernia reaches a larger size, the specialist will refer you for surgery to treat the hiatal hernia.

A herniated disc is a problem that arises in one of the cartilaginous cushions located between the individual bones that form the spine. Each disc has a nucleus which, in some cases, protrudes outwards, due to a tear in the annulus,resulting in a herniated disc.

Thus, this type of herniation can occur anywhere in the spine and, depending on where it occurs, may cause symptoms such as pain, numbness or loss of outward movement in an arm or leg.

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• The American College of Surgeons. (2014, mayo). Hernia: Inguinal/Femoral. Recuperado de https://www.facs.org/~/media/files/education/patient%20ed/herniaespanol.ashx
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