When people experience abdominal discomfort of all sorts they tend to immediately relate it to common food poisoning, stomach upsets or simple distension. However, this may not always be the case. If the pain involves weakness, pressure or a feeling of heaviness in the abdomen, a burning, gurgling sensation at the site of the bulge, it’s time to visit a doctor to rule out the likelihood of hernia.

Hernia occurs when an organ pushes through an opening in the muscle or tissue that holds it in place. For instance, intestines may break through a weakened area in the abdominal wall. Although this is common in the abdomen, it can appear in the upper thigh, belly button and groin areas. 

Dr Tharcisse Ngambe, a pediatrician at King Faisal Hospital, explains that both children and adults are prone to hernia and preventing it requires one to be conscious of any body protrusions.

"It starts with failure to close a hole that was initially being used for another purpose and it could be umbilical, inguinal, and inguinal-scrotal in the groin. Those are the main ones,” explains Dr Ngambe.

Telling it’s hernia

Hernias are of different types and normally are classified basing on their location in the body. Dr Ngambe adds that most hernias are identified depending on their position in the body.

According to US Mayo Clinic, an umbilical hernia occurs when part of the intestine protrudes through the umbilical opening in the abdominal muscles. These hernias are common in infants and are typically harmless. However they can affect adults as well. 

"Individuals should raise suspicion when infants start crying or show protrusions of the belly bottom,” explains Mayo Clinic.

Besides this type of hernia, a small portion of the bowel can bulge out through the inguinal canal or opening through the muscles of the abdominal (belly) wall into the groin. Such a bulge usually contains tissue lining the inside of the abdomen as well as fatty tissue from inside the abdomen. This is normally referred to as an inguinal hernia.

Sometimes, part of the stomach moves up through the hiatus and into the chest cavity which pushes the lower esophageal sphincter up into the chest cavity away from the hiatus to cause hiatus hernia. Hiatus hernia causes heartburn and gastro esophageal reflux disease.

On the other hand, a femoral hernia occurs when intestines enter the canal carrying the femoral artery into the upper thigh whereas an incisional hernia involves the intestines pushing through the abdomen at the site of a previous abdominal surgery.

Dr Leon Ngeruka, a specialist in minor surgery at Rwanda Military Hospital in Kanombe, explains that hernias are common in patients and sometimes are seen in areas around the groin.

"I see these patients once in a while but the good thing is that hernias are treatable,” says Dr Ngeruka.

He adds that medical consultation on seeing strange swellings is very essential in fighting hernia.

"People should at least endeavour to seek medical attention in case strange protrusions surface on their body,” he adds.

Global burden of hernia and its complications

Hernia International estimates that the lifetime risk for hernia stands at 27 per cent in men compared to only 3 per cent in women. Inguinal hernia is the commonest treatable surgical condition worldwide. Whereas untreated hernias kill 50,000 men each year in Africa, the organisation estimates that there are 6.3 million untreated inguinal hernias in sub-Saharan Africa with the highest prevalence being in rural areas.

Studies suggest that while most hernias may not immediately be life-threatening, they don’t go away on their own and could potentially require surgery as the bulge continues to cause a lot of discomfort.

Dr Rachna Pande, an internal medicine specialist at Ruhengeri Hospital, supplements these views explaining that chances for successful hernia surgery are high.

However, she points out that sometimes severe pain could result from obstruction in the blood flow.

"Part of the intestine can squeeze through an opening in a hernia, its blood supply can be cut off leading to strangulation or it may be obstructed due to sheer mechanical pressure,” explains Dr Pande.

She adds that certain lifestyle conditions and practices predispose individuals to hernia.

"Obesity, weakness of abdominal muscles as with old trauma, surgery, lifting heavy weights, chronic cough and constipation are some of the conditions which put stress on abdominal wall and can predispose one to hernia. Children can develop hernia due to congenital defects in openings of the abdominal wall or umbilicus,” she adds.

Although hernias are treatable, delayed management may result into complications.

According to studies the complication associated with hernia include; hematoma, urinary retention, bladder injury, and superficial wound infection. Even after repair, complications such as persistent groin pain, testicular complications, mesh infection, recurrent hernia and mesh migration and erosion may occur.

Studies presented by Dr Kevin Petersen last year during World Conference on Abdominal Wall Hernia Surgery in Milan, Italy, revealed that although the average pain patients before mesh removal is 8.4/10; it reduced to 2.6/10 after it was removed.

Hernia is curable but delayed treatment could result into complications. Other findings also warn of poor lifestyle habits such as smoking, alcoholism, low physical activity as predisposing factors to this disease.

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EXPERTS SHARE VIEWS

Eugene Habimana, a doctor at CHUKHernia can be managed conservatively by giving support to the affected part. A makeshift pad of thick cotton cloth can be put over a hernia to prevent its further exacerbation. Inguinal hernia belts are also available for this purpose. If hernia aggravates or bowel gets strangulated, surgery is the only option.

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Christian Bahati, a general practitionerOnce you have been diagnosed with the disease, changing your lifestyle is desirable. For instance, it’s advisable to limit the quantity of food one takes per day. On the other hand, after a meal one should always avoid bending since this may worsen the situation. However, keeping your body in a good health is also vital.

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Herondine Uwajeneza, a medical studentAvoiding smoking and foods with a lot of acid is important. A diet with a lot of spices is not good and should be avoided at any cost. If with these measures one still experiences severe pain, nausea and constipation, they should seek medical attention immediately as surgery may be needed.

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Daniel Gahungu, a general practitionerPeople with hernia should stop lifting of heavy objects and doing strenuous work as this may help in treating the symptoms. Lying on the stomach after eating is discouraged. It is essential to look out for the signs and symptoms early so that one can get medical attention before the hernia reaches a dangerous stage.

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Prince Rwagasore, a nurseAnyone with hernia should seek medical attention immediately before it develops into further complications. Patients suffering from it should also take in more water in order to prevent constipation, which can later aggravate hernia. Exercising is also helpful.