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        A hernia occurs when the inside of the abdominal muscles are weakened, a bulge or tear becomes inevitable. In the same way as an inner tube pushes through a damaged tyre, the inner lining of the abdomen pushes through the weakened area of the abdominal wall to form a small balloon-like sac. This can allow a loop of intestine or abdominal tissue to push into the sac. The hernia can cause severe pain and other potentially serious problems like strangulation leading to emergency operation.

        Dr Rajinikanth MS, Minimal Access Surgeon (laparoscopy) attached to BM Hospital in suburban Nanganallur explains about hernia and treatment of the same. Both men and women are prone to hernia, which may be congenital or develop over a time.

        How does a patient know that he/she has hernia?

        The common areas where hernias occur are in the groin (inguinal), belly button (umbilical) and the site of a previous surgery (incisional).

        It is usually easy to recognise a hernia. One may notice a bulge on the skin. Pain could be felt when a heavy object is lifted or while coughing and on urinating and by bowel movement or on prolonged standing or sitting. The pain may be sharp and immediate or a dull ache that gets worse toward the end of the day. Severe, continuous pain, redness and tenderness are signs that the hernia may be entrapped or strangulated. These symptoms are cause for concern and immediate contact of your physician or surgeon is advised.

        What causes hernia?

        The wall of the abdomen has natural areas of potential weakness. Hernias can develop at these or other areas due to heavy strain on the abdominal wall, aging, injury, an old incision or a weakness present from birth. Anyone can develop a hernia at any age. Most hernias in children are congenital. In adults, a natural weakness or strain from heavy lifting of weights, persistent coughing and difficulty with bowel movement or urination can cause the abdominal wall to weaken or separate.

        Treatment options:

        There is no acceptable non-surgical medical treatment. The use of hernia belt can help keep the hernia from bulging further but eventually will fail. The belt also causes the formation of scar tissue around the hernia making the repair more difficult. If one suspects that he/she has hernia the only option is to contact his/her physician.

        The doctor warns that 'delayed hernia repair can result in intestinal incarceration (intestine getting trapped inside the hernia sac) or strangulation - intestine getting trapped and gangrene developed and finally could be fatal.'

        Surgical repair can be done and there are two main options and they are open repair and minimally invasive (laparoscopic) repair. In the former one 5-10 different approaches are adopted routinely with local and intravenous sedation. Due to larger size of the incision, open hernia repair is generally painful with a relatively longer recovery period.

        And in the latter case minimally invasive (laparoscopy) repair which developed over the past decade, is performed under general anesthesia but spinal anesthesia is also another option. Local anesthesia can be used under special circumstances. Laparoscopic approach has several advantages: Tension- free repair, less tissue dissection and disruption of tissue planes, less pain post- operatively, low intra-operative and postoperative complications and early return to work.