Everyone knows that an overstretched part will normally give way or tear or burst. For example an overblown balloon can burst at its weak point. Likewise, in our body, due to overstretching or weakness, any part can give/tear and simultaneous propulsion of internal parts happens through them. This pop up is called hernia. Hernia is a protrusion of internal organs through an abnormal opening. It can occur in any weak part of the body which allows the part to protrude.

Incidences and causes – Hernia may develop in any part of the body; however, it occurs most commonly in the abdominal walls. Any increase in intra-abdominal pressure contributes for hernia formations. The incidences of tear mostly coincide with weakness of abdomen after obesity, pregnancy, multiple deliveries, diseases of the abdomen which makes it bulge or weakens it. Likewise, strain in lifting heavy objects, strenuous coughing, strain while passing stool or urine, standing continuously for a long time, putting on weight can also initiate popping of hernia.

Hernial sites - Even though hernia can occur anywhere, the commonest hernial sites (weak spots) are inguinal region, femoral region, umbilical area, epigastric area and in diaphragm (which splits chest from abdomen). According to the site, nature of sac, contents, covering may differ from one place to another. Normally, skin, superficial fascia, ligaments and fatty tissues are the coverings.

Types – Hernia can be classified in a different way:

• Congenital – by birth i.e., development disorders
• Infantile – during infant stage due to weakness
• Senile – due to weakness in elderly persons
• Traumatic – due to injury or strain

Further, it can be classified as:

• Bulging
• Sliding

It can also be classified as:

• Reducible – which get back easily to original position
• Non-reducible – which will not get reduced due to strangulation or obstruction

According to region

• Inguinal
• Femoral
• Umbilical
• Epigastric
• Hiatus

Inguinal hernia - is the most common hernia occurring in the groin (the lowest part of abdomen or pot belly near the junction of thigh). Weakness, ageing, strain and pregnancy are the major precursors for this type of hernias. Inguinal hernia can be classified further into

• Incomplete hernia – hernia which has not reached the scrotum
• Complete hernia – hernia that has reached the scrotum
• Direct hernia – hernia that comes directly forward. This type is more common in aged people irrespective of sex. It is usually bilateral and small. It will usually respond quickly to direct pressure and even just by lying down.
• Indirect hernia – hernia that passes through inguinal canal are called indirect hernia. It can occur at any age but can be seen only in men and it will be mostly unilateral. When attempting for reduction, it usually goes back into the abdomen by receding upward, backward and laterally.

Femoral hernia – Even though it can occur in any sex, fat women above the age of 40, who have given birth to multiple children, are more vulnerable to femoral hernia. This type of hernia lies below the pubic tubercle whereas inguinal hernia lies above it. When attempting for reduction, it goes first medially, then backwards and then upwards.

Umbilical hernia - is also one of the commonest types of hernia occurring more commonly in infants irrespective of sex. This type of hernia protrudes through umbilicus. It commonly arises due to development defect, premature delivery and in children who cry a lot, who cough a lot, and who strain a lot at stool. In adults, weak umbilicus gives way to protrusion in obese and multi-para female.

Epigastric hernia – occurs in median line in epigastric region i.e. just in front of stomach Hiatal hernia – means protrusion of stomach into chest through diaphragm.

Incisional hernia – means hernia occurring at the site of surgical incision. It can be compared with worn out thread in the stitch. It occurs due to strain or improper healing.

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