John Frazier, age 15, of Camden, N.J., for his question:
HOW IS A HERNIA TREATED?
A hernia is the protrusion of an organ or part of an organ or other structure through the wall of the cavity that normally contains it. Hernias, incorrectly called ruptures, are qualified by the name of the part that protrudes or the area through which protrusion occurs. Treatment varies with the type of hernia but usually involves surgery.
An inguinal hernia, perhaps the most common form, is one that passes through the abdominal wall in the groin area. A diaphragmatic or hiatus hernia is one in which part of the stomach or a loop of the intestine herniates upward through an opening in the diaphragm into the chest cavity.
An umbilical hernia is one in which the bowel or the membranous apron overlying it, known as the omentum, protrudes through the abdominal wall under the skin at the navel.
Inguinal hernia may be present at birth. In some male babies, the inguinal canals, the passages for the blood vessels and the supporting ligaments that belong to the testicles, are fairly large. When the baby cries, a part of the intestine may slip into the canal making a lump in the groin. The lump generally will disappear when the child is lying quietly on his back. Such hernias do not require immediate repair, since they sometimes correct themselves.
A persistent inguinal hernia in an older boy, or one that occurs as a result of strain in later life, is usually corrected by surgery.
Inguinal hernia can occur in females but is much less frequent than in males.
Hiatus hernia may cause heartburn. Surgical repair is possible but not usually necessary.
In adults, umbilical hernia may result from childbirth. Like other hernias, this one can be caused or aggravated by any condition that causes increased pressure inside the abdomen.
There is, however, no danger of strangulation. But people of an age to be concerned about their appearance in bathing suits or swim trunks will probably wish to have the defect repaired.
Hernias often develop in an area of weakness following unusual stress or strain. An inguinal hernia, for example, may follow the abrupt lifting of a heavy object or a severe bout of coughing.
The idea that a hernia is the protrusion of a loop of intestine through an actual break or tear in the abdominal wall is somewhat misleading. The muscular abdominal wall has many openings for blood vessels and ligaments. If these openings are unusually large, or if pressure inside the abdomen is increased, as by lifting heavy objects, straining, or coughing, part of the intestine may slip through.
The hernia effect is rather like that of poking a gloved finger between the treads of a rather loosely woven cloth. The fibers are stretched but not torn.
Women who have borne children are likely to have small vaginal hernias. These do no particular harm but are often blamed for all sorts of vague symptoms, such as minor backaches, headaches and general nervousness.