Hernia

Overview

A hernia happens when an internal organ or tissue pushes through a weakened muscle or surrounding tissue area. Hernias typically form between the chest and hips. In many instances, they may not cause noticeable symptoms, but you might observe a bulge or swelling in the abdomen or groin^[1].

Causes of Hernia

A hernia happens when a weakness or an existing opening in the muscle or connective tissue allows an organ or other tissue to protrude through it. While this weakness or opening can be present from birth, it typically develops over time. It may result from a traumatic injury or surgery, but more often, it is caused by repetitive stress. Over the years, constant pressure or strain can weaken the tissue, leading to a hernia^[2].

Types of Hernia

• Inguinal: An Inguinal hernia is the most prevalent type, making up 75% of all hernia cases. They primarily affect men or individuals assigned male at birth (AMAB). This type of hernia occurs when a portion of the bowel pushes through into the inguinal canal, which runs along the inner thigh^[2].
• Hiatal Hernia: A hiatal hernia is another frequently occurring type typically developed during adulthood. It occurs when the opening in the diaphragm where the oesophagus passes through becomes enlarged, causing the upper part of the stomach to push through into the chest cavity^[2]. 
• Femoral Hernia: A femoral hernia is a less common type of groin hernia that develops in the femoral canal, located just beneath the inguinal canal. In this condition, fatty tissue may protrude through the canal^[2]. This type of hernia is relatively rare, making up just 3% of all hernia cases and approximately 6% of all groin hernias. Due to the potential for serious complications, surgical repair is usually required for femoral hernias^[3].
• Umbilical hernia: An umbilical hernia happens when a portion of the intestine pushes through an opening in the abdominal muscles near the belly button (navel). These hernias are common and are usually not harmful. Umbilical hernias are most often seen in infants, though they can also occur in adults. In infants, the hernia is particularly noticeable when the baby cries, causing the belly button to bulge. This protrusion is a classic sign of an umbilical hernia^[4]. 
• Ventral HerniaL A ventral hernia refers to any hernia that occurs through the front (anterior) wall of the abdomen, which includes both umbilical and incisional hernias. An "epigastric hernia" is a specific type of ventral hernia that occurs just above the belly button^[2].
• Diaphragmatic: Diaphragmatic hernias are considered internal hernias because they are not visible from the outside. In severe cases, the herniated stomach can put pressure on chest organs, including the lungs and heart. These hernias can be congenital, meaning they are present at birth and may be detected in infancy or later in life, or they can be acquired, occurring due to trauma or as a complication from a medical procedure^[5]. 

Signs of Hernia

• Bulge that Changes Size: A visible bulge that may shrink or disappear when lying down, but tends to grow more prominent over time as the abdominal muscle wall weakens.

• Burning, Gurgling, or Aching Sensation: A discomforting feeling around the bulge, often described as a burning, gurgling, or aching sensation.

• Dragging, Weakness, or Pressure: A sensation of dragging, weakness, or pressure at the site of the hernia, often felt when standing or engaging in physical activity.

• Discomfort or Sharp Pain with Physical Strain: Pain or discomfort, particularly when straining, lifting, coughing, or exercising.

• Swelling in the Scrotum (Inguinal Hernia in Males): In men, an inguinal hernia may cause swelling or enlargement of the scrotum.

• Abdominal Pain: Persistent or sharp pain in the abdomen, often linked to the herniated area.

• Nausea or Vomiting: This could indicate a more serious issue, such as a blocked intestine, especially if accompanied by other digestive symptoms.

• Burping, Heartburn, or Indigestion (Hiatal Hernia): Other signs like burping, heartburn, or indigestion are common in cases of a hiatal hernia, due to stomach acid entering the chest.

• Bloating: Abdominal bloating or a feeling of fullness that may accompany a hernia, especially those in the abdominal region.

• Constipation: Difficulty with bowel movements or changes in stool consistency, often seen with certain types of hernias.

• Asymptomatic or Breathing Issues (Diaphragmatic Hernia in Newborns): Some diaphragmatic hernias may not show symptoms, but in newborns, poor diaphragm movement and lung development can lead to breathing problems and oxygen deficiency. This includes:

  • Difficulty breathing
  • Rapid breathing
  • Increased heart rate
  • Loss of appetite
  • Blu-ish skin (cyanosis) due to low oxygen levels^[5]. 

Hernia and TCIH Approaches

• Yoga: Yoga has shown promise in alleviating the discomfort associated with hernias, particularly inguinal hernias. A 2012^[6] study involving 19 adult males explored the effects of specific yoga poses, such as Vajrasana (diamond pose), on hernia symptoms. After three months of consistent practice, participants reported a significant reduction in pain and a decrease in the frequency and intensity of symptoms.
• Osteopathic Manipulation Therapy: Osteopathic Manipulation Therapy (OMT) offers another natural approach to treating hernia-related symptoms. Osteopathic physicians, who specialize in the musculoskeletal system, use hands-on techniques to promote healing and enhance bodily functions. A 2022^[7] case study demonstrated how OMT could help a patient with a hiatal hernia (a condition where part of the stomach pushes up into the chest cavity) experience relief from gastrointestinal symptoms and potentially reposition the gastroesophageal junction. The study showed that after a series of osteopathic treatments, the patient's symptoms improved significantly, with no further signs of the hernia or related dysfunctions.
• Physiotherapy: Physiotherapy can help alleviate hernia symptoms and reduce the risk of further issues by focusing on several key areas. The primary goal is to reduce pressure on the affected tissue, which may involve improving breathing mechanics. Strengthening the supporting muscles, particularly through deep core exercises, is another essential component. Physiotherapists may also apply compression support to provide additional stability. Additionally, they work to identify and minimize activities that aggravate the hernia, while gradually reintroducing safer movements to promote healing and prevent recurrence^[8]. Post-operative physiotherapy can aid in recovery following inguinal hernia repair. Techniques such as core stability exercises and hydrotherapy are employed to strengthen lower abdominal muscles, enhance mobility, and expedite return to daily activities^[9]. 
• Chiropractic Care: Chiropractic interventions have been explored for managing hiatal hernia symptoms. Adjustments aimed at realigning the stomach and diaphragm may alleviate discomfort associated with hiatal hernias. However, it's important to note that while some individuals report symptom relief, these methods do not address the anatomical defect causing the hernia^[10]. 
• Acupuncture: Acupuncture, a component of Traditional Chinese Medicine (TCM), is sometimes utilized to manage hernia-related discomfort. By targeting specific acupoints, acupuncture aims to restore the flow of Qi (energy) and alleviate pain. While some practitioners advocate for its use in inguinal hernia cases, comprehensive clinical evidence supporting its efficacy remains limited^[11]. 
• Naturopathic Approaches: In the context of hiatal hernias, naturopathic treatments have been considered. An article in the Naturopathic Doctor News and Review discusses the recognition and management of hiatal hernia syndrome, highlighting non-surgical techniques that may provide relief^[12].