How to recognize a hernia?

A hernia is any displacement of an organ outside its natural cavity. This most often develops in the abdomen, back, neck or pelvic floor. What are the different types of hernia? What are the symptoms and how to treat them? Answers with doctor Grégoire Deroide, visceral and digestive surgeon and doctor Eric Plotkine, orthopedic surgeon.

What is a hernia?

Hernias, which refer to the displacement of part or all of an organ out of its natural cavity, are frequent phenomena. Abdominal hernias , for example, represent " one of the most performed operations in France in general and digestive surgery ", explains Doctor Grégoire Deroide, visceral and digestive surgeon.

" These are physiological muscular orifices that allow intra-abdominal content to pass. A hernia is anything that is a protrusion of a viscus or peritoneum, which lines the inside of the abdominal cavity, and which passes through an orifice muscle. It's the image of the contents passing through the container, or the inner tube coming out of the tire. "

With a risk: the strangulation of a viscus in the hernia sac . “ Everything inside the abdomen can come out into this new cavity that has been created and become strangled. ” The pain is intense and the hernia becomes irreducible. Strangulation can eventually lead to bowel obstruction . It's a surgical emergency.

The herniated disc , just as common in the population, designates " the issue of the material from the inside of the disc outside its ring, which is called the annulus ", explains doctor Eric Plotkine , orthopedic surgeon. compression of a nerve root "with, eventually but more rarely, a risk of paralysis . 

Other examples of hernia: pelvic floor hernia, more commonly known as organ descent or genital prolapse, or muscle hernia, which is found in particular in compartment syndrome .

Abdominal hernias

Hernias of the anterior abdominal wall 

The inguinal hernia

We find the inguinal hernia mainly in men, above the fold of the groin. “ The orifice that allows the testicle to pass makes it a much more important element of weakness in men ,” explains Dr. Deroide. Currently, it is the treatment of inguinal hernia in men that is most common. “ The hernia repair with placement of a plate under laparoscopy on an outpatient basis is the most common procedure. ”

crural hernia

More common in women, it appears below the fold of the groin. " In the inguinal and crural region, between the anterior superior iliac spine and the pubis, there is the crural arch which passes above the iliac vessels, which go to the lower limbs. This crural arch delimits the crural hernia of the woman and the inguinal hernia of the man. In the woman, the point of weakness is therefore located rather under the crural arch, inside the vessels. "

The umbilical hernia 

Umbilical hernia is more common in women and newborns. It is located at the level of the navel. “ The navel is the weakest point of the anterior abdominal wall. It's the scar of the umbilical cord, so it's an area where the separation of the muscles is somewhat physiological. There may be a non-closure of the navel, which explains in particular umbilical hernias in very early children. ”

Other types of abdominal hernia

Epigastric hernia or white line hernia

Epigastric hernia, also called white line hernia, most often affects women, especially during postpartum . " The white line is the part between the navel and the xiphoid appendix (lower part of the sternum) where the two rectus abdominis muscles are united by white fibers , explains Dr. Deroide. This white line runs in the area which is called epigastric, which is above the navel and in front of the stomach. It can be the site of hernias in particular because the white fibers which unite the muscles are distended by the hormonal impregnation of pregnancy. "

Postoperative hernia 

We also speak of disembowelment . " Insofar as one makes an incision in the belly through muscles or white fibers which are called aponeuroses , or one performs an operation to place the camera at the level of the navel for an operation of the gallbladder or appendicitis for example, there is a small scar which can let go ", specifies the surgeon. 

Diaphragmatic hernia, including hiatal hernia

Hiatal hernia is the most common type of diaphragmatic hernia. It is characterized by the passage of part of the stomach into the esophageal orifice of the diaphragm. The diaphragm is the muscle that sits between the chest and the abdomen. Hiatal hernias are more common in older people.

Symptoms of abdominal hernias

Abdominal hernias have almost all the same symptoms: they are manifested by “ a small ball which is impulsive, reducible to coughing ” , explains Dr. Deroide. That is to say that when you touch, you feel the ball which swells under the skin, in front of the muscles, and it comes out with the effort because you put more pressure in your abdomen. “The diaphragmatic hernia is mainly characterized by gastroesophageal reflux .

A sometimes difficult diagnosis

The diagnosis, which is based on the history and clinical examination supplemented by imaging if necessary (ultrasound and scanner), can be difficult in two cases:

• In obese patients: " there is a skin thickness which makes the hernia more difficult to feel and suddenly it will grow a lot before being palpable. There are therefore larger hernias which appear in these people On the other hand, if the cavity is larger, the orifice is often wider and therefore there is a greater risk that there are digestive structures in it, which is much more difficult to repair. the smaller the hernia, the easier it is to repair. ”
• In women in the case of crural hernia: " it is located next to the pubis, a little in the fat. If the hernia does not come out or is not palpable, it is very difficult to diagnose. "

Treatment of abdominal hernias

Faced with the symptoms of an abdominal hernia, the patient, after seeing his general practitioner, is sent to a specialist: the general and digestive surgeon. The treatment of abdominal hernias is indeed exclusively surgical . " It is based on the dissection of the hernia sac , explains Dr. Deroide. You have to completely resect this neo-cavity which has formed outside the abdomen and bring in the fat that comes out because it is often accompanied of what is called the hernial lipoma. Then you have to sharpen the edges of the muscle or the edges of the aponeuroses and close with thread, or interpose a soft prosthetic material that is called a plate. "

Herniated discs

Lumbar disc herniation

Lumbar disc herniation results in back pain that may be accompanied by radiculalgia , the pain of sciatica .

Cervical disc herniation

Cervical disc herniation causes pain in the neck that can radiate into the arm: in this case, we speak of cervico-brachial neuralgia .

Symptoms of Herniated Discs

Many herniated discs are asymptomatic: " If we did an MRI to everyone, we would find lots of small protrusions , says Dr Eric Plotkine. But there is still a difference between the disc protrusion and the real herniated disc : the first corresponds to a somewhat degenerative disc which, under the pressure of the vertebra above, bulges backwards .

The herniated disc is thus characterized by " pain in the spine, whether neck pain or low back pain . This pain is generally mechanical, unlike inflammatory pathologies which are nocturnal: it occurs during effort, the standing position. ” She is “ impulsive, coughing or defecating ”.

Risk factors for herniated discs

The carrying of heavy loads and the practice of certain traumatic sports for the back are risk factors for herniated disc. " It is also decompensated in people who have muscle loss, adds Dr. Eric Plotkine:  the back holds less well, suddenly, the simple fact of sheathing, for example, can make the pain of the herniated disc go away. "

Diagnosis and treatment of herniated discs

The diagnosis is made on clinical examination. “ We think of a herniated disc when there is radiculalgia , explains the orthopedic surgeon. In 90% of cases, the pain subsides in a few weeks under medical treatment and there is no need for additional examinations. “Medical treatment consists of taking analgesics or anti-inflammatories and losing weight if necessary.