107 Hernia 49 Definition Bulge or protrusion of soft tissue that forces its way through or between muscles. Hernias may be congenital, resulting from the failure of certain structures to close after birth, or ac- quired later in life as a result of obesity, muscular weakness, surgery, illness, chronic cough, chronic constipation with straining, or lifting heavy objects. Hernias can occur in many parts of the body but are most common in the abdominal wall. The different types of hernias in- clude abdominal, diaphragmatic, femoral, hiatal, inguinal, and umbilical. Abdominal hernia: Loop of bowel protrudes through the abdominal musculature, often through the site of an old surgical scar. Diaphragmatic hernia: Protrusion of part of the stomach through an opening in the di- aphragm, most commonly in abnormally enlarged esophageal hiatus. The enlargement of the normal opening of the esophagus may be caused by trauma, congenital weakness, increased abdominal pressure, or relaxation of ligaments of skeletal muscles, and permits part of the stomach to slide into the thorax. Femoral hernia: Loop of intestine descends through the femoral canal into the groin. Hiatal hernia: Protrusion of a portion of the stomach above the diaphragm. The major diffi- culty in symptomatic patients is gastroesophageal reflux, the backflow of the acid contents of the stomach into the esophagus. Reflux may lead to heartburn 1–4 hours after eating, sub- sternal distress, dysphagia, or gastrointestinal bleeding. Inguinal hernia: Loop of the intestine enters the inguinal canal, sometimes filling the entire scrotal sac in the male. Surgical repair is recommended in almost every instance. This is the most common (75–80 percent) of all abdominal hernias, and recurrence is the most com- mon long-term complication of inguinal hernia repair. Umbilical hernia: Soft, skin-covered protrusion of intestine and omentum through a weak- ness in the abdominal wall around the umbilicus. Characteristics Usually the only symptom of a hernia is a bulge or swelling and may be accompanied by a dull sensation. The bulge usually appears gradually over several weeks, but occasionally it forms suddenly from any condition that increases intra-abdominal pressure such as cough, sneeze, or overexertion. A feeling of heaviness or slight tenderness may be felt at the site. Risks from hernias include obstruction, strangulation, and bowel perforation, which require immediate medical treatment. Most people with reducible hernias are asymptomatic or complain of only mild pain. People with strangulated hernias have colicky abdominal pain, nausea, vomiting, abdominal disten- tion, and hyperperistalsis. Policy Evaluate employee in the occupational health unit for severity of the problem, work-related aggravation, and referral for medical evaluation and treatment.