The lowdown on hernias

MALAYSIA - The word 'hernia' may sound like an exotic animal. In truth, it is a rather unappealing condition that occurs when an internal part of the body (for example, the intestines) juts through a weakness in the muscle or surrounding tissue wall.

"Do you smell what The Rock is cooking?"

We didn't, but we hear it was a brew of three hernias. It all started last April, when the semi-retired pro wrestler turned movie star got back into the ring to take on his famous arch-nemesis, John Cena at WrestleMania29.

The Rock (better known as Dwayne Johnson these days) subsequently lost the title match, and sustained injury in which his abductor tendon and rectus tendon was completely torn off his pelvis.

Not only did the assault get his wrestling shorts into a twist, the 41-year-old later told the media that they discovered he had "three wonderful hernia tears".

His condition prompted an emergency operation that forced the actor to miss the L.A. premiere of his action flick, Pain and Gain, an adage the actor appears to have taken to heart.

He later tweeted: "Saw my Dr who had to push my intestines back thru the tear in my abdomen. Kinda romantic. Surgery is next week. #BringItOn."

The actor has since recovered, telling fans in a separate tweet: "Surgery a success. Superman is on the mend."

Most of us will probably never come close to competing in a wrestling ring, or wearing a pair of super short wrestling shorts, but hernias are more common than we think.

Many people do not realise they have a hernia as hernias tend to be asymptomatic.

According to the UK's National Health Service, about one in four men, and three in every 100 women will have an inguinal hernia at some point in their lifetime.

What's a hernia?

A hernia occurs when an internal part of the body (the intestines) protrude through a weakness in the muscle or surrounding tissue wall. These muscles are typically strong enough to keep the organs in place. However, a weakness may cause a hernia to occur.

There are several types of hernia. Which type of hernia you have depends on where it is:

Inguinal hernia

Inguinal hernia is a bulge in the groin. It is the most common type of hernia, and accounts for three out of four of all hernia cases.

Inguinal hernia is more common in men and may go all the way into the scrotum. Approximately 90 per cent of all inguinal hernia repairs are performed on males.

The condition occurs mostly in men simply due to the nature of the male anatomy, says surgeon Dr Tee Shin Shan. "The absence of testicles in women make them less prone to developing an inguinal hernia," he notes.

Besides gender, other risk factors for inguinal hernias include ageing and being obese - having a body mass index (BMI) of 30 or above. "The reason for this is because the musculature system in an obese person tends to be weak, making it easily 'stretchable' compared to a healthy person, whose muscles are tighter and more compact," Dr Tee explains.

People who engage in regular and/or excessive heavy lifting activities are also more prone to developing hernias. "This is due to an increase in intra-abdominal pressure, which puts a strain on the abdominal muscles," he adds.

"Someone like The Rock will likely have a strenuous and regular workout routine that involves a lot of heavy lifting, which could have contributed to his hernia."

Conversely, while it is conventional knowledge that maintaining a regular weight-training regime can help to improve muscle strength and tone, Dr Tee opines that most people tend to focus on strengthening the larger muscle groups such as the back, arms, chest and legs. "Hernias usually occur in smaller areas, such as the pelvic muscles, which are not usually targeted."

Sometimes, hernias occur with repeated straining while using the toilet, with long-term coughing, or any activity that raises the pressure inside the abdominal region.

Femoral hernia

Femoral hernia is a bulge in the upper thigh, just below the groin. This type of hernia, though rare, is almost exclusive to women because of the wider bone structure of the female pelvis. Ageing and pregnancies increase a woman's risk of developing a femoral hernia, says Dr Tee.

Other types of hernia include:

Hiatal hernia, which occurs in the upper part of the stomach. Part of the upper stomach pushes into the chest.

Incisional hernia can occur through a scar if you have undergone abdominal surgery in the past.

Umbilical hernia appears as a bulge around the belly button. This type of hernia occurs when the muscle around the belly button doesn't close completely.

What causes a hernia?

Usually, there is no obvious cause of a hernia. "Hernias tend to develop over a period of time, and likely as a result of regular and prolonged activity - such as coughing or heavy lifting - that may have caused the muscles to weaken," Dr Tee points out. "It doesn't occur from a one-off incident."

Hernias may be present at birth, but the bulge may not become apparent until later in life.

Babies and children can get hernias. About five out of 100 children have inguinal hernias, though some may not experience symptoms until they are adults.

Lifestyle habits or medical problems that increases one's likelihood of getting a hernia include smoking, overexertion, poor nutrition, and undescended testicles.

There are usually no symptoms, though some people experience swelling and pain. Dr Tee describes the pain as a "dragging or tugging sensation. It is not a sharp pain, but it may get worse when you stand, strain your muscles or lift something heavy."

In time, most people will complain about a bump that is sore and growing.

If a hernia gets bigger, it may get stuck and lose its blood supply. This is called "strangulation". If this happens, you will require immediate medical treatment.

Fixing the hernia

Currently, surgery is the only treatment that can permanently get rid of a hernia.

Dr Tee describes it as a minor surgery that works to secure the weakened abdominal wall tissue (fascia) and close up any holes. "Basically, we are putting in a sort of mesh to strengthen the walls of the muscle. It's like putting cement to a wall to strengthen it," says Dr Tee.

Today, most hernias are closed with "cloth" patches to plug up the holes.

Hernias can be fixed by open surgery or with the use of a laparoscope (a keyhole surgery). The advantages of a laparoscope include smaller surgical cuts, faster recovery, and less pain after the procedure, though the procedure will cost more, says the doctor.

Emergency surgery is sometimes required. If a sac containing the intestine or other tissue becomes stuck in a hole in the abdominal wall, they cannot be pushed back through. This can lead to a strangulated loop of intestine. If left intreated, this portion of the intestine will die because it loses its blood supply.

The outcome for most hernia surgeries is usually good, without complications. Though it is rare for a hernia to come back, incisional hernias are more likely to return.

In rare cases, inguinal hernia surgery can damage structures involved in the function of the testicles. Another risk of hernia repair surgery is nerve damage, which can result in numbness in the groin area.

If part of your bowel was trapped or strangulated prior to surgery, it may lead to bowel perforation or a dead bowel.

Of course, like any other surgery, there is a possibility of bleeding or infection of the wound post-surgery, though such cases are uncommon, says Dr Tee. "Any pain resulting from the surgery will usually go away on its own in a couple of weeks."

Keeping hernias away

While there is no real answer as to what exactly causes hernia, there are preventive measures that you can take to reduce the risk of getting a hernia or to keep it from coming back.

For starters, regular gym-goers or weightlifters should pay extra attention to form and using proper lifting techniques to avoid strain or injury.

If you have problems with constipation, you are advised to consume plenty of fibre, drink plenty of fluids, and exercise regularly.

The last we checked, The Rock has upped his incredible muscles even more, eating up to seven meals a day, to prep for the titular role in his upcoming film, Hercules: The Thracian Wars.

The fantastical action-adventure directed by Brett Ratner, is based on the Greek myth of the mighty muscle man born of the immortal Zeus and the mortal Alcmene.

Now, that's some hefty movie magic that we smell.