A hernia occurs when an internal organ or tissue protrudes through a weak spot in the surrounding muscle or connective tissue. The term “stomach hernia” typically refers to specific types of hernias in the abdominal area. Hiatal hernias involve the upper part of the stomach pushing up into the chest through an opening in the diaphragm, the muscle separating the chest from the abdomen. Other hernias in the general “stomach area” include epigastric hernias, between the breastbone and belly button, and umbilical hernias, near the navel.
Defining Hernia Size
The size a hernia can reach varies considerably, ranging from a few millimeters to several centimeters. For hiatal hernias, a small one might measure around 2 to 3 centimeters, while a medium one could be 4 to 5 centimeters. Those exceeding 5 centimeters are generally considered large. In severe cases, the opening in the diaphragm can become wide enough for the entire stomach and even other organs like the colon, small intestine, or spleen to move into the chest cavity.
Abdominal wall hernias also exhibit a wide range of sizes. Epigastric hernias, often small, can be less than 1 centimeter, but large ones may reach about 4 centimeters. Umbilical hernias can be less than 1 centimeter, range from 1 to 3 centimeters for medium sizes, and can grow to 8 to 10 centimeters. There is no definitive “maximum” size for a hernia, as their growth is influenced by various factors.
Why Hernias Grow
Hernias tend to increase in size over time as the underlying muscle or tissue weakness expands. This gradual enlargement is driven by increases in intra-abdominal pressure. Any activity that elevates pressure within the abdomen can contribute to a hernia’s growth, pushing more tissue through the weakened area.
Common sources of increased pressure include chronic coughing, straining during bowel movements, and regularly lifting heavy objects. Conditions like obesity and pregnancy also place additional strain on the abdominal wall, which can lead to enlargement. The natural aging process can weaken muscles, making them more susceptible to stretching and allowing hernias to expand.
Impact of Large Hernias
As hernias grow larger, they are more likely to produce noticeable symptoms and complications. A prominent bulge is often the most obvious sign, accompanied by discomfort or pain when coughing, straining, or lifting. For large hiatal hernias, symptoms can include severe acid reflux, difficulty swallowing, chest pain, shortness of breath, and a feeling of fullness after eating.
One complication is incarceration, where the protruding tissue becomes trapped and cannot be pushed back. An incarcerated hernia can cause increased pain, nausea, vomiting, or a bowel obstruction. If a large abdominal wall hernia involves the intestine, an obstruction can lead to severe abdominal pain and constipation.
A more severe and life-threatening complication is strangulation, which occurs when the blood supply to the trapped tissue is cut off. This lack of blood flow causes the tissue to die (necrosis) and requires immediate emergency surgery. Signs of a strangulated hernia include sudden, intensifying pain, fever, a rapid heart rate, nausea, vomiting, and a change in the skin color over the hernia. If left untreated, strangulation can lead to gangrene or sepsis, which can be fatal.