Battle of the Bulge

What is a hernia?

A hernia may appear as a bulge in an area of the body that should be flat. Just as in people, a hernia occurs when the muscle wall or tissue becomes weak or tears, allowing internal organs or other body tissue such as fat to push through the weakened area.

Not all hernias are life threatening, but they still should be checked by a veterinarian. There is a risk of strangulation, causing obstruction to the blood supply of the organ or tissue trapped in the hernia. If the hernia is small and involves fat rather than a vital organ or tissue, your veterinarian might recommend closely monitoring the hernia. However, even with small hernias, there is the possibility that an organ could become entrapped, so surgery would be advised to close the hernia.

Are there different types of hernias?

Yes, there are different types of hernias based on their location in the body. These vary in severity from non-concerning to life threatening.

Umbilical hernias are the most common type of hernia seen in puppies. It is usually noticeable as a squishy protrusion near the puppy’s navel. Depending on the size, in most cases it is a bit of abdominal fat protruding, but if the opening is large enough, a section of intestines may push through.

Some umbilical hernias can be left alone, but the larger ones should be closed surgically. If a loop of intestines gets trapped in the hernia, the blood supply may be compromised, and this is a life-threatening emergency.

Inguinal hernias occur as a bulge in the groin area where the inner fold of the dog’s hind leg attaches to their body. These hernias can range in size, and if they are large enough, parts of the urinary bladder or uterus may get trapped, which is a surgical emergency.

Inguinal hernias are most common in middle-aged female dogs, especially when they are pregnant. Herniation and entrapment of the uterus can be fatal to the dam and the puppies if not reduced quickly. If the urinary bladder slips into the hernia, the dog may be unable to urinate. This condition needs to be resolved quickly. Radiographs or an ultrasound will be performed by your veterinarian to confirm the presence of an inguinal hernia.

Diaphragmatic hernias are named for the sheet of muscle that separates the heart and lungs from the abdomen. A tear in the muscle of the diaphragm allows organs, usually intestines, to enter the dog’s chest cavity. This compresses the lungs and makes breathing difficult.

With this type of hernia, you will not see any external lumps or bulges, as it is happening inside the body. If you see your dog taking rapid, shallow breaths, a diaphragmatic hernia may be the reason. Your veterinarian will take radiographs of the chest and abdomen in order to diagnose a diaphragmatic hernia.

Perineal hernias occur when there is a rupture in the muscles of the pelvic diaphragm. This is a muscular wall in the lower abdomen that separates the abdominal organs from the rectum. A tear in these muscles allows the intestines and urinary bladder to slip through.

Perineal hernias appear as a swelling in the area around the anus. They are most common in intact male dogs over the age of five years. If you see your dog is straining to poop, have your veterinarian examine him for a perineal hernia.

Hiatal hernias can also involve the diaphragm, but in many cases, the hernia occurs where the stomach and esophagus meet. Part of the stomach protrudes into the esophagus. These types of hernias are most common in Bulldogs and other brachycephalic breeds, as the increased pressure created by their small airway can suck the stomach through the esophageal sphincter into the esophagus.

Dogs with hiatal hernias may vomit with blood, drool, regurgitate and have trouble breathing.

What causes hernias?

All hernias are caused by pressure combined with an opening or weakness of muscle or tissue. They may appear in many different areas of the body. There are three main causes. In dogs, some hernias are congenital, some are secondary to trauma, and some are the result of an underlying medical condition, such as pregnancy or straining to defecate.

A congenital or genetic hernia is present at birth. All hernia types can occur this way, but umbilical hernias, which occur around the dog’s belly button, are the most common type of hernia in dogs. These hernias are always congenital. While the fetus is developing in the mother’s uterus, blood vessels from the mother pass through an opening in the fetus’ abdominal muscles known as the umbilical ring. Normally that ring closes after birth. In some puppies, the ring remains partially open. Depending on the size of the opening, some fat or a loop of intestines can slip through.

Secondary hernias can develop as the result of a traumatic injury, such as being hit by a car or attacked by another dog or wild animal. Tears in internal tissue such as the body wall or diaphragm can lead to the displacement of organs and other tissues.

Hernias due to underlying medical conditions are seen in cases where repeated straining produces a tear in certain muscles. Dogs with frequent constipation that strain to defecate may cause a perineal hernia by damaging the muscles in the pelvic diaphragm. Dogs suffering with chronic esophagitis from an inflamed esophagus may cough so violently they put enough pressure on the muscles of the diaphragm to cause a hiatal hernia.

How are hernias treated?

The treatment recommended depends on the type and size of the hernia. Small umbilical hernias may not require any treatment at all, but surgical correction is recommended for most hernias to prevent future complications.

The surgical repair for umbilical and inguinal hernias is pretty straightforward. The fibrous or scar tissues that have formed around the hernia are dissected out and removed. The opening is then stitched closed.

With a diaphragmatic hernia, the patient must be stabilized before the hernia can be corrected, especially is there is a history of recent trauma. This surgery is often done in specialty veterinary practices by surgical and anesthesia specialists. Surgery is performed to remove the abdominal contents from the chest cavity and replace them in the abdomen. The tear in the muscles of the diaphragm is then repaired with sutures.

In most cases, a perineal hernia does not require emergency surgery. However, when a dog’s bladder is trapped in the hernia, the dog will get very sick very quickly. A catheter will be passed to empty the bladder and allow normal urination. If the dog is constipated, manual removal of the feces under sedation may be required. Stool softeners and special diets can be used to reduce stool volume while waiting for surgery.

The most successful treatment of a perineal hernia is the surgical correction of the defect in the muscle. Simple hernias can be repaired externally, but more complicated hernias may require abdominal surgery to reposition the herniated organs. These are then sutured in place to prevent them from becoming herniated again. A mesh implant to support the surrounding muscles may be needed in severe cases or if repeat surgery is required.

Surgical correction may be needed for a hiatal hernia if your veterinarian finds the need to close the opening or needs to attach the stomach to the abdominal wall so that it does not protrude further. Antibiotics and therapeutic breathing treatments may be necessary if aspiration pneumonia develops as the result of breathing problems. Drugs that aid digestion and increase the tone of the sphincter in the lower esophagus can be prescribed. Medications to decrease the acidity of the reflux and promote healing of the damaged esophageal tissue are also helpful.

Not all hiatal hernias require surgical or prescription-medication treatment. Feeding small but frequent portions of a low-fat diet may be successful in controlling the symptoms.