Yoga class. I haven’t done this in a while. When did my toes get so far away? I mindfully follow the teacher’s instructions, but my hiatal hernia objects to the pose. Burping discreetly, I shift to a more comfortable position. A hernia is defined as the protrusion of an organ, or other bodily part, through a wall that normally contains it. In my case, I have a fairly common condition affecting older, heavier people in which a small portion of the junction of my esophagus and stomach protrudes through the diaphragm into my chest. In a small number of human cases, surgical repair is warranted, but most hiatal hernias are small, like mine, causing few if any symptoms, and easily managed medically.
Hernias in pets come in many sizes and locations. The most common and least serious is the congenital umbilical hernia. When puppies and kittens are in utero, each one is attached to a separate placenta via an umbilical cord, which enters their tummies through an opening in the belly wall — the umbilicus. Normally at birth, the cord is broken and the opening in the belly wall closes spontaneously. But occasionally it stays open, allowing a little abdominal fat or membrane to poke out, creating a bulging “outie” belly button. These can range from tiny to fairly large protrusions, but rarely cause serious problems, and are easily diagnosed by location and feel. Often the contents can be “reduced”; in other words, the stuff sliding out can be slid back in by gentle massage. This confirms the diagnosis but doesn’t cure the hernia, as the defect in the abdominal wall persists, and things just slip out again later.
The main concerns with umbilical hernias are that an intestinal loop can get caught and “strangulated,” or the bowel may become obstructed. In these rare cases, the swelling will become warm and painful. The pet may vomit, experience loss of appetite or depression, or be straining to defecate. This is a surgical emergency. Radiographs or ultrasound can be useful in determining the contents of the hernia, but are rarely indicated if it is small and nonpainful. The cause of congenital umbilical hernia is not known, but it is generally thought to be an inherited condition, so affected animals should not be bred. More common in puppies than kittens, it can be easily repaired when the pet is neutered, though there is a high rate of post-surgical recurrence.
Other types of hernias include inguinal, diaphragmatic, abdominal, scrotal, and perineal. Anywhere things are supposed to be contained in one place but somehow poke into another place, you’ve got a hernia. Last year I saw a cat, Wolfy. Missing for three days, he had returned home, weak and in pain, with a swelling on the lower right side of his tummy. He had eaten moderately well, but was uncomfortable walking. His owner reported he had a penchant for climbing on the roof, so perhaps he had taken a tumble off the house. Despite cats’ amazing ability to land on their feet, it doesn’t always work out that way. In fact, it has been suggested that shorter falls may result in more serious trauma for cats, as they have less time coming down to right themselves. In any case, Wolfy had clearly had some kind of accident. Radiographs revealed loops of intestines protruding through the belly wall — an abdominal hernia.
Now in case you are picturing guts falling out on the exam table, back up a minute. There are multiple layers that hold Wolfy’s belly together. The outside layers that constitute the skin were intact. Just the inner abdominal muscles had ruptured, allowing intestines to slide out of the belly, but they were still enclosed within the skin. Traumatic abdominal hernias can vary widely in location, severity, and prognosis. I knew one elderly cat, Hope, who sustained a similar though much smaller injury. Because of her advanced age, her owners opted not to pursue surgical repair, and Hope lived a good long time after, with no complications. But Wolfy’s hernia was big and, although no spring chicken, Wolfy was considerably younger than Hope had been. Surgical repair of abdominal hernias can often be accomplished by simply sewing the damaged muscle layers back together. Sometimes, however, the defect is too large, the damage too extensive. Then the hole needs to be closed using a synthetic mesh implant. There was also the possibility that when Wolfy hit the ground, the blow caused other internal injuries, like a diaphragmatic hernia.
The diaphragm is the muscle that separates the chest and the abdominal cavities. Blunt force trauma, like being hit by a car, or falling off the roof, can cause a sudden increase in intra-abdominal pressure, altering the pressure gradient between chest and belly, resulting in a tear in the diaphragm. Maybe it’s a small tear, with nothing displaced from tummy to chest. Or maybe it’s bigger, with organs ranging from liver to stomach to intestines protruding into the thorax and putting pressure on the lungs and/or heart. In the latter situation, the patient will likely be in shock, with labored, rapid breathing. The gums may be pale or even blue if lung function is sufficiently compromised. Although surgery is necessary, first the patient must be stabilized. Surgical repair of diaphragmatic hernias is difficult. Once the surgeon opens the abdomen, the animal can no longer breathe independently, and a mechanical ventilator or trained assistant must “breathe for” the patient during surgery. Occasionally animals with diaphragmatic hernias show no symptoms at all, and can live for years without treatment, but the majority require surgery.
We referred Wolfy to a larger hospital here, with more veterinarians and fancier equipment. They did a wonderful job repairing a three-inch tear in his abdominal wall, replacing multiple loops of bowel in their rightful place. Happily, there was no damage to his diaphragm. I hope he will stay off the roof now. I am still trying to go to yoga, but taking it easy on those Downward Dogs.