Ask a Doc - Hernias

Each year, it is estimated that 5 million people experience some type of hernia, but only 750,000 Americans seek medical treatment.  Ignoring symptoms may lead to life-threatening complications.  A hernia is an uncomfortable condition in which an organ or tissue pushes through a weak area in the surrounding muscle or connective tissue that holds the organ in place.  The condition can occur and develop anywhere in the body, especially in the abdominal wall.  Hernias can occur gradually with age and regular use of the muscles.  An injury, surgery, or birth disorder may also cause a hernia.

The inguinal hernia is the most common type of hernia accounting for 75 percent of all reported cases.  The injury occurs in the lower abdominal wall and groin area when part of the intestines protrude into the inguinal canal, a passageway for structures between the intra- and extra-abdominal structures located near the thigh.  An inguinal hernia may occur on one or both sides of the body and are much more common in men than women.  These types of hernias can develop over time due to increased pressure on the walls of the abdominal muscles from straining to use the bathroom, coughing over a long period, being overweight, or lifting heavy weights.  Infants may be born with an inguinal hernia that may not be discovered until they become adults.  About five out of every 100 children are born with the condition while Infants born before their due date are at higher risk.

Several other types of hernias can affect various areas of the body.  The hiatal hernia occurs when the upper part of the stomach protrudes through an opening in the diaphragm and into the chest cavity.  The diaphragm is the thin muscle wall that separates the chest cavity from the abdomen.  The opening in the diaphragm is where the esophagus and stomach join.  A small hiatal hernia typically may not cause serious issues; however, a large hiatal hernia may allow food and acid to enter the esophagus, leading to heartburn.  Self-care measures or medications are often prescribed to relieve the symptoms.  

A ventral hernia occurs at any location along the midline, known as the vertical center, of the abdomen wall.   There are three types of ventral hernia, the epigastric, umbilical, and incisional.  The epigastric hernia affects the area below the breastbone to the navel.  The umbilical hernia is located in the area of the belly button, and incisional hernia develops at the site of a previous surgery.   Up to one-third of patients who have had an abdominal surgery will develop an incisional hernia at the site of their scar.

A perineal hernia occurs when organs or tissue push through pelvic floor muscles into the abdominal cavity.  Perineal hernias are very rare, and women are more likely than men to develop this type of hernia.  The risk of a perineal hernia is greater after pelvic surgery.  Injuries and pregnancy also cause this type of pelvic floor hernia.

Not all hernias cause symptoms, and different types of hernias may cause different symptoms.  One telltale sign of a hernia is a visible lump or bulge that appears during certain activities or in certain physical positions and retracts at other times.  Pressure may be felt in the area along with a dull ache or pinching when the hernia is visible.  The hernia may protrude when straining, lifting, laughing, or coughing.  Risk factors for developing a hernia include: frequent heavy lifting or many hours of standing,  chronic cough or allergies that cause chronic sneezing, chronic constipation and straining, a history of abdominal or pelvic surgery, and chronic obesity, a body mass index, or BMI, greater than 30.

When most hernias develop, the internal tissue that protrudes through the muscle gap is typically fat.  However, parts of the bowel or other organs may also protrude through the opening.  Most hernias are not serious; however, if the organ becomes lodged inside the weakened area and does not retract, serious side effects may occur including intense pain.  In severe cases, the blood supply is cut off from the tissue causing necrosis (tissue death).  The risk is very low, but when the blood supply is cut off, emergency repair may be required.  Seek immediate medical attention if you have:

• A painful bulge that does not reduce in size when laying down and resting
• Worsening pain
• Nausea and/or vomiting
• Difficulty having a bowel movement
• Bloating
• Racing heart rate
• Fever

A simple physical exam is often enough to diagnose a hernia; however, some hernias may require a form of soft tissue imaging, such as a CT scan, to diagnose.  Most hernias will need surgical repair, but not necessarily right away.  A small or mild hernia that only protrudes occasionally can simply be monitored to determine whether it requires further action.  Hernias do tend to worsen over time, which is why providers recommend surgical repair.  Hernia repair surgery is common and generally a minor procedure unless there are complications.  A surgeon will return the herniated tissue into place and reinforce the weakened area where the tissue protruded through with stitches or with surgical mesh.  Surgeons often use minimally-invasive methods for a routine hernia repair, which means smaller incisions, less postoperative pain, and a faster recovery.

| Posted On : 8/24/2023 8:44:51 AM