For any number of reasons, someone could be born with or develop a weak spot in the muscle or tissue of the abdominal wall. Sometimes, a piece of bulging organ or tissue pokes through that weak spot and causes a bulge, or a hernia. Although very common and often self-diagnosable, some types of hernias can require evaluation by your primary care provider or even immediate attention by a general surgeon, like Dr. Adel El-Ghazzawy, MD. So, how do you know if you have a hernia, or what type of hernia it is?
What Is A Hernia?
Hernias are common; there are about 1 million hernia surgeries in the US each year. While some hernias stay small and non-bothersome or asymptomatic, others can create serious problems and/or a great deal of pain or discomfort. Most often, hernias develop in the abdominal wall, where the bulge becomes visible, making hernias fairly easy to diagnose. Aside from the obvious bulge and possible pain and discomfort in that area, there are a few other symptoms you can keep an eye out for.
- Increased abdominal or groin pain/discomfort with standing, straining or heavy lifting
- Dull aching sensation
- Symptoms of bowel obstruction (inability to pass gas or bowel movements)
- Increased size and pain level in and around the bulge or hernia
While you should always get a suspected hernia checked out by your doctor, some more serious hernias may require emergency treatment or surgery. If you notice increased pain, nausea, vomiting and an inability to push the bulge back easily into your abdomen, you should seek medical attention immediately. These are symptoms of a possible strangulation of your gut, meaning blood is no longer able to get to that piece of organ or tissue. THIS IS AN EMERGENCY!
Hernias can come about from a number of causes. Some hernias are congenital, primarily in premature babies and babies who are born at a low birth weight or occur naturally over time in weak areas such as the groins or belly button. Most hernias, however, occur later in life, from wear and tear. Some causes of hernias are:
- Straining on the toilet or with urination
- Persistent coughing
- Overuse of a muscle
- Cystic fibrosis
- Enlarged prostate
- Increased abdominal fluid
- Heavy lifting
- Peritoneal dialysis
- Poor nutrition
- Physical exertion
- Undescended testicles
Types Of Hernias
Of all the hernias diagnosed each year, 75-80% of hernias are in the groin area and these are called inguinal or femoral hernias. In men, these tend to be inguinal hernias or groin hernias. More commonly in women, a different type of groin hernia occurs that are called femoral hernias, these are more dangerous than inguinal hernias because of a higher risk of incarceration or strangulation of the intestines. Most inguinal hernias occur in adults. Inguinal hernias tend to be more symptomatic and less frequently can cause a strangulation of the gut, requiring emergency surgery. A few risk factors for inguinal hernias are:
- A previous personal or family history of hernias
- Chronic constipation
- Premature birth or low birth weight
After you undergo any type of surgery, the tissue around the surgical site turns to scar tissue. On the abdominal wall, this scar tissue can become weakened, giving rise to an incisional hernia. While they usually are not medically urgent, about 2% of hernias are incisional. They commonly occur between 3-6 months after surgery but can occur even years later in these weakened areas. The usual risk factors for incisional hernias are strenuous activity, weight gain, smoking, steroid use, and pregnancy.
Umbilical hernias occur when a piece of tissue pokes through at the belly button. Approximately 3-5% of hernias are umbilical, mostly occurring in premature babies or babies with low birth weight. Most children’s’ umbilical hernias will resolve on their own within a few years and cause little to no problems or discomfort at all for the child. Other risk factors for umbilical hernias are multiple pregnancies, obesity and being female. Less common hernias can occur anywhere along the midline of the abdominal wall or between the rectus muscles or “six-pack” and the flank.
A hiatal hernia is when a portion of the stomach comes up into the chest cavity through a weakness in the diaphragm. The exact cause behind hiatal hernias is unclear, though recent studies show a collagen or connective tissue defect may be the cause. Some hiatal hernias are symptomless and harmless, while others are accompanied by heartburn and discomfort in your chest and abdomen and require medication or surgery. Hiatal hernias are one of the least common hernias. Although there aren’t many risk factors linked to hiatal hernias, they are most common in people over the age of 50 or are overweight.
If your hernia is smaller and doesn’t cause a great deal of pain or disruption to your health, your doctor might elect to wait to perform surgery in the event that the hernia does become bothersome. Given that many hernias are considered low risk, surgery might not be necessary at this time. In this case, you should keep an eye on your hernia and ensure you go back to your doctor if there is any change in size or if symptoms occur.
However, when surgery is necessary, there are two options.
Open surgery is a very common, yet more invasive approach to treating a hernia. Using a single long incision, the hernia surgeon goes in and gently returns the bulging tissue back into place. If putting back or reducing the bulging tissue is not possible, the surgeon may tie off, or remove, that section of tissue instead. A surgical mesh is often used to help reinforce the tissue; this lessens the chance of the hernia returning or recurring. Some meshes are synthetic and some are made from animal or cadaveric tissues. Temporary meshes absorb into your body over time as it heals. Other kinds of mesh don’t absorb and provide long term reinforcement for the area.
Laparoscopic or robotic surgery
Although a laparoscopic approach is a more expensive approach to hernia mesh repair, it’s also less invasive. Laparoscopic surgery requires several very small incisions in your lower abdomen and the use of small cameras and instruments. These repairs are usually reinforced with mesh and the less invasive procedure means a shorter recovery time and less scar tissue compared to open surgery. Recovery is quicker with less chance of infection, making laparoscopic surgery, if technically feasible, the preferred method of hernia repair.
If you think you may have a hernia, you should make an appointment with your primary care provider right away. While many hernias can be harmless, most still need at least a watchful eye or evaluation for repair. Your doctor can diagnose your hernia and refer you to a hernia surgeon, if necessary.