By Jennifer Robb
What's a hernia?
If you have a hernia, a piece of intestine, fat, or other tissue is bulging through a torn or weakened abdominal muscle. Hernias can develop painlessly over time, or occur suddenly -- all it takes is increased pressure in the abdominal cavity. They commonly result from age-related wear and tear, heavy lifting, a congenital defect, sustained coughing, or obesity, but many hernias have no apparent cause.
What are the different types of hernias?
Different kinds of hernias show up in various areas of the body. The most common type, known as an inguinal hernia, is a protrusion of tissue in the groin region. (This is usually the one people mean when they refer to a hernia.) Other types include a femoral hernia, which occurs at the spot where the abdomen meets the top of the thigh; an incisional hernia, which results when muscles are weakened by surgery; and a hiatal hernia, which occurs internally when part of the stomach pushes through the diaphragm into the chest cavity.
How can I tell if I have a hernia?
If you have a hernia, you'll probably notice a soft bump under the skin near your groin or abdomen. This bump might feel tender and squishy to the touch, and it may (or may not) disappear when you lie down. Hernias can be either relatively painless or almost excruciating. They're frequently the cause of a dull, aching sensation that gets worse when you cough, strain your bowels, or lift something heavy. This discomfort may increase over time as more tissue pushes through the tear. Hernias that worsen quickly can cause sharp, intense pain.
Do only men get hernias?
Although nearly 80 percent of people who experience hernias are men, anyone can get them. Women whose abdominal muscles have been weakened from childbirth are particularly susceptible. Even a newborn can have a hernia if his abdominal muscles haven't developed properly.
Are hernias dangerous?
Most are not. Doctors can usually push the protruding tissue back into the abdominal cavity and close the weakened muscles surgically. However, in some cases, a protruding section of intestine can become "strangulated," or pinched between the ruptured muscles (Imagine a kink in a garden hose.) Strangulation is agonizingly painful and can be life threatening: It requires immediate surgery to prevent serious consequences like blood loss to the tissue or a blockage in the digestive tract.
What's the treatment for a hernia?
A common myth is that limiting activities and getting plenty of rest can cure a hernia. While this will certainly alleviate symptoms, surgery is the only way to repair a hernia. Since neglecting a hernia can have serious consequences, consult with your doctor about the best course of treatment.
About 600,000 people undergo inguinal surgery in the United States each year, making it one of the most common operations performed. In the traditional method of hernia repair, herniorrhaphy, the surgeon makes a small incision over the hernia, pushes the protruding tissue back into place, and sews the torn muscles back together. You can usually resume normal activities four to six weeks after the procedure.
Another surgical method, hernioplasty, uses synthetic mesh screens or "plugs" to fortify the damaged muscles. After several weeks, new tissue grows on and through the screen, creating a stronger bond that is less likely to weaken again. Hernioplastic procedures can be done under a local anesthetic, and recovery time is usually shorter than after a herniorrhaphy. Your doctor will let you know what activities you can do based on how you feel afterwards.
Laparoscopic surgery, the newest form of hernioplasty, has received a lot of favorable attention because it's minimally invasive with a recovery period of just a few days. In this method, the surgeon makes a few tiny incisions in the abdominal wall and inserts the necessary surgical instruments. These include the mesh patch and laparoscope, which is like a little video camera that magnifies the internal organs and enables the surgeon to view the hernia on a video monitor as he repairs it. Get some background on your surgeon: Studies show a surgeon's level of experience is an important factor in determining the outcomes of laparoscopic surgery.
Regardless of what method you and your doctor decide is best for you, be sure to choose a board-certified surgeon to perform the procedure, and make sure the hospital or outpatient surgery center is accredited. The American College of Surgeons has a searchable database to help you find a general surgeon or specialist in your area. Your family doctor should be able to help you with a referral as well.
Is there any way to prevent a hernia?
There are definitely a few precautions you can take:
- Be careful when lifting heavy objects. Lift with your knees rather than your back, and don't attempt to move anything too heavy for one person to manage.
- Quit smoking. Smokers often have a violent and persistent cough, which can increase the risk of hernia.
- Exercise. Getting regular exercise is an important safeguard, since strong muscles are less likely to rupture.
- Maintain a healthy weight. Being overweight strains your body and can also dangerously stretch the peritoneum, or abdominal lining.
- Get plenty of fiber. Regular bowel movements will prevent undue straining.
- Don't strain your muscles. Weight lifters, football players, and golfers frequently strain or tear the muscles prone to hernia. Be sure to warm up enough before such activities, and watch out for that telltale bulge.
National Digestive Diseases Information Clearinghouse. Digestive Diseases Statistics.
Mayo Clinic, Inguinal Hernia, June 15, 2016, http://www.mayoclinic.org/diseases-conditions/inguinal-hernia/diagnosis-treatment/treatment/txc-20206412
American Medical Association. The Causes and Surgical Treatment of Abdominal Hernia.
Comparison of conventional anterior surgery and laparoscopic surgery for inguinal-hernia repair, Liem MS et al. New England Journal of Medicine, Vol. 336 (22):1541-7.
The PDR Family Guide Encyclopedia of Medical Care. Hernia Repair, What You Should Know. Three Rivers Press.
McCormack K, Scott NW, Go PM, Ross S, Grant AM. Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane systematic database of reviews.