It’s a bulge that doesn’t belong. That’s how many people experience hernias, believed to be the most common cause of surgery in the United States.
A hernia is a weakness or opening in the abdominal wall that allows part of an organ or any intra-abdominal contents to push through the opening.
“Most people with hernias are born with them. You may have a hernia for years, and one day, when you lift something or move in a certain way, you notice the swelling or pain,” said Dr. Stephanie Dunkle-Blatter, a surgeon with OhioHealth Physician Group in Athens.
The telltale bulge associated with hernias may come and come and go in different positions and during activities such as straining, lifting, laughing, or coughing. Symptoms include pressure, a dull ache, pinching or pain, although not everyone experiences these.
Hernias don’t get better on their own
Most hernias aren’t serious, but most will require surgical repair eventually since they tend to enlarge and worsen over time. Sometimes hernias become “incarcerated,” with contents stuck in the hole, which can become increasingly painful and serious. Rarely, hernias become “strangulated,” which cuts off blood supply and causes tissue death.
“That can be extremely dangerous and requires emergency surgery,” Dunkle-Blatter said.
It’s better to see a doctor quickly than let the situation get to that point, though.
“If you’re worried you might have a hernia, it’s best to get checked out. Don’t be embarrassed — it’s what medical professionals are trained for. It’s not something you did or didn’t do,” she said. “It’s much better to act pre-emptively than to need emergency surgery. Elective hernia repair is much easier and safer.”
Types of hernias
Hernias come in many forms and occur in different locations.
Groin hernias are the most common type, accounting for 75% of all hernias.
- Inguinal hernias occur mostly in men, when part of the bowel or abdominal contents protrudes into a passageway that runs down into the scrotum. Researchers estimate that about 27% of men will develop an inguinal hernia sometime in their lives, according to the National Institutes of Health.
- Women rarely get inguinal hernias but are more likely to develop femoral hernias, another type of groin hernia that occurs when there is an abnormal passageway to the inner thigh. They are more common in women due to the widened female pelvis and more prone to sudden incarceration with a higher rate of emergency surgery, Dunkle-Blatter said. “Any groin hernia is diagnosed less often in women because symptoms sometimes are mistaken for endometriosis or ovarian conditions,” she added.
Other hernia types:
- Umbilical hernias occur when part of the intestine or other abdominal contents pokes through an opening in the abdominal wall at the belly button. Most umbilical hernias are present from birth and are the only type to go away on their own.
- Epigastric hernias are similar to umbilical hernias but occur anywhere in the midline of the belly above the bellybutton and below the sternum.
- Incisional hernias occur when tissue protrudes through a former incision in the abdominal wall that weakened over time. It’s a common side effect of abdominal surgery and the reason doctors put limits on how much patients can lift in the weeks following surgery.
- A hiatal hernia is a completely different type of hernia that occurs when the upper part of the stomach pushes up through the diaphragm — the muscle separating the abdomen and chest —into the chest cavity. Patients can experience pain, heartburn, reflux and difficulty sleeping on their backs.
Hernia risk factors
Whether or not you develop a hernia is largely out of your control, experts say. However, controlling your weight and activity can help lessen pain and symptoms, Dunkle-Blatter said.
Risk factors that can worsen symptoms from hernias include:
- Heavy lifting or many hours of standing
- A chronic cough or chronic sneezing
- Constipation and straining to go the bathroom
- A history of abdominal or pelvic surgery
- Pregnancy, especially repeat pregnancies
- Obesity (a body mass index, or BMI, greater than 30)
- Overeating
Symptom management for hernias includes rest, putting light pressure on the area and taking medication for pain, but those are temporary measures.
A common surgery
Surgical repair involves pushing the herniated tissue back into place, closing the opening with stitches and/or reinforcing the barrier with surgical mesh. Surgeons repair around 800,000 groin hernias in the United States each year.
Most hernia repair surgery is done on an outpatient basis. For some hernias, laparoscopic and robotically assisted procedures allow surgeons to operate within the abdominal wall instead of opening the abdomen. Compared to open surgery, laparoscopic procedures are less invasive, resulting in less pain and faster recovery time. Your surgeon will help you determine the best course of treatment for you.
