Hernia

If you think of your abdominal wall as an old-fashioned tire with an inner tube, a hernia would be a defect or an opening in the tough outer layer. A similar defect in the abdominal wall allows for the contents of the abdomen to spill out; usually intestines or a layer of fatty tissue called "omentum."

Types of Hernias

There are two general types of hernias: abdominal and groin.

Abdominal hernias usually form around the navel (umbilical hernia), at the site of previous surgical incisions (incisional hernia), or in the upper abdomen at the midline (epigastric hernia).

Groin hernias are the most common types of hernias and include: indirect inguinal hernias, direct inguinal hernias, and femoral hernias.

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Symptoms

Hernia symptoms often vary from patient to patient. The most common complaints are pain/discomfort and a bulge or swelling at the site of the hernia. The bulge may be persistent or may go away. It may get bigger over time.

If the hernia bulge does not flatten when you lie down, the contents of the hernia may be trapped. This is called "incarcerated hernia." This type of hernia can cause blockage of the intestines. If the intestines are tightly trapped, the blood supply to the gut can get blocked and the intestines can die (i.e. become gangrenous). This is called "strangulated hernia." These may be associated with symptoms of abdominal distention, nausea, vomiting, worsening pain and skin discoloration at the site of the hernia. If, while considering surgical hernia repair, you experience any of these symptoms, please seek urgent medical attention immediately.

Causes and Risk Factors for a Hernia

Although some hernias are present at birth, the majority develop later in life. Family history of hernias can predispose you to developing a hernia. In general, conditions that increase pressure within your abdomen contribute to formation of a hernia, including:

  • Pregnancy
  • Obesity
  • History of heavy lifting
  • Conditions that predispose you to chronic cough, such as smoking or asthma
  • Straining during a bowel movement, such as caused by chronic constipation
  • Straining to urinate, such as caused by prostate enlargement
  • Fluid in the abdominal cavity
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Diagnosis

Most hernias can usually be detected by a physical examination. Sometimes, very infrequently, special imaging studies may be needed to confirm or establish the diagnosis.

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Treatments

A hernia will not repair itself. It is a structural defect of the abdominal wall and most hernias should be surgically repaired. The exact type of repair depends on the type of a hernia you have. Your surgeon will discuss with your the best type of repair for your individual case. The procedure may be done under a local or general anesthesia, depending on the type and location of the repair.

To strengthen the repair and decrease pain after surgery, most surgeons use special mesh materials. The mesh is made of a thin and very strong plastic material that stays in the body. It helps the surgeon do the repair without pulling on muscles and acts as a patch that effectively closes the hole. Since the muscles are not pulled together, this type of repair facilitates faster and less painful recovery.

Risks of Surgery

Although hernia surgery is one of the most commonly performed operations in the United States, as with any surgery, it is associated with risks. These include, but are not limited to, bleeding, infection, scar formation, postoperative pain, damage to the testicles or testicular function, numbness in the groin or the thigh, mesh complications, inability to urinate, bowel or bladder injuries, hernia recurrence, and anesthesia complications. Although deaths, heart attacks, and strokes have been reported at the time or following hernia surgery, these are extremely rare.

After Surgery

Most uncomplicated hernias can be repaired in an outpatient setting. This means that it is possible for you to have your hernia repaired during the day and be home in the evening. You can help make your surgical recovery faster by gently easing into your daily routine as soon as possible. Start by taking short walks as soon as you can. This helps blood circulation and prevents blood clots from forming in the veins of your legs. Reduce pain and swelling by adhering to your doctor's advice regarding post-operative care and medication. Of course, some hernias may be too large or too complicated to qualify for same day surgery. Some patients may be too elderly or to ill to have ambulatory repair. Please, make sure you bring up these topics for discussion during your office visit.

Returning to Work

When you can return to work depends on the type of hernia, the type of repair, and a number of your personal characteristics. If for instance you have a desk job in an office and have an uncomplicated repair of a simple groin hernia, you may be able to return to work in a few days after your operation. If, on the other hand, your job requires constant heavy physical activity (e.g. warehouse worker), you will probably require several weeks to be able to resume your full work duties. Make sure you discuss these issues with your surgeon before scheduling the repair.