Hernias

Hernia’s are extremely common and there are several different types of hernia’s that people can have. The most common ones I treat are umbilical, inguinal, ventral, incisional and hiatal. Hiatal hernia will be recovered under GERD, but the rest will be explained here. In essence, a hernia is a hole or weakness that has formed in the abdominal wall. An umbilical hernia occurs at the belly button. An inguinal hernia occurs in the groin and is more common in males. An incisional hernia is one that forms where an incision from a previous surgery is located, and a ventral is one that forms in the abdomen that is not classified by any of the above.

A hernia is usually caused by the combination of several factors. The most common risk factors are obesity, pregnancy, smoking, repetitive straining ( coughing/sneezing, lifting heavy weights, constipation), and genetic factors or congenital defects.

A hernia can be diagnosed by physical exam, but at times a CT scan may be needed to diagnose or further characterize it. We will discuss if surgery is needed and the options to repair including open, laparoscopic and robotic.

Symptoms of Inguinal Hernia

Inguinal hernia signs and symptoms include:

• A bulge in the area on either side of your pubic bone, which becomes more obvious when you're upright, especially if you cough or strain
  
• A burning or aching sensation at the bulge
  
• Pain or discomfort in your groin, especially when bending over, coughing or lifting
  
• A heavy or dragging sensation in your groin
  
• Weakness or pressure in your groin
  
• Occasionally, pain and swelling around the testicles when the protruding intestine descends into the scrotum

You should be able to gently push the hernia back into your abdomen when you're lying down. If not, applying an ice pack to the area may reduce the swelling enough so that the hernia slides in easily. Lying with your pelvis higher than your head also may help.

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When to see a doctor

See your doctor if you have a painful or noticeable bulge in your groin on either side of your pubic bone. The bulge is likely to be more noticeable when you're standing, and you usually can feel it if you put your hand directly over the affected area. Seek immediate medical care if a hernia bulge turns red, purple or dark.

Causes of Inguinal Hernia

Some inguinal hernias have no apparent cause. Others might occur as a result of:

• Increased pressure within the abdomen
  
• A pre-existing weak spot in the abdominal wall
  
• A combination of increased pressure within the abdomen and a pre-existing weak spot in the abdominal wall
  
• Straining during bowel movements or urination
  
• Strenuous activity
  
• Pregnancy
  
• Chronic coughing or sneezing

In many people, the abdominal wall weakness that leads to an inguinal hernia occurs at birth when the abdominal lining (peritoneum) doesn't close properly. Other inguinal hernias develop later in life when muscles weaken or deteriorate due to aging, strenuous physical activity or coughing that accompanies smoking.

Weaknesses can also occur in the abdominal wall later in life, especially after an injury or abdominal surgery.

In men, the weak spot usually occurs in the inguinal canal, where the spermatic cord enters the scrotum. In women, the inguinal canal carries a ligament that helps hold the uterus in place, and hernias sometimes occur where connective tissue from the uterus attaches to tissue surrounding the pubic bone.

Symptoms of Umbilical Hernia

An umbilical hernia creates a soft swelling or bulge near the navel (umbilicus). In babies who have an umbilical hernia, the bulge may be visible only when they cry, cough or strain.

Umbilical hernias in children are usually painless. Umbilical hernias that appear during adulthood may cause abdominal discomfort.

When to see a doctor

If you suspect that your baby has an umbilical hernia, talk with the baby's pediatrician. Seek emergency care if your baby has an umbilical hernia and:

• Appears to be in pain
  
• Begins to vomit
  
• Has tenderness, swelling or discoloration at the site of the hernia

Similar guidelines apply to adults. Talk with your doctor if you have a bulge near your navel. Seek emergency care if the bulge becomes painful or tender. Prompt diagnosis and treatment can help prevent complications.

Causes of Umbilical Hernia

During gestation, the umbilical cord passes through a small opening in the baby's abdominal muscles. The opening normally closes just after birth. If the muscles don't join together completely in the midline of the abdominal wall, an umbilical hernia may appear at birth or later in life.

In adults, too much abdominal pressure contributes to umbilical hernias. Causes of increased pressure in the abdomen include:

• Obesity
• Multiple pregnancies
• Fluid in the abdominal cavity (ascites)
• Previous abdominal surgery
• Long-term peritoneal dialysis to treat kidney failure

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Prevention of Hernias

You can't prevent the congenital defect that makes you susceptible to hernias. You can, however, reduce strain on your abdominal muscles and tissues. For example:

• Maintain a healthy weight. Talk to your doctor about the best exercise and diet plan for you.
  
• Emphasize high-fiber foods. Fruits, vegetables and whole grains contain fiber that can help prevent constipation and straining.
  
• Lift heavy objects carefully or avoid heavy lifting. If you must lift something heavy, always bend from your knees — not your waist.
  
• Stop smoking. Besides its role in many serious diseases, smoking often causes a chronic cough that can lead to or aggravate an inguinal hernia.
  
• Don't rely on a truss. Wearing a supportive garment designed to keep hernias in place (hernia truss) doesn't correct the problem or help prevent complications.

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