Conversations for Confidence: Expert Answers About Hernias

Hernias are common. They can be a visible bulge in your abdomen or a hole in a muscle wall you can’t see. Every year, doctors diagnose 1.5 million Americans with a hernia, and surgeons perform approximately 700,000 hernia repairs.

In a recent webinar, hernia experts from The Christ Hospital Health Network including primary care physician, Michael Oehler, MD; general surgeon, Jonathan Schilling, MD; and general surgeon, Steven Weber, MD, explained the different types of hernias and offered insights about risk factors, surgery options, and recovery.

Here’s what they want you to know if you think you may have a hernia.

What is a Hernia, and Who is at Risk?

A hernia happens when a small part of your insides – fat, intestines, or stomach – pushes through a weak spot in your abdominal wall. They can be big or small and can cause pain or create no symptoms.

Although hernias are common, they appear more often in men than women. Men have a 30 percent lifetime risk of developing a hernia, while women have a 5 percent chance.

Still, Dr. Schilling says anyone can develop a hernia. These factors can increase your risk:

• Age (particularly between ages 0 to 5 and 70 to 80)
• Being male
• Chronic constipation (frequent straining can weaken your abdominal wall)
• Chronic cough
• Family history
• Genetics (impaired collagen mechanism, or the quality of connective tissue)
• Prostate disease or prostatectomy (prostate gland removal)
• Smoking

The Types of Hernias and Symptoms to Notice

There are several types of hernias that can occur in different parts of the body, Dr. Schilling says.

Groin Hernias

Also called an inguinal hernia, these are the most common types of hernias. They happen when part of your intestines or abdominal fat pushes through your lower abdominal muscles and into your groin.

Inguinal hernias are classified as direct, indirect, or femoral. That classification matters a lot when talking about the type of repair to perform, according to Dr. Schilling.

The most common symptoms for a groin hernia include:

• Discomfort after activity (like lifting or yard work)
• Dull ache
• Heaviness in your groin
• A bulge in your groin

The more serious signs are:

• Bloating
• Nausea
• Pain
• Vomiting

In men, a groin hernia may also produce testicular fullness. Women may feel fullness throughout the pelvis. But for many people, things just feel “off.”

“Most of the time, people say they feel uncomfortable or that things feel different,” Dr. Oehler says, adding that doctors can use a physical exam and advanced imaging to identify a groin hernia.

Hiatal Hernias

Hiatal hernias are another common type of hernia. They develop when your diaphragm (the large muscle below your lungs that helps you breathe) weakens around your esophagus and lets part of your stomach push into your chest. You can’t see them. It’s possible to have a hiatal hernia and not know it.

“Sometimes hiatal hernias create no signs, and patients don’t even know they have them,” Dr. Schilling says. “Other times it leads to significant symptoms that may cause complications if left untreated.”

Those symptoms can include:

• Acid reflux
• Difficulty swallowing (dysphagia)
• Heartburn

Without treatment, chronic acid reflux can lead to anemia, scar tissue in the esophagus, and ulcers. In severe cases, Dr. Schilling says patients may develop precancerous conditions like Barrett’s esophagus or esophageal cancer.

To diagnose a hiatal hernia, your doctor will start with a physical exam. If they need additional information, they may order advanced imaging studies like CT scans, an endoscopy, or X-rays.

Ventral Hernias 

These hernias occur when part of your intestines pushes through the front of your abdominal wall. There are several types of ventral hernias:

• Umbilical: This is the most common ventral hernia. It’s three times more common in women than men, and it creates a visible bulge near your belly button.
• Epigastric: This hernia occurs between your breastbone and belly button.
• Femoral: Also called a “sports hernia,” these rare hernias push through your abdominal wall in your upper thigh near your groin.
• Incisional: This hernia appears in spots where you’ve had prior surgery, including colon or prostate surgery.
• Lumbar: These rare hernias develop when tissue or organs push through the muscles in your lower back.
• Obturator: This rare pelvic hernia develops when fat or part of the intestines pushes through the canal that connects your lower belly to your upper leg.
• Parastomal: Patients with an ostomy or stoma may develop these types of hernias.
• Recurrent: This type of hernia develops after a prior hernia repair.
• Spigelian: This rare hernia happens when fat or part of the intestines pushes through a weak spot in the fascia that covers your lower abdominal muscles.

Symptoms

The different types of ventral hernias produce many of the same symptoms. These include:

• Dull ache
• Feeling of achiness or fullness
• Nausea
• “Outie” belly button
• Sharp pain when bumped
• Visible, but painless, bulge

More serious symptoms may include vomiting and a bulge that becomes hard, tight, and tender.

Risk Factors

The most common risk factors for ventral hernias include:

• Cirrhosis or liver disease
• Pregnancy
• Previous abdominal surgery near the belly button
• Significant weight loss or gain

When it’s Not a Hernia

A bulge near your belly button isn’t always a hernia. Dr. Schilling says it could also be:

• Abdominal muscle strain
• Cyst or infection around the belly button area
• Hematoma (a blood clot from a fall or injury)
• A soft tissue mass or a lipoma (a noncancerous, fatty tumor)
• Rectus diastasis (a stretched-out part of connective tissue)

If you aren’t sure whether something is a hernia, Dr. Schilling says it’s best to have it examined by a physician.  

When to See a Surgeon

Hernias don’t respond to rest, medication, or physical therapy. They don’t get better on their own, Dr. Schilling says.

“Hernias aren’t going to cure themselves. They worsen over time – some quickly, some slowly,” he says. “Because of the way our body is positioned, a small hernia can turn into a big hernia given enough time.”

Because hernias are a surgical disease, the only treatment is surgical repair. But just because you have a hernia, that doesn’t mean you must have surgery.

If your hernia isn’t causing uncomfortable symptoms or you can push your bulge back in, you may choose to monitor it closely. Many people choose to watch their hernia for years. Still, Dr. Oehler says seeing a surgeon can help you choose your best path.

“I often tell my patients that we’re not going to a surgeon because their hernia absolutely needs to be operated on,” he says. “We’re going to a surgeon because they are the expert in deciding who should have surgery and who shouldn’t. They can answer your questions about the pros and cons [of surgery].”

Deciding whether to have surgery is a personal choice. When choosing to schedule surgery now or wait for a later date, Dr. Oehler recommends that you talk with a surgeon and together, consider factors like your activity level, personal and work responsibilities, symptoms, and other health factors such as diabetes, high blood pressure, or smoking.

Hernia Treatment: Elective vs. Emergency Repair

A hernia is only an emergency in one of these situations:

• Incarceration: You can’t push your bulge back in, so blood flow to the trapped tissue decreases. Incarcerated hernias may lead to intestinal blockages. Only 3 percent of hernias become incarcerated.
• Strangulation: Tissue becomes trapped, loses all blood flow and dies. A strangulated hernia is a surgical emergency because it can cause sepsis, a life-threatening infection. Only 1 percent of hernias become strangulated.

If you’re experiencing either emergency situations, Dr. Schilling says it’s important to seek emergency medical and surgical care immediately.

Most hernia surgeries are elective procedures. That means you choose when to have surgery.

“When we’re able to perform a hernia repair electively, we can time it right for the patient’s schedule,” Dr. Schilling says. “We can coordinate with the primary care physician, the surgeon, the anesthesia team – we can make sure we have the best possible scenario for their individual repair.”

For elective surgeries, you will have one pre-operative visit with your surgeon. During this consultation, they will perform a physical exam to confirm surgery is your best option. You’ll also discuss whether you’ll have a minimally invasive or open procedure and if your surgeon will use mesh to fix your hernia.  

Dr. Schilling says it’s important to choose a surgeon familiar with all hernia surgery techniques.

“When you’re considering surgery, find a surgeon who can do both minimally invasive and open repairs,” he says. “Together, you can decide the best approach for your individual needs and how to achieve a good outcome, which is what’s most important.”

Minimally Invasive vs. Open Repair

Minimally invasive surgery can be laparoscopic or robotic. With these techniques, your surgeon makes several tiny incisions (a few millimeters long) on either side of your hernia. Then, they use small tools to cover the weak spot in your abdominal wall with a tightly woven mesh patch.

Minimally invasive surgery, particularly robotic surgery, offers multiple benefits. Procedures are faster. Instead of lasting six to eight hours, surgeons can complete your repair in one to three hours. Most people feel less post-surgical pain, need less narcotic pain medication, and have a lower infection risk. Additionally, you may go home the same day and recover faster. For example, the typical recovery time for a robotic inguinal hernia repair is two to three weeks.

In comparison, open surgery requires one large incision. Your surgeon may choose to repair your hernia with mesh. But if your hernia is smaller than two centimeters, a few small stitches can close it. Open surgery is equally effective, but the post-surgery experience is different. Your hospital stay will be longer, you may need more pain medication, and your full recovery will take four to six weeks.

“The best approach to hernia repair is based on the individual patient presenting with the hernia,” Dr. Schilling says.

A Note About Surgical Mesh

If you need hernia surgery, you may have concerns about the mesh surgeons use in hernia repair. While older mesh products were sometimes associated with problems, Dr. Schilling says many current types of mesh, including what’s used at The Christ Hospital, deliver excellent outcomes.

“Modern mesh is typically made from polypropylene or plastic. It’s very well-researched,” he says. “When you talk with your surgeon, make sure you discuss the types of mesh products they’re using. You want to be sure they’re using one with an excellent track record for safety.”

What to Expect on Surgery Day

Most elective hernia repairs are outpatient procedures. But that doesn’t mean fast, Dr. Weber says.

“Hernia repair may be a same-day surgery,” he says, “but it’s an all-day affair.”

On the day of your procedure, you’ll need to arrive a few hours early. Once your care team prepares you for surgery, you’ll receive general anesthesia to help you sleep through surgery.

Your full care team, including your surgeon, anesthesiologist, surgical technologist, surgical assistant, and nurses, is in the operating room. Together, they monitor you and help ensure you have the best surgical outcome. Depending on your type of hernia, the procedure may last up to four hours.

After surgery, you’ll wake up and spend a few hours in the recovery room before going home.

“Your procedure may be a full-day event, but the goal is for you to sleep in your own bed that night,” Dr. Weber says.

Recovering from Hernia Surgery

Recovery from hernia surgery can take three to four weeks after a minimally invasive procedure or four to six weeks after an open repair. During that time, pay attention to your pain and monitor your activities.

Most patients need narcotic pain medication for the first few days after surgery, Dr. Weber says. After that, pain steadily improves. Over-the-counter medications can help manage it.

Activity restrictions are the biggest part of recovery. The time frame depends on your type of hernia and whether your surgery was minimally invasive or open. For smaller hernias, recovery may take two to three weeks. Recovery for larger repairs can take up to ten weeks.

“You’ll need to pull back from lifting anything over ten pounds and from physical activities like exercising or moves where you’re pushing, pulling, twisting, bending over, or picking things up,” Dr. Schilling says. “The point is to give your core a rest for as long as your surgeon recommends.”

As you heal, Dr. Schilling suggests calling your surgeon’s office with any questions or concerns.

The Christ Hospital Difference in Hernia Care

At The Christ Hospital Health Network, our surgeons are regional leaders in hernia repair. Each provider performs hundreds of minimally invasive and open procedures every year. Our dedicated surgical teams take a patient-centered approach to providing individualized care. We know hernia care isn’t one-size-fits-all. Instead, our surgeons recommend the kind of procedure you should have – and when you should have it – based on your unique needs.

“Hernia in one person is not the same thing as hernia in another person,” Dr. Schilling says. “So, we use our knowledge and surgical principles and we leverage technology to give everyone their own experience.”

For a consultation with one of our hernia experts, call 513-285-1781 or complete this form to request a call back.