Hernia is one of the most common primary care diagnoses. It’s a bulge that appears when a small part of your insides—fat, intestines or stomach—pushes through your muscle wall. Doctors diagnose roughly 1.6 million Americans with a hernia every year. Nearly half require surgery to fix the problem.
In a recent webinar, Kenneth Farber, DO, a family medicine specialist, and Jonathan Schilling, MD, a general surgeon specializing in hernia repairs, discussed the types of hernias, risk factors, symptoms and treatment options.
If you think you may have a hernia, here’s what these experts from The Christ Hospital want you to know.
1. Types of hernias
A hernia can be big or small. You can develop several types of hernias over your body, including:
Epigastric—This hernia develops between your breastbone and belly button. It happens when fat or part of your intestines pushes through a weak spot in your abdominal wall.
Femoral—This uncommon hernia is also called a “sports hernia.” It develops when tissue pushes through your abdominal wall in the upper thigh near your groin. These hernias can be dangerous if they cut off blood supply to the trapped tissue.
Groin and inguinal —This is the most common type of hernia. It occurs when your intestines or abdominal fat push through a weak spot in your lower abdominal muscles into your groin.
Hiatal—These hernias develop when your diaphragm (the large muscle below your lungs that helps you breathe) loses strength around your esophagus, the tube that passes food to your stomach. This weakness allows part of your stomach to push into your chest.
Incisional—These hernias develop in areas where you’ve had surgery before.
Umbilical—This common hernia develops when your intestines squeeze through your abdominal muscles near your navel. The result is a bulge that looks like an “outie” belly button.
2. Hernia risk factors
According to Dr. Farber, hernia is one of the most common problems primary care doctors see. But it’s more common in males than in females. Overall, males have a 20 percent to 40 percent risk of hernia over their lifetimes. For females, the risk is only 5 percent.
Still, Dr. Farber says, almost anyone can develop a hernia. These factors can increase your risk:
Age (particularly people between ages 0-5 and 75-80)
Being male
Chronic constipation (frequent straining can contribute to a hernia)
Chronic cough
Family history
Prostatectomy (removal of the prostate gland)
Smoking
3. Hernia symptoms
Hernia signs and symptoms can vary slightly based on where the problem develops on your body.
Groin hernia
A visible bulge in your groin area is the most common sign of a groin hernia. It appears more often in males than in females. Doctors can diagnose a groin hernia with a physical exam or an imaging exam such as an ultrasound, a CT scan or an MRI.
Groin hernias can be painless. But you may feel a dull ache or heaviness in your groin, Dr. Farber says.
“If you’re lifting, straining or doing sit-ups—those things tend to increase the pressure in your abdomen or groin and actually force a hernia to protrude and become visible,” he says. “Coughing or prolonged standing can do the same thing because you increase that pressure.”
More serious symptoms of groin hernia include:
Bloating
Nausea
Pain
Vomiting
Umbilical hernia
Doctors can identify up to 50 percent of umbilical hernias during a routine physical exam. They occur three times more often in females and are frequently linked to pregnancy, weight gain or loss, or underlying liver disease.
A visible, painless bulge around your belly button is the most common sign. Other symptoms can include:
4. Hernia treatment: surgery
Hernias don’t go away on their own. Surgical repair is the only treatment. But not every patient who has a hernia needs surgery, Dr. Schilling says. Even after surgery, there’s a 10 percent to 15 percent risk that your hernia will come back.
If you aren’t experiencing uncomfortable symptoms or can push the bulge from your hernia back in, you may choose to monitor your hernia—a practice called watchful waiting. Many patients choose this option.
“Before you decide on surgery, you should have a conversation with your surgeon,” Dr. Schilling says. “You need to figure out what type of hernia may exist, what the problem is and how—and if—it should be fixed.”
Most hernia surgeries are elective procedures. That means you can choose when to have the operation. A hernia becomes a medical emergency if you develop either of these rare complications:
Incarceration—You can’t push the bulge back in. Blood flow to that trapped tissue decreases. An incarceration may create a blockage in your intestines that causes increased nausea and vomiting.
Strangulation—Trapped tissue loses all blood flow and dies. Strangulation is a surgical emergency because it can lead to a life-threatening infection called sepsis.
According to Dr. Schilling, you should consider surgery when your hernia begins to bother you or impact your daily activities.
“When you start noticing symptoms, that’s the time to start working with your healthcare team,” he says. “Talk with your primary care provider about a referral to a surgeon and start planning that operation.”
There are two surgical options for hernia repair: minimally invasive hernia repair and open hernia repair. Your surgeon will recommend the right procedure based on your unique health needs.
Minimally invasive hernia repair
During this robotic or laparoscopic surgery, you are asleep with general anesthesia. Your surgeon makes several small incisions on either side of your hernia. Using small tools, they cover the weak spot in your muscle wall with a tightly woven shield called mesh.
“Mesh is a screen that basically reinforces your connective tissue,” Dr. Schilling says. “We use it to add strength to that tissue and to the repairs that we perform. With mesh in place, your hernia is less likely to recur.”
Minimally invasive repairs offer many benefits. You experience less pain after surgery, need less pain medication and recover faster, usually within two to three weeks.
Open hernia repair
Open hernia surgery typically requires only one incision, and surgeons may be able to perform your procedure with local anesthesia instead of general anesthesia. Surgeons often use mesh to repair hernias in open procedures. But it may be easier to fix your hernia with simple stitches. You will feel more pain after an open hernia repair, so you may need more pain medication. Recovery is also longer, averaging four to six weeks.
5. Recovering from hernia surgery
Most hernia surgeries are outpatient procedures. The operation typically lasts 60 minutes, and you can have someone drive you home the same day, Dr. Schilling says. Rest and relax for the remainder of the day.
“You’ll be able to take care of yourself while you recover. You can walk, use the bathroom and move around your house as needed. Going up and down stairs is fine,” he says. “Focus on taking care of yourself instead of others.”
You can shower the day after surgery and return to driving within five days.
To ease your recovery, Dr. Schilling also recommends:
Alternating between acetaminophen and ibuprofen to relieve pain
Avoiding foods that cause bloating or gas
Drinking lots of fluids
Taking a stool softener to reduce any straining
Using ice or cold compresses on pain and inflammation at the surgery site
If you had a groin hernia repaired, avoid heavy lifting, exercising and swimming for two to three weeks. After that, you can return to most normal activities. But a full recovery takes up to three months.
6. Get the hernia care you need
If you think you have a hernia or are experiencing symptoms, reach out to your primary care provider. Evaluating your hernia early can lead to your best outcome.
To learn more about hernia and surgical services at The Christ Hospital Health Network, or to schedule an appointment, call 513-813-5711 or complete this form and a member of our team will contact you.