Hernias: What you need to know about them

Jul 23, 2017 Dr Zulfikar Bux, Features / Columnists

---

By Dr Zulfikar Bux

Assistant Professor of Emergency Medicine

I can recall growing up and hearing of guys having hernias (sometimes mistakenly called “goady”) and being ridiculed by others. Even now patients tend to be very sensitive if they have hernia. It is not something to be ashamed of, as it can occur in anyone, and it is a condition that can be reversed once you seek help.

WHAT IS A HERNIA?

A hernia occurs when part of an internal organ or body part protrudes through an opening into another area where it ordinarily should not be located. There are many different types of hernias, but the most common is when a portion of the intestine protrudes through a weak area in the muscular wall of the abdomen. This causes an abnormal bulge under the skin of the abdomen, usually near the groin or the navel.

Hernias occur in various locations. Some hernias are present at birth, while others develop during adulthood. Hernias may enlarge due to increased pressure inside the abdomen, such as during straining, persistent coughing, obesity, or pregnancy. There are different types of hernia. The most common ones occur around the umbilical (navel), inguinal (groin) or post incision site of the abdomen (after surgery).

 WHAT ARE SOME SYMPTOMS OF A HERNIA?

Most hernias cause a bulge under the skin. The location of this bulge depends on the specific type of hernia. For example, an inguinal hernia appears as a bulge in the groin, while an umbilical hernia appears as a bulge near the navel. Some hernias can cause twinges of pain or a pulling sensation, but most do not cause pain. Hernias are usually easier to see with coughing or straining. They also tend to be more prominent with standing and often disappear with lying down.

A hernia is considered “incarcerated” if a portion of intestine becomes trapped in the hernia and is unable to slide back into the abdomen. Rarely, the trapped intestine can “strangulate.” This means that the contained intestine dies because its blood supply has been cut off by the constriction of the hernia. This causes severe pain and requires urgent surgery.

HOW ARE HERNIAS DIAGNOSED?

Most people discover their own hernias by noticing a bulge. Sometimes, however, your doctor will find a small hernia as part of a routine examination. Your doctor makes the diagnosis by physical examination. He or she may ask you to strain or cough (especially while standing), which may make the bulge easier to see or feel.

Rarely, you may have symptoms that suggest a hernia, but the doctor will be unable to find one at the time of examination. In these circumstances, your doctor may recommend a computer tomography (CT) scan or an ultrasound of the abdomen.

HOW LONG CAN THEY LAST?

Most hernias stay the same or slowly get larger over time. Umbilical (navel) hernias, however, are a special situation. Most small umbilical hernias that appear before a baby is 6 months old will disappear before the child’s first birthday. Even larger umbilical hernias may disappear before age 3 or 4.

HOW CAN THEY BE PREVENTED?

Losing weight is helpful if you are overweight. If you frequently need to strain when you move your bowels, speak to your doctor. Your doctor may prescribe stool-softening medication or suggest that you modify your diet to include more high-fibre foods. Doing exercises to strengthen your abdominal muscles is also a good way to prevent your muscles from getting weak and acquiring a hernia.  You should always practice proper techniques when lifting weights and should always avoid lifting heavy weights by yourself.

WHAT ARE THE TREATMENT OPTIONS?

Although not all hernias need to be operated on, hernias that cause symptoms or that become larger should be repaired by a surgeon. The technique used to repair your hernia depends on its type, size and location. The surgical options include:

-Simply stitching the defect closed

-Using mesh plugs or patches to repair the defect

-Performing laparoscopic surgery to fix the defect. The surgeon makes a small incision in the skin and performs the surgery using a telescope).

If you are considering having a hernia repaired, you and your surgeon will discuss which technique is most appropriate for you. Hernias that become incarcerated or strangulated require immediate medical attention. Your doctor will try to massage the hernia back through the hole in which it is stuck. If this cannot be done, emergency surgery may be needed. Otherwise, most hernia repairs can be done on an outpatient basis as a non-emergency.

Umbilical hernias in infants usually are not treated surgically unless the hernia continues past the child’s third or fourth birthday, becomes larger, causes symptoms or strangulates. Umbilical hernias are more likely to need surgery if the opening through which the hernia passes is greater than 2 centimetres in diameter. 

WHEN TO CALL A PROFESSIONAL?

Call your doctor right away if there is significant pain at the site of a hernia. This can be the first sign that a hernia is incarcerated or strangulated. See your doctor if you notice a new, painless lump or swelling in a location where hernias typically occur.

When surgery is used to repair hernias, the outlook is generally very good. If you suspect you have a hernia, do not hesitate to get it checked. The earlier they are treated the better.

---

---