Hernia

Lawrence + Memorial Hospital offers Digestive Health services comprised of a team of expert clinicians who diagnose, treat, and help patients manage a range of gastrointestinal symptoms and conditions, including all kinds of hernias.

A hernia is a hole or weakness in the body’s tissues. It can develop between the muscles of the abdominal wall, in the groin or even in the diaphragm. This allows parts of organs to push through this area of weakness. This can cause a noticeable bulge, pain, and can occasionally be dangerous. Hernias are very common. In many cases, small hernias may have been present since birth, and they can enlarge over time. Other hernias can develop as we age from repetitive strain, heavy lifting or at sites of previous abdominal surgeries. Hernias do seem to run in families.

Implanted materials like hernia mesh are sometimes used in hernia repairs. In rare cases, these cause problems of their own. We can evaluate and treat these problems.

Other contributing factors for hernias are:

• Physical exertion
• Obesity
• Pregnancy
• Frequent, heavy coughing
• Straining due to constipation
• Prostatism (prostate disorder)
• Smoking
• Prior hernia surgery

Types of Hernias We Treat

There are a number of common types of hernias:

• Hiatal hernia: These hernias cannot be seen on physical exam and are identified with abdominal or chest imaging studies like a CT scan or Upper GI series. They can also be seen in an upper endoscopy exam. In a hiatal hernia, an opening we naturally have in the diaphragm to let the esophagus reach the stomach opens up and part or all of the stomach can slide up into the chest. The simplest type of hiatal hernia is the most common. This is called a “sliding” hiatal hernia and is most commonly associated with acid reflux or GERD. A more complex type of hiatal hernia is called a paraesophageal hernia. This hernia can twist and cause a blockage or obstruction to inflow and outflow of the stomach. This can result in sudden onset of chest or back pain and the inability to swallow. These hernias are often underappreciated, and the symptoms can develop gradually over years. Patients often have discomfort with large meals and a feeling of being full very easily. They often are more comfortable “grazing” and eating multiple small meals a day than the traditional three meals a day. They may have GERD and intermittent issues with chest or back pain that passes with vomiting or belching. These are symptoms of intermittent obstruction and can be warning signs of a possible emergency. Untreated, twisted and obstructed paraesophageal hernias can be life threatening and require immediate attention
• Incisional hernias: happen at the site of a previous surgery that weakened the abdominal wall. These hernias vary in size and can be small, or occasionally quite large.
• Inguinal hernia: The bulge may contain intrabdominal fat or abdominal contents like intestine, colon, or even bladder. Hernias can develop at any age. Inguinal hernias are more common in men. They follow the inguinal canal, an anatomic structure that contains the spermatic cord and blood vessels to the testicle. Larger inguinal hernias can bulge into the scrotum. An inguinal hernia can also occur in newborns and children resulting from a weakness in the abdominal wall present at birth.
  Women can also develop inguinal hernias, often a slightly different type that are harder to detect on an exam. Pain, rather than an obvious bulge, may be the most common symptom. An inguinal hernia may be more prominent during menstruation or pregnancy. An ultrasound can be very helpful in detecting small inguinal hernias in women. If a patient has a hernia on one side of the groin, there is a 50% chance there is a hernia on the other side that hasn’t been noted yet.
• Recurrent hernias: Any hernia that was previously repaired, that has now returned.
• Umbilical hernia: This is a very common hernia and develops near the “belly button”. It develops at a natural weak point in the abdominal wall where the three blood vessels in the umbilical cord penetrated during pregnancy. These holes can enlarge over time. The most common type contains fat just outside of the abdominal cavity, which can be painful but are rarely dangerous. If the hernias enlarge enough to allow intestines to enter, they can become dangerous by causing intestinal blockage. They can also be common in those who are overweight and with multiple pregnancies.
• Ventral hernia: a bulge of tissue through an opening, or defect, in the abdominal muscle wall. This type of hernia is usually umbilical hernias (belly button) and epigastric hernias (just under the breast bone).

Less common hernias include:

• Flank hernias: on the side of that abdomen or even between ribs. These often result from spine or kidney surgery incisions and sometimes from old injuries.
• Lumbar hernias: can cause a bulge on one side at the lower back.
• Spigelian hernias: occur on the lower side of the abdomen that push into, not through the abdominal wall and can be hard to detect, but cause pain in that area.
• Morgagni or Bochladek hernias: rare congenital forms of diaphragmatic hernias due a defect on the diaphragm. 

How to Tell If You Have a Hernia

A noticeable lump or bulge in the abdomen or groin may mean you have a hernia. In many cases, the bulge may come and go. Both men and women can develop hernias, but men are more likely to have groin hernias. Hernias can appear at the sites of prior surgery, we call these incisional hernias.

Other symptoms of hernia may include

• The bulge can be pushed back in, or goes in spontaneously (reducible hernia).
• The bulge may be more prominent with lifting, straining, or coughing.
• The bulge may be more noticeable or uncomfortable at the end of a long day, when you have been on your feet.
• Straining on the toilet or to urinate may cause the bulge to appear or become uncomfortable.
• A tender, hard lump that develops with or without obstructive symptoms can indicate that emergency attention is required.

It is important to call your doctor if you suspect you have a hernia. Waiting too long to see a doctor could result in the need for emergency hernia surgery. A doctor is normally able to see or feel a bulge from a hernia during a physical exam, but some cases might require a CT scan, ultrasound or other imaging to accurately diagnose the condition and plan the repair. If you have had any of these studies, we can review them.

Treatment for Hernias

If left untreated, a hernia can worsen and require surgery. They can occasionally be dangerous and symptoms shouldn’t be ignored. Pain from a hernia, especially in the groin, can increase with both regular and strenuous activity.

Treatments vary, depending on the type and size of the hernia. We offer minimally invasive approaches to most hernias, including robotic surgery and laparoscopic surgery. Our approach focuses on repairing the hole and stabilizing and, in some cases, reconstructing the abdominal wall to enable unrestricted activity, including work and exercise. In any type of hernia in adults, surgery is typically the best remedy in treating the condition and provides a durable repair.