Approximately 750,000 to 1 million people have hernia surgery each year, and there are many more patients with hernias that remain untreated. Although wearing an abdominal truss is sometimes recommended to prevent an increase in the size of the hernia, surgery is the only way to truly repair a hernia. Fortunately, this commonly performed procedure is usually safe for most patients.
Hernias affect men, women, children, and infants; however, certain types are more likely to affect each group of people. In general, a hernia is when tissue—most often intestines or fat—squeezes through a hole or weakened area of muscle. Although the surgery is slightly different for each type of hernia, the basic procedure is very similar. First, using either an open or laparoscopic procedure, the bulging tissue is pushed back into its proper place. Next, the weakened or open spot in the abdominal wall is reinforced, usually with synthetic mesh or sutures.
Inguinal Hernia
About 80 percent of all hernias are inguinal. Most of them occur in men, due to a natural weakness in the groin area. A direct inguinal hernia is the result of intestines, fat, or the bladder pushing through a weak spot in the abdominal muscles. This usually occurs as the result of daily wear and tear. In addition to aging of the muscles, lifting heavy objects, or putting undue pressure on the abdomen—through excess weight, pregnancy, or straining during a bowel movement—can increase the likelihood of an inguinal hernia for some people.
An indirect inguinal hernia is more common than a direct inguinal hernia. Shortly before birth, the opening in the inguinal canal (the passage from the abdomen to the genitals) normally closes. If it doesn’t close, intestines or other tissue can push into the inguinal canal. In men, the hernia may even push into the scrotum. Women are more likely to have an indirect inguinal hernia than a direct hernia due to this anatomic defect.
Femoral Hernia
This kind of hernia is found below the groin in the canal that carries the femoral artery into the upper thigh. These are more common in obese individuals or pregnant patients and are more common in women than men.
Incisional Hernia
In this type of hernia, tissue bulges through an opening or weakness in or near an incision. An incisional hernia can occur months—or even years—after a surgery. Incisional hernias are more likely to happen among elderly, obese, or inactive patients or in those who experience infection in the original wound.
Umbilical Hernia
A bulging or inflated navel may be an indication of an umbilical hernia. Although it can occur in anyone, it’s more common in newborns, obese women, or patients who’ve had multiple children. In children, these often go away if left alone for a few years.
Hiatal Hernia
The hiatus is an opening in the diaphragm through which the esophagus passes from the chest into the abdomen. The esophagus empties into the stomach normally just below diaphragm. When this opening becomes weakened or enlarged, a portion of the stomach and/or esophagus can bulge into the chest cavity. Bringing the stomach back into the abdominal cavity and closing the esophageal hiatus around the esophagus repairs a hiatal hernia.
Symptoms and Treatment
While not all patients notice obvious symptoms, in the case of inguinal, femoral, incisional, and umbilical hernias, some individuals may see a swelling in the abdomen or groin (which may shrink when lying down), feel heaviness in the abdomen, or have discomfort in the abdomen or groin when lifting. Hiatal hernias may cause upper abdominal pain or heartburn.
In any of these situations, if you suspect a hernia or have undiagnosed symptoms, your safest course of action is to discuss your concerns with your physician. He or she can help determine what treatment, if any, would be recommended. Most hernias require surgical repair, with or without synthetic mesh; however, certain hernias sometimes can be observed if they’re asymptomatic or deemed to be at low risk for complications. The opinion of an experienced surgeon is required for proper evaluation. TPW