#hernias

One thing I learned from my hernia surgery recovery journey is that, at least in the United States, surgeons are entirely unequipped to provide their patients with any meaningful recovery advice beyond the usual “don’t lift anything above ten pounds for six weeks”, or something similar. I went into my recovery process thinking I could take my surgeon’s advice and I’d be all set, but I was…

I had a bilateral inguinal hernia repair performed open, with mesh, a little over 30 years ago. It held up extremely well over the years and I nearly forgot I had ever had it done. Over the years, my activity level varied, ranging from very active to fairly sedentary. I was even a cigarette smoker for a brief period of time, and at one point had gained about 50 pounds.  Once I embarked on my…

Hernias are a common medical condition that can affect people of all ages. They occur when an organ or tissue pushes through a weak spot in the surrounding muscle or connective tissue. While hernias can occur in various parts of the body, they most commonly affect the abdomen. If left untreated, hernias can lead to complications such as pain, discomfort, and even life-threatening conditions. Understanding the different types of hernias and their treatments can help identify symptoms and provide timely medical care with a hernia specialist. Let’s take a look in depth!

Different types of hernia, their symptoms and treatment options suggested by a surgeon for hernia

Inguinal hernia

An inguinal hernia happens when part of the intestine bulges through a weak spot in the lower abdominal wall, usually in the groin area. This type of hernia is more common in men because, after birth, their testicles drop through the inguinal canal, which sometimes doesn’t close properly, leaving a weak point. In women, this canal holds a ligament that supports the uterus. If the canal remains weak, it can lead to a hernia over time, especially during activities that strain the abdomen, like heavy lifting or coughing.

Causes:

Weakness in the abdominal muscles

Straining due to heavy lifting, coughing, or constipation

Pregnancy and obesity

Symptoms:

A bulge in the groin or scrotum

Pain or discomfort, especially when bending over, coughing, or lifting

A heavy sensation in the groin

Treatment:

The most effective treatment for inguinal hernia is surgery. There are two main surgical options:

Open hernia repair: The surgeon for hernia makes an incision in the groin, pushes the protruding tissue back into place, and strengthens the weakened area with stitches.

Laparoscopic surgery: A minimally invasive procedure with small incisions and a laparoscope (a thin tube with a camera) to guide the repair. The mesh may be placed to reinforce the abdominal wall.

Umbilical hernia

Umbilical hernias often affect babies and occur when the intestines push through the abdominal wall near the belly button, creating a visible bulge, especially when the baby cries. Most of these hernias heal independently by age 1 or 2 as the abdominal muscles strengthen. If it continues until age 5, surgery may be needed. Adults can also develop umbilical hernias due to factors like obesity, pregnancy, or abdominal fluid buildup.

Causes:

Weakness in the muscles around the belly button

In infants, it occurs when the abdominal wall doesn’t close properly after birth

Obesity, pregnancy, or excessive abdominal pressure in adults

Symptoms:

A visible bulge near the navel, which may increase in size when coughing or straining

Mild pain or discomfort around the belly button

Treatment:

For infants, umbilical hernias usually close independently by age 1 or 2. Surgery is only necessary if the hernia continues or complications arise after this age. Surgical repair is generally recommended in adults, as the hernia cannot resolve independently. The surgery involves pushing the bulge back and closing the opening with stitches or mesh.

Femoral hernia

A femoral hernia happens when tissue pushes through the femoral canal, which is located just below the inguinal canal in the groin. This type of hernia is more common in women, especially older women.

Causes:

Weakness in the lower abdominal wall

Pregnancy or childbirth

Chronic coughing or heavy lifting

Symptoms:

A lump in the upper thigh or groin area

Groin pain, particularly when straining or lifting

Discomfort or pressure in the groin

Treatment:

Femoral hernias are usually treated because they carry a higher risk of becoming strangulated, cutting off blood flow to the tissue. Both open surgery and laparoscopic surgery can be used to repair a femoral hernia, with mesh reinforcement to strengthen the abdominal wall.

Hiatal hernia

A hiatal hernia occurs when part of the stomach pushes through the diaphragm into the chest cavity. This type of hernia is more common in older adults and can lead to gastroesophageal reflux disease (GERD).

Causes:

Age-related changes to the diaphragm

Constant pressure on the stomach due to coughing, vomiting, or straining during bowel movements

Obesity and pregnancy

Symptoms:

Heartburn or acid reflux

Difficulty swallowing

Chest pain or discomfort

Treatment:

For small hiatal hernias, lifestyle changes and medications to reduce acid reflux are usually sufficient. These include:

Avoiding large meals

Eating more slowly

Raising the head of the bed

Taking antacids or proton-pump inhibitors

According to a hernia specialist, surgical intervention may be necessary in severe cases or when GERD is not controlled. The surgery involves tightening the diaphragm opening to prevent stomach protrusion.

Incisional hernia

An incisional hernia happens when the intestine pushes through a surgical incision in the abdomen. It often occurs after abdominal surgery, especially if there’s a rupture or injury to the intestines. While generally manageable, incisional hernias can lead to serious issues like intestinal blockages or ruptures if not treated properly.

Causes:

Incomplete healing of the surgical wound

Excessive strain on the abdomen after surgery

Infection at the surgical site

Symptoms:

A bulge near the previous surgical scar

Pain or discomfort, especially when straining or lifting

Redness or swelling around the site

Treatment:

Surgical repair is the most effective treatment for incisional hernias. Depending on the size of the hernia, an open or laparoscopic process may be used. Mesh is usually placed to support the weakened area and prevent recurrence.

Epigastric hernia

An epigastric hernia occurs in the upper part of the abdominal wall, between the navel and the breastbone. It generally affects fatty tissue pushing through a weak spot in the abdominal muscles.

Causes:

Congenital weakness in the abdominal wall

Straining during activities like heavy lifting, coughing, or constipation

Obesity or rapid weight gain

Symptoms:

A small bulge or lump between the navel and breastbone

Pain or tenderness in the upper abdomen

Discomfort that worsens with movement or physical activity

Treatment:

Epigastric hernias do not resolve on their own and generally require surgical repair. The surgeon for hernia makes an incision over the hernia site and pushes the tissue back into place. The weakened area is then closed with stitches or reinforced with mesh to prevent recurrence.

Spigelian hernia

A Spigelian hernia is a rare type that occurs along the edge of the rectus abdominis muscle, which runs vertically along the front of the abdomen. This type of hernia is difficult to notice due to its location beneath fat and muscle layers.

Causes:

Abdominal muscle weakness due to age or injury

Chronic coughing or straining

Pregnancy or excessive abdominal pressure

Symptoms:

Abdominal pain or discomfort

A bulge or lump in the lower abdomen

Symptoms worsen with physical activity or straining

Treatment:

Surgery is necessary to repair a spigelian hernia. Since the hernia can be difficult to detect, imaging tests like an ultrasound or CT scan may be needed for diagnosis. Both open and laparoscopic processes can be used to repair the hernia and reinforce the weakened area with mesh.

Conclusion