What Is a Hernia and What Can You Do About It?
By Michael DeHaan, MD
When you hear about hernia, you might picture a man lifting a heavy box and then groaning in pain. That is one way a hernia is discovered. But there are different types of hernia and any number of ways they will make their presence known. A hernia is a condition in which a portion of organ or soft tissue pushes through a hole or weak spot in a muscle or surrounding connective tissue (fascia) that line your abdomen or groin.
Hernias happen to men, women, and even infants. A hernia is caused by the interplay of two factors: a weak spot in muscle or fascia and an action that puts pressure or strain on an organ or tissue in that weak spot. Lifting something heavy can cause the strain, but there has to be a weakness in the area for a hernia to occur. The weakness may have been present from birth or it may have developed later. The pressure or strain may come from lifting something heavy as well as from constipation or heavy coughing or sneezing.
You can suffer from a hernia regardless of your level of fitness, whether you are a healthy weightlifter or someone who stays on the couch. But weak muscles make you more vulnerable, so aging, obesity and smoking can make hernias more likely. Some types of hernia are more common in men than women or in infants than adults.
Types of hernia
The most common types of hernia are:
- Inguinal. This groin hernia involves a portion of intestine or bladder protruding. It is the most common type of hernia and far more common in men than women. Men have a tiny natural weakness in one small area of the groin that makes them vulnerable to inguinal hernia. This natural weakness develops before birth, when the testicles, which form in the abdomen, descend to the scrotum.
- Femoral. In this type of groin hernia, the intestine pushes through tissue near where the femoral vein enters the upper thigh. These affect women more often then men, but they are uncommon.
- Incisional. These hernias happen at the site of a surgical incision. These are as common with women as they are with men.
- Ventral. This abdominal hernia happens at other sites of natural weakness or from a birth defect in which the abdominal wall does not completely close. Ventral hernias are treated by reconstructing the abdominal wall.
- Umbilical. A hernia at the belly button, or naval, is common in infants, as well as women who are obese or have had several children. There is a natural weakness in that area. It is where all of the muscles and tissues come together.
- Hiatal. This hernia occurs when the upper stomach squeezes through the hiatus, an opening in the diaphragm where the esophagus passes through. The condition can lead to heartburn and gastroesophageal reflux disease (GERD) and may also cause serious stomach problems.
A hernia may cause extreme pain, or it may not cause any pain. It may appear as swelling under skin on the abdomen, groin or chest. Other symptoms include bloating, constipation, a heavy feeling near your stomach or blood in your stool.
While umbilical hernias in infants can correct themselves, other hernias are corrected with surgery. Whether open surgery or minimally invasive laparoscopic surgery is best treatment will depend on the hernia – its size, location and how long it has been there. Certain types respond better to one procedure than the other, and one option may be better for one person than for another. Each method has a reason to do it and a reason not to do it.
The hernia repair will need to strengthen the weak area to help prevent reoccurrence. Otherwise, whatever tension pulled the muscle apart will do it again. That’s why a mesh material, like a soft screen, is used to reinforce the muscle or fascia. The tissue will grow around the mesh and add support to the tissue. While a hernia is not always a medical emergency, it is often best to treat it right away. If you experience hernia symptoms, you should see your primary care doctor. Don’t let a hernia keep you from doing what you enjoy. Get it fixed and get back to your life. At Loyola Medicine, our hernia program surgeons partner with other specialists so our patients have individual care that includes access to whatever expertise is needed, such as nutrition services, rehabilitation or gastroenterology.
Michael DeHaan, MD, is a board-certified surgeon at Loyola Medicine and assistant professor of surgery at Loyola University Chicago Stritch School of Medicine. He sees patients at Loyola Center for Health at Gottlieb.