UNDERSTANDING HERNIAS AND RELATED PAINS
From blinking an eye to running a marathon, the muscles throughout your body make your every movement possible. But that’s not all they do. Because muscle is dense and strong, it also helps hold your organs in place. Sometimes though, you can get a weak spot in a wall of muscle that’s normally tight. When that happens, an organ or some other tissue can squeeze through the opening and give you a hernia. Picture an inner tube bulging through a hole in a beat-up tire — you get a bubble popping out where it doesn’t belong. There are a lot of different types of hernias. They can hurt, but most of the time, you’ll just see a bulge or lump in your belly or groin. And they don’t usually go away without some kind of treatment, which often means surgery. Recently, we have received several questions from our readers concerning hernias and if there are possible treatment options besides surgery, and whether they may mean a surgical emergency. Before we address ourselves to those questions, it is impertinent to first understand what hernias are, and how and where they happen.
What is a hernia?
An abdominal hernia occurs when an organ or other piece of tissue protrudes through a weakening in one of the muscle walls that enclose the abdominal cavity. The sac that bulges through the weak area may contain a piece of intestine or fatty lining of the colon (omentum) if the hernia occurs in the abdominal wall or groin. If the hernia occurs through the diaphragm, the muscle that separates the chest from the abdomen, part of the stomach may be involved. The abdominal wall is made up of layers of different muscles and tissues. Weak spots may develop in these layers to allow contents of the abdominal cavity to protrude or herniate. The most common abdominal hernias are in the groin (inguinal hernia), in the diaphragm (hiatal hernia), and the belly button (umbilical hernia). Hernias may be present at birth (congenital), or they may develop at any time thereafter (acquired).
Types of hernias
- Groin Hernias
About 3 out of every 4 hernias are in the groin. There are 2 types: inguinal and femoral.
Inguinal: Almost all groin hernias are this kind. You get them when part of your intestine pushes through a weakness in the lower belly and affects an area of the groin called the inguinal canal.
There are 2 kinds of this hernia:
- Indirect inguinal hernia. The more common type; it enters the inguinal canal
- Direct inguinal hernia. Does not enter the inguinal canal.
People often get them by lifting heavy objects. They’re much more common in men than women, but they’re not limited to adults. In fact, surgery to repair them is one of the most common operations for kids and teens. With an inguinal hernia, you’ll likely see a lump where your thigh and groin come together. It may seem to go away when lying down, but you see it clearly when you cough, stand, or strain. If it causes you pain, it may get worse when you bend over, cough, or lift something heavy. Generally, these hernias aren’t dangerous. But if you don’t treat them, they can lead to more severe problems. For example, the part of the intestine that’s poking through can have its blood supply cut off. That can be life-threatening.
Only a few out of every 100 groin hernias are femoral. They’re more common in older women. They are often mistaken for inguinal hernias. They bulge into a different area of the groin called the femoral canal. You might see a lump right around the crease of the groin or just into the upper thigh.
They can be life-threatening in the same way as inguinal hernias. The danger with femoral hernias, though, is that you often don’t get or feel any symptoms or see anything until you need medical help right away.
- Umbilical hernias
An umbilical hernia occurs when part of your intestine sticks out through the opening in your abdominal muscles through which your umbilical cord passed before you were born. Umbilical hernias are common and typically harmless. They are most common in infants, but they can affect adults as well. In an infant, an umbilical hernia may be especially evident when the infant cries, causing the bellybutton to protrude. This is a classic sign of an umbilical hernia.
Children’s umbilical hernias often close on their own in the first two years of life, though some remain open into the fifth year or longer. Umbilical hernias that appear during adulthood are more likely to need surgical repair.
- Incisional hernias-After surgery in which a doctor must make an opening through your belly, you might get an incisional hernia. Tissue pokes through a surgical wound that hasn’t totally healed. Like groin hernias, they can lead to more serious problems if not treated. For people who’ve had surgery, these are fairly common. The only way to fix them is through another surgery, but they can be hard to treat.
- Hiatal hernias-A hiatal hernia is when your stomach bulges up into your chest through an opening in your diaphragm, the muscle that separates the two areas. The opening is called the hiatus, so this condition is also called a hiatus hernia.
With a hiatal hernia, part of the stomach bulges up through this opening and into the chest. You won’t see any lump with one, but you might get heartburn, chest pain, and notice a bad, sour taste in your mouth. They’re the most common hernias for pregnant women, but they’re most often found in people 50 and older.
- Other hernias-There are other less common types of hernias that include:
- Epigastric hernia- This is when fat pushes through the belly somewhere between the belly button and lower part of the breastbone. These show up in men more often than women.
- Giant abdominal wall hernia-You might get one of these if you have an incisional hernia or some other kind that’s hard to treat and keeps coming back. You usually need more surgery to fix it.
- Spigelian hernia-You get this type when fat tissue pushes through muscle below your belly button along the bottom edge of where your six-pack might be.
Are there symptoms associated with hernias?
You might not have symptoms, depending on the type of hernia you have. One common sign of a hernia is the visible bulge in the affected area. Other reported symptoms include;
- Heartburn from gastro-esophageal reflux disease (GERD)
- Chest pain.
- Trouble swallowing.
- Bad taste in your mouth.
- Upset stomach and vomiting.
- Backflow of food or liquid from your stomach into your mouth.
- Shortness of breath.
How can you know if you have a hernia?
Your doctor usually can detect a hernia in a physical exam. He or she also might order tests to further assess your condition and the cause. An ultrasound test uses sound waves to scan your body. A barium X-ray takes images of your digestive area and intestines. A computed tomography (CT) scan also uses X-rays to get pictures. An endoscopy studies your esophagus and stomach using a small camera at the end of a flexible tube.
What are the risk factors for developing hernias?
There are different factors that exacerbate the risk of developing a hernia as discussed below. We are going to restrict ourselves to inguinal hernias, since they are the most common, although these factors cut across almost all types;
- Being male. Men are eight times more likely to develop an inguinal hernia than are women.
- Being older. Muscles weaken as you age.
- Being white.
- Family history. You have a close relative, such as a parent or sibling, who has the condition.
- Chronic cough, such as from smoking.
- Chronic constipation. Constipation causes straining during bowel movements.
- Pregnancy. Being pregnant can weaken the abdominal muscles and cause increased pressure inside your abdomen.
- Premature birth and low birth weight.
- Previous inguinal hernia or hernia repair. Even if your previous hernia occurred in childhood, you’re at higher risk of developing another inguinal hernia.
What are treatment options for hernias?
- The only way to effectively treat a hernia is through surgical repair. However, whether or not you need surgery depends on the size of your hernia and the severity of your symptoms. Your doctor may want to simply monitor your hernia for possible complications. This is called watchful waiting.
- In some cases, wearing a truss may help to ease the symptoms of a hernia. This is a supportive undergarment that helps to hold the hernia in place. You should always see your doctor to make sure that a truss fits properly before using it.
- If you have a hiatal hernia, over-the-counter and prescription medications that reduce stomach acid can relieve your discomfort and improve symptoms. These include antacids, H-2 receptor blockers, and proton pump inhibitors.