A hernia is a protrusion of the bowels out through an area of weakness in the muscular layers surrounding the abdomen. This most often occurs in the groin area, at the belly button, or along an old surgical scar in the abdomen. The most common hernia is an inguinal, or groin, hernia, which is more common in men than women. Umbilical hernias are also common.
The intestines and other organs in the abdomen are completely surrounded by a thin membrane called the peritoneum. If a weakness in the muscle wall around the abdomen develops, this membrane can stretch out through the muscular defect toward the skin. Strictly speaking, this membrane, extending through the defect, is a hernia. Anything inside the membrane, such as intestines or fatty tissue, constitutes the hernia contents.
Causes
Hernias in boys and young men (about 40 years and under) are usually the result of an enlargement of the opening where the blood supply to the testicle exits the abdomen. This usually small opening can be of variable size, and if it’s too large, the bowels can slip out, too. Women can develop hernias just like boys and men, in the same areas. There is a similar hernia type called a femoral hernia, which bulges out through a weak area slightly lower in the groin than where the inguinal hernias develop. This hernia type is more common in women. The repair of these hernias is quite similar to what is done for inguinal hernias.
Older people are more likely to have a different area of weakness, but the bulge that results is in about the same place as in the other groin hernias. For patients with prior abdominal surgery, there may be incomplete healing of the abdominal wall layers after the initial surgery. A hernia may be more likely to occur after abdominal surgery if a patient had any infection in the incision, if the patient is overweight, or if steroid medicine is being taken.
Diagnosis
If you can actually see a “bulge” beneath the skin in the groin area, or at the bellybutton, or along an old abdominal incision, chances are, it’s a hernia. But a bulge can signal other things, such as enlarged lymph nodes, a fatty tumor, or another type of tumor. A bulge caused by a hernia typically goes away when you lie down, and it increases in size with coughing or straining.
Pain in the groin area without any visible bulge might be a hernia, but can also be due to simple muscle strain or inflammation. Your surgeon can check for a groin hernia by placing his finger just under the skin fold above the scrotum, asking you to cough or strain. Sometimes an ultrasound of the area can be helpful.
Hernias are very common, particularly in men. Often it is very easy to diagnose a hernia, and you may have found this page on your own, without getting a diagnosis from a doctor. If you have an obvious bulge, you are probably correct in your diagnosis, but there are some other things that can look like hernias. And if you just have pain in that area, without an obvious bulge, the pain may be from something else.
Treatment
Although many surgeons automatically recommend surgical repair for any hernia, one might consider an option of “observation only” in certain circumstances. Of course, if you’re having pain or other symptoms from a hernia, it just makes sense to repair it, unless the risk for a complication from the surgery, or the risks of recurrence are too high. But, if you are not having any symptoms whatsoever, there may be reason to just wait until you develop symptoms. Now we would not recommend you make this decision on your own, but rather after consultation with a surgeon. Be confident that the surgeons at DeKalb Surgical Associates will consider a nonsurgical option with you, if appropriate. It is more likely to be an option the older you are.
If you are very young (and perhaps we can just let you define what “young” is for you!), then it probably makes better sense just to go ahead and fix it, since you have such a long life ahead of you. But if you are in your 70s or 80s, and are having no pain, particularly if you have some active medical problems, it may be worth considering just waiting to see if you have symptoms. It might be that you can live out the rest of your life without ever having to undergo surgery. Now, if you do not have it fixed, there is always the small possibility that you will develop an incarceration (that means that the hernia contents are stuck) at some point. If this ever happens, you will probably need urgent or emergent surgery. Fortunately, this does not happen often, but if you know you have a hernia and are just waiting to see if you have symptoms, you are a bit vulnerable to this possibility.
Laparoscopy
We now have a variety of techniques available for repairing hernias. One method is to use laparoscopy. This technique involves placing some instruments behind the area of weakness, and placing some mesh underneath the weak area, instead of on top of the weak area. Other methods involve using mesh as a “plug,” or as an “overlay” to repair the weak area. Each case should be evaluated individually to determine which alternative makes the most sense for a given patient. Our surgical group offers all the various techniques for hernia repair, and would be happy to discuss with you how your hernia might best be repaired.
FAQ
If I have my hernia fixed, how long will I be out of work?
Your time away from work after hernia surgery depends very much on the type of work you do, and what your individual pain threshold is. If you have a very sedentary job, sitting at a desk all day, your time away from work might be just a few days. If you do heavy manual labor all day long on your job, and you will not be allowed to take any breaks, you may need to be off work between 4-6 weeks. These estimates are based more on trying to predict how much pain he will have, and not because of the possibility of disrupting the repair. It would be extremely difficult to cough or strain or work in such a way that the repair would be disrupted. It is just a matter of how much pain he might have.
So, if you are someone who can tolerate a lot of pain, and your job is not too strenuous, you may miss little or no time from your job. We always recommend avoiding situations in which you might be vulnerable to injuring yourself if you do have a sudden jolt of pain in the area of surgery. For this reason, you should not be up on a ladder or do any competitive sports for a few weeks after surgery. Also, in order to be sure you are a safe driver, driving is not permitted until you are reasonably comfortable without the use of pain medications.
I had my hernia fixed once, and it came back. What should I do?
Although the risk for recurrence of a hernia is low, there are patients who unfortunately develop a recurrence of a hernia after repair. This can happen whether it is fixed through the “open” technique or through a laparoscopic technique. It can happen just a few weeks after repair, or even 10-20 years later. If a recurrent hernia bothers you in any way, with pain, discomfort, or even just concern about the appearance of the bulge or the sensation of the bulge, another operation is certainly an option. Our surgeons can discuss the options with you. No matter how your hernia was repaired previously, both the open and laparoscopic techniques might be considered. The procedure is sometimes a bit more challenging technically for the surgeon, but one still can expect a very high likelihood of a successful repair the second time around. DeKalb Surgical surgeons are very experienced with hernia repairs, with a combined total of over 100 years of surgical expertise!