Chances are good you have heard somebody exclaim that they were going to get a hernia upon lifting something heavy like a toddler or a piece of furniture.
By Nisa Dhir
Chances are good you have heard somebody exclaim that they were going to get a hernia upon lifting something heavy like a toddler or a piece of furniture.
But what exactly is a hernia? How do you get one? And can it be fixed?
In short, a hernia occurs when the inside layers of the abdominal wall weaken, allowing tissue or an organ to bulge through, creating a balloon-like sac.
Sometimes abdominal tissue or part of the intestine can slip into the sac, causing potentially dangerous complications.
No one is immune to hernias. They are fairly common and affect men, women and children of all ages.
Approximately 600,000 hernia repair surgeries are performed in the United States annually, according to the Society of American Gastrointestinal and Endoscopic Surgeons, with an increasing number being performed using a minimally invasive approach.
Hernia causes
The causes of a hernia are not always clear.
Sometimes they happen when the abdominal muscles become strained from lifting or other strenuous activity. Hernias can also be present at birth but not show symptoms or become noticeable until later in life.
In some cases other medical problems will increase pressure on the abdominal wall and muscles, causing a hernia to occur. These related health issues include extra weight, poor nutrition, chronic cough, cystic fibrosis, enlarged prostate, constipation or blockage of the bowel. Pregnancy can also cause hernias.
Hernia types
There are five main types of hernias, each with its own set of symptoms and locations.
One of the more common types of hernia is called inguinal. The inguinal hernia occurs more often in men when tissue or an organ pushes into the groin. In some cases the bulge caused by an inguinal hernia can run all the way to the scrotum.
Another common type of hernia is a hiatal hernia. A hiatal hernia occurs when the stomach pushes up through the diaphragm. The hiatal hernia is more likely to occur in people over age 50, women and those who are obese.
Other types of hernias include:
• Femoral hernia. The femoral hernia usually occurs in women when tissue or an organ pushes into the upper thigh, just below the groin.
• Umbilical hernia. This type of hernia occurs when muscle surrounding the belly button fails to close completely, leaving an opening for tissue or organ to bulge through.
• Incisional hernia. An incisional hernia happens when tissue or organ pushes through a scar caused by abdominal surgery.
Hernia symptoms
Often hernias will show no symptoms.
However when they do cause symptoms, you might feel pain or discomfort, especially when standing, or have a bump that is sore and growing. If you notice swelling in your groin, abdomen, scrotum or thigh, consult your doctor.
In cases of hiatal hernia, symptoms may include heartburn or chest pain.
Complications can occur when a hernia increases so much that it becomes stuck in the hole it created in the wall of the muscle or membrane and loses blood flow. This is called strangulation.
If left untreated, strangulation can lead to puncture of the bowel or a dead bowel. If this happens, emergency surgery is needed.
Diagnosis and treatment
During a hernia exam a doctor or nurse will ask a patient to cough, lean or do other physical movements that increase the size of the hernia, making it easier to find. Usually the doctor or nurse will see or feel the hernia during the exam.
In cases where a hernia is difficult to find, an ultrasound, x-ray or CT scan can help identify its location. Hiatal hernias can typically be seen with endoscopy and studies to evaluate swallowing.
The only way to repair a hernia is with surgery.
There are two types of surgery used to remove hernias: traditional open surgery or minimally invasive laparoscopic surgery, which uses a small camera to allow the surgeon to see inside the patient’s body and make small, precise incisions.
Surgeons at University Medical Center of Princeton at Plainsboro use minimally invasive procedures that include robotic surgery to treat hernias and perform other abdominal surgeries.
The da Vinci System is a state-of-the-art robotic surgical platform with 3D, high-definition vision and miniaturized instruments that enable surgeons to operate through small incisions (one to two centimeters) with enhanced vision, dexterity and control.
Potential benefits of surgery with da Vinci include:
• Significantly less pain.
• Less scarring.
• Shorter recovery time and, faster return to normal daily activities.
• Better clinical outcomes in many cases.
If your doctor recommends abdominal surgery whether for a hernia or other condition, talk to him or her about whether you are candidate for da Vinci.
Prevention
There are a number of simple things you can do to minimize your risk of suffering a hernia, including the following:
• Maintain a healthy weight. Obesity increases risk of hernias by putting added pressure on the abdominal wall. Keep your weight down by eating right and exercising.
• Eat a high-fiber diet. Eating fruits, vegetables and whole grains is good for your heart and body. These foods are also high in fiber, which helps prevent constipation and risk of straining.
• Bend from your knees, not from your waist. Be careful when weight lifting or while lifting heavy objects. Do not lift items that are too heavy and when you do lift something, use proper lifting technique.
• Stop smoking. Smoking causes coughing that can strain your abdominal muscles. Plus, quitting smoking will dramatically improve your health in other ways, too.
To find a physician affiliated with Princeton HealthCare System, call (888) 742-7496 or visit www.princetonhcs.org.
Nisha S. Dhir, M.D., F.A.C.S., is board certified in general surgery and a fellow of the American College of Surgeons. She is a member of the medical staff at University Medical Center of Princeton at Plainsboro.