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All about hernias: symptoms, diagnosis and treatment

June 07, 2018 | UCI Health
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You’ve most likely heard of hernias, but they are fairly rare and usually are not serious.

A hernia occurs when one of our internal organs pushes through a wall of muscle or tissue that is holding it in place.

Only about 5 percent of Americans will develop a hernia. And because hernias often develop without symptoms, you may never know you have one.

“Some patients may see a bulge or feel pressure or minor discomfort,” says Marcelo W. Hinojosa, MD, a UCI Health surgeon who specializes in gastrointestinal and bariatric surgery.

“Others may notice pain late in the day when they have been on their feet, during exercise or when trying to bend down to perform everyday activities. Still others may experience severe pain.”

However, if a hernia in the abdominal area is large enough, the protruding organ can become strangulated within the muscle or tissue fibers, cutting off the blood supply or obstructing the bowel. This rare occurrence can be serious and requires emergency surgery.

Live Well spoke with Hinojosa, an assistant professor in the UCI School of Medicine’s Department of Surgery, about the various types of hernias, their treatments and ways to prevent them or their recurrence.

What are the most common types of hernias?

  • Inguinal: These occur when fat, the intestine or the bladder protrudes through the abdominal wall or into the inguinal canal in the groin. This is by far the most common type of groin hernia, and most occur in men.
  • Femoral: These develop when the intestine enters the canal carrying the femoral artery into the upper thigh. This type of groin area hernia is most common in women.
  • Incisional: This type of hernia, also called a ventral hernia, appears when the intestine pushes through the abdominal wall at the site of previous abdominal surgery.
  • Umbilical: These occur when the small intestine passes through the abdominal wall near the navel. They are most common in newborns and pregnant women.
  • Hiatal: This type of hernia happen when the upper portion of the stomach squeezes through the hiatus, an opening in the diaphragm through which the esophagus passes.

What treatments are available?

  • Watchful waiting: Small hernias that don’t affect one’s quality of life and are asymptomatic can be observed until a patient is worried about the risk of it growing larger or the hernia becomes symptomatic.
  • Surgical repair: If the hernia needs repair, the hole can be closed with sutures or with surgical mesh, which is a woven sheet of either synthetic material or tissue from a cow or pig. Surgery may also be performed with a combination of sutures and surgical mesh.

What should you expect with surgical repair?

The repair method used by surgeons depends on the type of hernia, its size and location.

  • Minimally invasive surgery (laparoscopic or robot-assisted): Many hernias can be repaired through a keyhole-sized incision. Surgery is typically performed under general anesthesia and some patients are able to go home the same day. Recovery time depends on the type and size of the hernia, but patients typically can return to normal activity with the exception of strenuous exercise or heavy lifting — within one or two weeks.
  • Open surgery: Larger hernias in the abdominal wall and those that require abdominal wall reconstruction (which may be needed when hernias are large and recur in the same location) are done under general anesthesia through a larger incision. Patients may stay in the hospital two to five days.

Recovery takes two to four weeks, with no strenuous exercise or heavy lifting for six weeks. Normal activity can be resumed when the patient is feeling well, usually in about two weeks.

Can hernias be prevented?

Some of the contributing factors for developing a hernia can be:

  • A previous abdominal wall surgery
  • Obesity
  • Coughing
  • Heavy lifting
  • Straining during a bowel movement or urination

To help minimize the risk of developing a hernia, or a recurrence after a hernia repair, Hinojosa says it’s a good idea to:

  • Keep your body weight down
  • Quit smoking, which can cause chronic coughing
  • Take precautions when lifting heaving objects

Seeking treatment for constipation, urinary retention and prostate issues may also help minimize hernia symptoms or recurrence, he says.

And if you do have hernia repair, following these guidelines will help ensure a successful recovery and prevent a recurrence.

“There are a number of different types of hernias and multiple repair techniques,” Hinojosa says. “But the most important factor in getting a good repair is to have a surgeon who is skilled in that particular technique and who also can give you options.”

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