Julie Lindholm, MD, is a general surgeon at Page Hospital.
Question: What is a hernia?
Answer: A hernia is a weakness, or a defect, in the fascia, the strong white tendon that holds an organ in place. The abdomen is a common location for hernias to occur. With an abdominal hernia, a part of the intestine or nearby internal fat can slip through the opening (hernia) in the fascia, causing a bulge or pain and sometimes serious complications.
The most common kind of hernia is inguinal, where there is a natural weakness in the fascia in an area of the groin called the inguinal canal. It is present in both men and women. Prior to birth, the inguinal canal allows passage of testes from inside the abdominal cavity to outside, when they descend to the scrotum. Although females have the same anatomic inguinal canal, gender difference allows ovaries to remain inside.
Inguinal hernias are much more common in males but are common in females as well. If you have been checked for a hernia during a physical exam, you were probably asked to cough, while an exam of the groin was performed.
Another common abdominal wall hernia is called an umbilical hernia, where there is a natural weakness in the fascia around the belly button. After we are born, scar tissue replaces what was once an opening to the umbilical cord. Babies that have umbilical hernias often do not need surgery as scar tissue will form over the hernia, thus fixing it.
Hernias can also occur after scar tissue has healed over surgical incisions. Since scar tissue is never as strong as the original fascia, any surgical scar on the abdominal wall can be a weaker place where a hernia might form. A surgical scar hernia is called an “incisional hernia”.
Risks for developing a hernia include mechanical factors like being overweight, heavy lifting, or chronic coughing. Strength of fascia itself is affected by metabolism changes that occur with aging (the fascia can get weaker), malnutrition, or smoking tobacco. It is always healthier, and better for fascia, to lose weight and stop smoking if either of these applies.
Diagnosis of hernias is done by physical exam. The doctor can feel for the defect while a patient is forcing the bulging, by pushing or coughing. If a hernia can be felt or seen, treatment may be conservative, such as waiting and watching for any changes, or surgical repair. There is not any medication or physical therapy that can heal a hernia.
Two serious complications of hernias are “incarceration” and “strangulation”. An incarcerated hernia is stuck, meaning a segment of bowel or internal fat is trapped and there is swelling in the opening, preventing its return into the abdomen. A strangulated hernia means an incarcerated hernia with gangrene. Strangulation is more dangerous, and is a surgical emergency.
Surgery is the only treatment for hernias but not all people choose surgery. Since hernia pain can limit activities, most people decide upon surgery eventually, so they can resume full sports and work activities.
Surgical treatments vary. Hernias in children require minimal suture repair, while adult patients with complex or recurrent hernias require mesh repair. Mesh is a very durable and flexible material (the most widely used mesh is made by Gore, in Flagstaff, Ariz.). Most adult hernias are repaired with mesh, but this is usually decided upon during surgical planning or even during the operation.
Hernia repairs are normally done as outpatient procedures, and patients should walk (but not drive) after surgery. Heavy lifting is not recommended until the wound has had time to heal.