What does that bump mean?
You sneeze, just like you normally would, but this time you feel something pop out around your groin area. You feel the crease where your thigh meets your hip and notice that there is something protruding under your skin that wasn’t there just a moment ago. What happened? How do you fix it?
Definition
A hernia is when an organ or fatty tissue slips through an area in the surrounding muscle or connective tissue (fascia). This is caused by the muscle or fascia being weak and an increase of pressure in the area around the organ or fatty tissue. Anything that increases the pressure in your stomach can put you at risk. These potential risk factors can include lifting heavy objects without stabilizing your abdominal muscles, persistent coughing/sneezing and diarrhea/constipation. There are several types of hernias, but the most common are inguinal, femoral, umbilical, hiatal and incisional.
- Inguinal occur in the inner groin and usually involves the intestines or bladder protruding into the inguinal canal. This is the most common form of hernia and often occurs more in men due to natural weakness in the area.
- Femoral occur when intestines enter the canal that carries the femoral artery into the upper thigh. This most often occurs in people who are obese or pregnant women.
- Umbilical is when a small portion of the intestines pass through the abdominal wall near your naval. This is most common in newborns, obese people or women who have had a lot of children.
- Hiatal is when the upper part of the stomach goes through the opening (hiatus) that your esophagus passes through from your chest into your abdomen. This usually effects obese people or those over 50 years of age.
- Incisional is when intestine pushes through the stomach muscles or fascia at the site of a previous surgery. This is most common in elderly or overweight people who are inactive after abdominal surgery.
Symptoms for hernias depend on the type. Inguinal hernias will have a bulge on either side of the groin and it becomes more pronounced if you cough or strain. They will also have a burning/aching sensation at the area with pain/discomfort in the area, especially when coughing, lifting and bending over. Sometimes, men will have pain and swelling in their testicles when the protruding intestines enter the scrotum. Femoral hernias have similar symptoms to inguinal. Umbilical hernias will have a bulge in/around the naval and usually goes away on its own when it occurs in children. Not usually as painful as other kinds. Hiatal hernias typically do not cause any symptoms unless they are large. If they do have symptoms, they are heartburn, belching, difficulty swallowing, chest/abdominal pain, feeling extremely full after meals and vomiting blood or passing black stools (which is a sign of a serious medical condition called gastrointestinal bleeding). With hiatal hernias, you will not have bulge protruding underneath your skin (the protrusion occurs internally where you cannot see it without the benefit of radiographic imaging). Incisional hernias symptoms are similar to umbilical.
Treatment
In order to treat hernias, it depends on the type. Most often the first step is to try to gently push the bulge back in. After that, as long as the hernia is small, most doctors will take a wait and see approach. If the hernia is large or painful, the recommendation is to have surgery in order to repair the damage or to place mesh inside the abdomen to help provide support to the weakened muscles. This can be done through either regular open surgery or laparoscopic. Typically for children, surgery is not recommended unless the hernia is painful, bigger than half an inch in diameter, large and doesn’t decrease in size over the first two years, doesn’t disappear by four years of age, or becomes trapped and blocks the intestines from blood flow/ability to move stool. Hiatal hernias are the only type of hernia that does not follow this treatment course. Typically, the treatment is aimed at controlling the heartburn and preventing symptoms from occurring. Surgery is an option in severe hiatal hernia cases.
A significant complication that anyone with a hernia should be aware of is incarcerated hernia. This is when the hernia is unable to be pushed in and the contents become trapped in the abdominal wall. If the blood flow to the trapped tissue is cut off, this is called strangulation and is considered a life-threatening emergency. Symptoms of this include nausea/vomiting, fever, sudden pain that quickly intensifies in the area of the hernia, a hernia bulge that turns red/purple/dark colored and the inability to move bowels or pass gas. This needs to be treated immediately.
Prevention
For most types of hernias, the prevention is the same. The best things that you can do are to maintain a healthy weight and have a diet high in fiber to keep your bowel movements regular (this helps to reduce the need to strain when having one). Lift heavy objects carefully and remember to use proper lifting techniques that keep your abdominal muscles from having too much stress placed upon them. If you can avoid lifting heavy objects when possible by using a device to do the lifting, it is a good idea to do so. Don’t rely on an abdominal truss to protect your muscles. Don’t smoke or stop smoking since this can increase the likelihood of coughing which strains your abdominal muscles. For hiatal hernias, it is recommended that you eat smaller, more frequent meals throughout the day. This helps to decrease the volume of food in your stomach to something that it can manage and not have it trapped in the hernia. Avoid foods that trigger heartburn or gas, such as fried foods or alcohol. Do not eat within two to three hours of going to bed. This gives your stomach time to empty out before you lay down to sleep. Elevate the head of your bed by six inches to help reduce the amount of stomach contents entering your esophagus while laying down and causing heartburn. Losing weight can also help with reducing the pressure being placed upon your abdominal muscles.
Having a hernia usually comes as a shock to people, but they are manageable and can be treated. By taking control over your hernia, you will be able to have a healthy and active life. If you have any questions or concerns about hernias, please talk to your doctor. If you would like more information about hernias, please visit Gastroenterology.com at http://www.gastroenterology.com/conditions/hernia