“About two weeks ago I’m on one end of my mother’s piano trying to horse it up the ramp into the moving truck. First my back starts to feel not so good. Then I notice down near my groin isn’t feeling just right either. I figured I’d just strained something a little. But now it’s not going away. When I walk or lift or cough or even stand for a while it starts talking to me down there. And I think it’s a little swollen or something.”
A hernia is the protrusion of an organ through the wall of the cavity that normally contains it. In the case of an inguinal hernia, which this man had, a loop of intestine pushes from the lower abdomen down toward the groin (toward the scrotum in males).
Any young man who has been involved in school sports and has had a sports physical is aware of the “turn your head and cough hard” part of the exam where the doctor checks for an inguinal hernia. Usually the symptoms are either a bulge along one side of the groin or pain in that same area, or both. Inguinal hernias make up over 75% of all abdominal hernias and they are almost 10 times more common in males than females. The rest of abdominal hernias are made up of umbilical hernias (a hernia at the belly button), femoral hernias (slightly lower than the inguinal hernias and almost exclusively found in females), incisional hernias (at the site of past surgeries), and a small number of other less common hernias.
Inguinal hernias are sometimes found at birth and are particularly common in premature babies. Overall, they occur in about 4% of babies, while umbilical hernias occur in about 17% of newborns. Inguinal hernias in babies need to be repaired to avoid the 10-20% chance of strangulation – a complication in which the blood supply to the loop of intestine contained in the hernia is cut off causing that part of the intestine to die if surgery is not done right away.
Umbilical hernias in newborns have a more benign outcome with the vast majority closing before age 3 to 5. If they do not close by this age they can be surgically repaired.
In adults the picture is a little different. Risk factors for hernias in adults include heavy lifting, overweight and obesity, straining at bowel movements, and chronic cough. If a new bulge or pain occurs in the groin or abdomen, a physical exam by a doctor can usually diagnose whether a hernia has occurred. Rarely, imaging is called on to verify or rule out a hernia.
The chance of strangulation is lower in adults. For this reason, if a hernia is painless some adults choose to take a wait and see approach rather than get surgery right away. Of course the hernia won’t ever go away without surgery; exercises and trusses and supports don’t repair the defect.
If surgical repair is decided on, the surgeon can give the pros and cons of an open repair vs. laparoscopic (where a scope is used, allowing for smaller incisions and a quicker recovery). Although it varies, one can usually count on 4-6 weeks of avoiding vigorous physical activity after an open repair, and perhaps half of this time if laparoscopic repair is done. The surgery itself is usually a day surgery except in complicated cases.
One last common, but somewhat different, hernia is a hiatal hernia. These can’t be seen from the outside but usually are noticed on an upper GI study or occasionally on an x-ray. A hiatal hernia is where a portion of the stomach pushes up through the diaphragm, usually at the opening through which the esophagus passes. They are very common occurring in over 60% of individuals over 50 years old. Ninety percent of them give no real symptoms but about 10% give some increased heartburn, indigestion or upper abdominal discomfort. If these symptoms occur, an acid blocker such as Prilosec or others is usually helpful. Very rarely a surgical repair is carried out for an unusually symptomatic case.
But back to the common groin hernias, if you have a tell-tale ache or bulge, you know the drill: see your doc, turn your head and cough.More