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Hernia

A hernia occurs when an organ pushes through an opening in the muscle or tissue that holds it in place. For example, the intestines may break through a weakened area in the abdominal wall.

Hernias are most common in the abdomen, but they can also appear in the upper thigh, belly button, and groin areas. Most hernias aren’t immediately life-threatening, but they don’t go away on their own. Sometimes they can require surgery to prevent potentially dangerous complications.

Common Hernia Types

Inguinal Hernia

If you feel a pain in your groin when you cough or lift something heavy, you may have what doctors call an inguinal hernia. It happens when a part of the small intestine or fat pushes through a weak area of your lower abdominal wall.

This type of hernia is named for the inguinal canal. That’s a passage in the lower abdominal wall that houses blood vessels and nerves, as well as the spermatic cord in boys and men, and ligaments that support the uterus in girls and women.

An inguinal hernia could be a serious health problem, so you shouldn’t ignore symptoms. A physical exam is usually all it takes to diagnose the problem. If the hernia is large enough, you’ll need surgery to fix it.

How do they form?

A baby can get an indirect inguinal hernia if the lining of their abdomen doesn’t fully close while they’re developing. What’s left is an opening at the upper part of the inguinal canal. That’s where a hernia can take shape.

Older adults usually get a direct inguinal hernia because the muscles of their abdominal wall can weaken.

Women rarely have this type of hernia. The broad ligament of the uterus is right behind the abdominal wall, which supports it and shields the inguinal canal.

Men don’t have that barrier, so stress and gradual weakening of their abdominal muscles over time make it more likely something can push through to the inguinal canal.

Hiatal hernia

The hiatus is an opening in the diaphragm – the muscular wall separating the chest cavity from the abdomen. Normally, the esophagus (food pipe) goes through the hiatus and attaches to the stomach. In a hiatal hernia the stomach bulges up into the chest through that opening.

There are two main types of hiatal hernias: sliding and paraesophageal (next to the esophagus).

In a sliding hiatal hernia, the stomach and the section of the esophagus that joins the stomach slide up into the chest through the hiatus. This is the more common type of hernia.

The paraesophageal hernia is less common, but is more cause for concern. The esophagus and stomach stay in their normal locations, but part of the stomach squeezes through the hiatus, landing it next to the esophagus. Although you can have this type of hernia without any symptoms, the danger is that the stomach can become “strangled,” or have its blood supply cut off.

Many people with hiatal hernias have no symptoms, but others may have heartburn related to gastroesophageal reflux disease, or GERD. Although there appears to be a link, one condition does not seem to cause the other, because many people have a hiatal hernia without having GERD, and others have GERD without having a hiatal hernia.

What Causes a Hiatal Hernia?

Most of the time, the cause is not known. A person may be born with a larger hiatal opening. Increased pressure in the abdomen such as from pregnancy, obesity, coughing, or straining during bowel movements may also play a role.

Hiatal hernias occur more often in women, people who are overweight, and people older than 50.

Umbilical hernia

If your baby has a bulge around his belly button, he may have an umbilical hernia.

Before his umbilical cord falls off, you may notice that the area seems to stick out a little more when he cries. Or maybe, once the cord is gone, you see that his naval sticks out. In some cases, even if you can’t see a bulge, you might be able to feel one.

What causes umbilical hernias?

While you’re pregnant, the umbilical cord is connected to your baby’s abdominal muscles through a small hole. This usually closes up after he’s born. When it doesn’t, the gap that’s left is called an umbilical hernia. If intestines and fluid poke through it, they cause your baby’s belly to bulge or swell.

Forget what you may have heard: the way the doctor cuts or clamps the cord when your child is born doesn’t affect whether an umbilical hernia will form or not.

Incisional hernia

Incisional hernias can occur after you’ve had an abdominal surgery. Your intestines may push through the incision scar or the surrounding, weakened tissue.

What causes a hernia?

Hernias are caused by a combination of muscle weakness and strain. Depending on its cause, a hernia can develop quickly or over a long period of time.

Common causes of muscle weakness include:

• Failure of the abdominal wall to close properly in the womb, which is congenital defect

• Age

• Chronic coughing

• Damage from injury or surgery

Factors that strain your body and may cause a hernia, especially if your muscles are weak, include:

• Being pregnant, which puts pressure on your abdomen

• Being constipated, which causes you to strain when having a bowel movement

• Lifting heavy weight

• Fluid in the abdomen, or ascites

• Suddenly gaining weight

• Surgery in the area

• Persistent coughing or sneezing

Am I at risk for a hernia?

The factors that increase your risk of developing a hernia include:

• A personal or family history of hernias

• Being overweight or obese

• A chronic cough

• Chronic constipation

• Smoking, which can trigger a chronic cough

Conditions such as cystic fibrosis can also indirectly increase your risk of developing a hernia. Cystic fibrosis impairs the function of the lungs, causing a chronic cough.

What are the symptoms of a hernia?

The most common symptom of a hernia is a bulge or lump in the affected area. In the case of an inguinal hernia, you may notice a lump on either side of your pubic bone where your groin and thigh meet.

You’re more likely to feel your hernia through touch when you’re standing up, bending down, or coughing.

If your baby has a hernia, you may only be able to feel the bulge when they’re crying. A bulge is typically the only symptom of an umbilical hernia.

Other common symptoms of an inguinal hernia include:

• Pain or discomfort in the affected area (usually the lower abdomen), especially when bending over, coughing, or lifting

• Weakness, pressure, or a feeling of heaviness in the abdomen

• A burning, gurgling, or aching sensation at the site of the bulge

Other symptoms of a hiatal hernia include:

• Acid reflux, which is when stomach acid moves backward into the esophagus causing a burning sensation

• Chest pain

• Difficulty swallowing

In some cases, hernias have no symptoms. You may not know you have a hernia unless it shows up during a routine physical or medical exam for an unrelated problem.

How is a hernia diagnosed?

Inguinal or incisional hernias are usually diagnosed through a physical examination. Your doctor may feel for a bulge in your abdomen or groin that gets larger when you stand, cough, or strain.

If you have a hiatal hernia, your doctor may diagnose it with a barium X-ray or endoscopy.

A barium X-ray is a serious of X-ray pictures of your digestive tract. The pictures are recorded after you’ve finished drinking a liquid solution containing barium, which shows up well on the X-ray images.

An endoscopy involves threading a small camera attached to a tube down your throat and into your esophagus and stomach.

These tests both allow your doctor see the internal location of your stomach.

If your child has an umbilical hernia, your doctor may perform an ultrasound. An ultrasound uses high-frequency sound waves to create an image of the structures inside the body.

Treatment options for a hernia

Whether or not you need treatment depends on the size of your hernia and the severity of your symptoms. Your doctor may simply monitor your hernia for possible complications. Treatment options for a hernia include lifestyle changes, medication, or surgery.

Lifestyle changes

Dietary changes can often treat the symptoms of a hiatal hernia, but won’t make the hernia go away. Avoid large or heavy meals, don’t lie down or bend over after a meal, and keep your body weight in a healthy range.

Certain exercises may help strengthen the muscles around the hernia site, which may reduce some symptoms. However, exercises done improperly can increase pressure at the area and may actually cause the hernia to bulge more. It’s best to discuss what exercises to do and not do with your doctor or physical therapist.

If these changes don’t eliminate your discomfort, you may need surgery to correct the hernia. You can also improve symptoms by avoiding foods that cause acid reflux or heartburn, such as spicy foods and tomato-based foods. Additionally, you can avoid acid reflux by losing weight and giving up cigarettes.

Medication

If you have a hiatal hernia, over-the-counter and prescription medications that reduce stomach acid can relieve your discomfort and improve symptoms. These include antacids, H-2 receptor blockers, and proton pump inhibitors.

Surgery

If your hernia is growing larger or causing pain, your doctor may decide it’s best to operate. Your doctor may repair your hernia by sewing the hole in the abdominal wall closed during surgery. This is most commonly done by patching the hole with surgical mesh.

Hernias can be repaired with either open or laparoscopic surgery. Laparoscopic surgery uses a tiny camera and miniaturized surgical equipment to repair the hernia using only a few small incisions. Laparoscopic surgery is less damaging to the surrounding tissue.

Open surgery requires a longer recovery process. You may be unable to move around normally for up to six weeks. Laparoscopic surgery has a much shorter recovery time, but the risk of your hernia reoccurring is higher.

In addition, not all hernias are suitable for laparoscopic repair. This includes hernias where a portion of your intestines has moved down into the scrotum.

Potential complications of a hernia

If left untreated, your hernia may grow and become more painful. A portion of your intestine could become trapped in your abdominal wall. This can obstruct your bowel and cause severe pain, nausea, or constipation. An untreated hernia can also put too much pressure on nearby tissues. This can cause swelling and pain in the surrounding area.

If the trapped section of your intestines doesn’t get enough blood flow, strangulation occurs. This can cause the intestinal tissue to become infected or die. A strangulated hernia is life-threatening and requires immediate medical care.

You can’t always prevent the muscle weakness that allows a hernia to occur. However, you can reduce the amount of strain you place on your body. This may help you avoid a hernia or keep an existing hernia from getting worse. Prevention tips include:

• Not smoking

• Seeing your doctor when you’re sick to avoid developing a persistent cough

• Maintaining a healthy body weight

• Avoiding straining during bowel movements or urination

• Lifting objects with your knees and not your back

• Avoiding lifting weights that are too heavy for you