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June is Hernia Awareness Month, an opportunity to increase our understanding of this common problem, how you can minimize your risk and what treatment options are available.
Hernias don’t go away on their own. You may need surgery to repair the problem.
Swedish general surgeon Aileen M. Hwang, M.D., discusses the risks and how you can reduce them.
Do you have an ache in your groin or belly that seems to linger? Maybe it’s worse at some times than others, but it never really goes away? Do you notice a bulge where you didn’t have one before? If that’s the case, you may have an abdominal hernia. Don’t worry — you’re not alone. Surgeons repair more than 1 million abdominal hernias nationwide every year.
Most abdominal hernias aren’t considered emergencies, but they can be painful and interfere with your quality of life and daily function. Plus, once you have a hernia, it doesn’t go away, so you’ll need surgery to repair it.
“The consequences of not paying attention to a hernia can be life-altering,” says Aileen M. Hwang, M.D., a general surgeon with Swedish Medical Center. “Even as a benign disease, there are emergency cases that can be life-threatening. So it’s important for doctors to talk with their patients and discuss the signs and symptoms of a hernia to improve earlier detection.”
Knowing what causes a hernia can help you either avoid one or let you know when you should talk with your doctor.
What is a hernia?
Hernias are a relatively straightforward problem. A gap forms in the tissues of your abdominal wall, and your internal organs — commonly your intestines — can protrude through. Abdominal wall hernias are common. They’re to occur in at least 2% of men. More than 20 million hernias are estimated to be repaired every year around the world. Per year, approximately 700,000 hernia repairs are carried out in the United States.
Hernias can occur for any number of reasons, such as frequent coughing, straining from constipation, extended physical exertion, or even pregnancy. These activities can place a constant strain on your abdominal wall, making a hernia more likely.
A noticeable bulge or lump in your abdomen or groin is the biggest sign of a hernia. It may be possible for you to push it back in or it may disappear when you lie down. But it almost always returns. You may also experience these other symptoms:
- Pain (cramping, sharp or radiating) at the site of the bulge or lump
- Pain during exertion
- Dull aching sensation
- Increased size of the bulge over time
- The feeling of abdominal fullness or blockage
“Symptoms can vary by the different types of hernias, but if the pain is affecting your quality of life, you need to seek help,” Dr. Hwang says. “If you’re thinking about it three or four times a day or if you’re worried that you have a lump that’s just not going away, can’t be reduced or that is getting bigger, it’s time to reach out.”
What are the types of hernias?
There are several types of abdominal wall hernias:
- Inguinal hernia: This is the most common type of hernia, and it occurs more often in men. There are multiple spaces within the groin where a hernia can occur. It can be there from birth, or you can develop one. They can occur in both men and women but are more common in men.
- Femoral hernia: These hernias are less common but can be more often seen in women. These occur below the ligament that connects your abdominal muscles to your pelvic. This hernia often requires emergency surgery because they’re difficult to reduce.
- Incisional hernia: These hernias result from a prior incision caused by a previous operation. Research shows up to 40% of patients who have undergone an open abdominal surgery eventually develop an incisional hernia.
- Ventral hernia: This type of hernia occurs on your anterior abdominal wall and can be present at birth or developed later. Congenital hernias include umbilical and epigastric hernias which are bulges that occur anywhere along your upper midline and belly button area. If it appears later in life, it is a type of incisional hernia.
- Spigelian hernia: These are rare hernias that can be difficult to detect as it is a hernia that does not involve all layers of the abdominal wall so the bulge may not be as obvious. These can be difficult to diagnose and if there is suspicion of one, it is important to discuss it with a surgeon.
What treatments are available?
Hernias do not go away on their own, but there are scenarios where it can be safe to keep an eye on a hernia. These include asymptomatic hernias or ones with mild symptoms — ones that remain the same size. If you choose to proceed with definitive hernia repair, surgery is your only option, Dr. Hwang says. At Swedish, surgeons opt for minimally invasive repair techniques whenever possible.
“Whether your case is an emergency or if you’ve opted for an elective procedure, we will use a minimally invasive technique whenever possible because it offers you a quicker turnaround so you can return to normal life faster,” she says. “These techniques minimize your pain and therefore decrease the need for pain medication, and they are often a same-day procedure.”
Typically, minimally invasive procedures last between 45 minutes to two hours, depending heavily on the location of the hernia and the complexity of the repair. Recovery time also varies based on the type of hernia that is repaired. For inguinal hernias, you are restricted from heavy activity or lifting for two weeks. Most abdominal wall hernias require a restriction of four-to-six weeks.
Minimally invasive options include:
- Laparoscopic Surgery: This procedure involves three small incisions in your abdomen. Your surgeon inserts a special fiber-optic light, a camera and surgical tools into the incision to push the organs or tissue poking through the gap back where it should be. They will use a synthetic mesh to strengthen that part of your abdomen.
- Robotic Surgery: Much like laparoscopy, surgeons make small incisions and place the instruments into the abdominal space. They use the robot to control the surgical tools. Most hernias require repair with a synthetic mesh, and the robotic platform allows surgeons to place the mesh within the layers of the abdominal wall which avoids interaction between the mesh and intra-abdominal organs like the small intestine or colon. At Swedish Issaquah, the general surgery team has access to the robot 24/7. This allows the same standard of care despite your surgery is elective or emergency.
There are some instances when your hernia may be particularly complex, Dr. Hwang says, or your intestines or other organs can get pinched (strangulated) in the hernia. This problem leads to worsening pain, vomiting or constipation. It can also cause infection or tissue death due to a lack of blood flow. To fix these problems, you will likely need:
- Emergent (Emergency) Surgery: Emergent surgery can be performed as minimally invasive or open. For an open procedure, this surgery involves an incision in your abdomen of varying lengths depending on the size of the hernia. The surgeon will then examine the involved organs (small intestine, colon, stomach, etc.) to ensure that they are viable (healthy and functioning) and will return them to the abdominal cavity. In certain cases, they are not viable, and a section of the involved organ may need to be removed. Ultimately, the surgeon will close the gap in your abdominal wall tissues and may place a mesh. They close the skin with stitches or staples. The hospital stay varies between open and minimally invasive surgery, but both can require six-to-12 weeks of recovery.
How can you reduce your risk?
Although you may not be able to completely prevent a hernia, there are several things you can do to limit your risks, Dr. Hwang says.
“Prevention really lies in lifestyle modifications,” she says. “There’s a lot you can control about your own behaviors.”
To reduce your risk:
- Avoid constipation (and straining) and have good toilet hygiene
- Maintain a healthy body weight
- Exercise regularly
- Use correct form when lifting any heavy objects or working out
- Avoid smoking or talk to your doctor about smoking cessation
- Treat chronic cough
- Avoid poor nutrition
Maintaining or rebuilding good core strength, particularly after surgery, can help you avoid a hernia, as well, she says. She advises all patients to begin an abdominal core health program as part of their post-surgery plan and recovery. This can involve referrals to physical therapy in certain cases.
Every hernia is different, she says, and the goal is to ensure each patient has a personalized approach to their care. It’s important to combine evidence-based care with each patient’s personal beliefs and goals. It’s a collaboration that prioritizes safety, patient experience, and the highest quality care.
Learn more and find a provider
If you have concerns about or think you might have a hernia, it’s important to see a general surgeon or primary care doctor. Whether you require an in-person visit or want to consult a doctor virtually, you have options.
Swedish Virtual Care connects you face-to-face with a nurse practitioner who can review your symptoms, provide instruction and follow up as needed. If you need to find a doctor, you can use our provider directory.
Join our Patient and Family Advisory Council.
This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.