A hernia is the abnormal protrusion of an organ or part of an organ through the wall of its containing cavity. Hernias can occur anywhere in the body, but most commonly occur on the abdominal wall, mostly at the belly button (umbilicus). Hernias can also occur in the groin area with the incidence being higher in men as compared to women and children.
The abdomen is covered in layers of muscle and strong tissue that help a person move and protect internal organs – a hernia is a gap in the muscular wall that allows the contents inside the abdomen to protrude outward.
When most hernias start, the internal tissue that pushes through the muscle gap is usually fat. But it’s also possible for part of the bowel to protrude through the opening. The risk of this is very low but, when it happens, it needs emergency repair. Sufferers are encouraged to seek medical attention if they have a painful bulge that does not reduce in size when they lie down and rest, experience worsening pain, nausea and/or vomiting, difficulty having a bowel movement, bloating, racing heart or fever.
Hernia surgery tends to be relatively low risk according to surgical oncologist Dr. Don Major. He said people should have a hernia electively repaired if it is causing symptoms and limiting their daily activities.
“It will be emergently repaired if it becomes complicated which leads to a blockage in the bowel and even perforation of the hernia contents. These individuals may require hospitalization and even intensive care admission,” said Major.
Hernias are common in both men and women. But just when should you opt to have your hernia fixed?
“This is a common question we as surgeons are faced with,” said the doctor. “Patients all the time have the swellings and they always wonder, if and when they should have their hernia fixed?”
The doctor encourages people to discuss their symptoms and whether they should have their hernia repaired.
Groin hernias he said can be acquired due to the weakening in the muscles, or they can be congenital, and a person born with it.
“Hernias that are acquired are usually due to strain on the muscles of the abdominal wall. This strain may be caused by obesity, chronic coughing, constipation, physical exertion and pregnancy.”
Major said 80 percent of hernias occur in the groin area as inguinal or femoral hernias. And usually present as a bulge in the affected groin area or even a swelling in the scrotum or labia of a female.
“The bulge usually appears after straining or heavy lifting and it tends to disappear when the individual lies down,” said the doctor. “These swellings can be associated with pain in the groin, a dragging sensation or heaviness in the groin area. At times, the individual may be able to gently push the lump back into the abdomen to relieve some of the symptoms. When a hernia becomes complicated and requires emergency surgery, there tends to be additional symptoms such as fever, chills, nausea, vomiting and excruciating abdominal pains associated with an irreducible swelling.”
He said some patients may have a swelling with no associated symptoms, meaning they have no pain, ache or discomfort.
“In these cases, when the groin hernia is asymptomatic, it is reasonable to observe these cases, and only intervene if symptoms develop, or the hernia increases in size.”
When assessing a patient for an inguinal hernia, Major said it’s important for doctors to determine if the patient has any predisposing factors for development of a hernia, such as chronic cough, or straining to pass urine or stools. He said if any of the symptoms are present, the patient should be investigated and treated prior to correcting the hernia.
Commonly, the individual that presents with a groin hernia is over the age of 45.
“According to the US
Preventive Services Task Force, it is recommended that all individuals 45 and above undergo screening for colorectal cancer. This means that these individuals should have a screening colonoscopy prior to their operation to fix their hernia. If the colonoscopy is normal, then that individual would not need another colonoscopy for five to 10 years,” said the surgical oncologist.
“When it’s decided that the patient needs an operation to have the hernia repaired, it can be done in one of two ways. The more common way is the open approach where the individual is taken to the operating room and put to sleep. Once asleep, an incision is made over the hernia swelling and the contents of the hernia returned to the abdomen and the weakened abdominal wall is reinforced with synthetic mesh that is permanent. The incision is then closed after injection of local anesthesia. The patient is then awakened and they are usually discharged home some two to three hours post-surgery.”
The alternative way for surgical repair he said can be done via laparoscopy which he said is generally reserved for obese individuals – people with bilateral groin hernias or athletes that he said need to return to training immediately. Major added that in the laparoscopic approach, a mesh is also placed to reinforce the weakened abdominal wall.
“Some of the complications associated with hernia repair include bleeding and infection. Patients can also experience chronic groin pain if a nerve has been trapped in the repair. Some patients may also have a recurrence of the hernia. These are all complications that individuals should be aware of even though they are rare. Hernia surgery tends to be relatively low risk,” said Major.