Several weeks ago I met with a patient who we’ll call Joe. He was fairly certain that he had a hernia. Joe was experiencing pain in his lower left abdomen on a summer afternoon when his wife, a professional nurse, instructed him to lie down, relax and remain calm. Then she gently massaged the affected area and as Joe said, “she pushed it back into the abdominal wall and I felt better immediately.”
Joe indeed had an inguinal hernia. An inguinal hernia occurs when tissue, such as part of the intestine, protrudes through a weak spot in the abdominal muscles or fascia. Hernias typically involve the stomach or intestines and are generally found in the groin (femoral, inguinal). Hernias also develop in the upper part of the stomach (hiatal), and the belly button (umbilical or periumbilical). Hernias can also arise as a result of a past surgical scar (incisional). In our discussion we will focus on the most common type of hernia, the inguinal hernia. In most cases, there is not an obvious reason for a hernia to occur. The risk of hernia increases with age and is more common in men than women. With over 200,000 US cases a year, hernias are treatable and usually self-diagnosable. Lab tests or imaging are rarely required.
A hernia can be congenital in children who have a weakness in their abdominal wall. Activities and medical problems such as straining on the toilet due to constipation or straining to urinate can cause a hernia. Other causes include enlarged prostate, persistent cough, heavy lifting, physical exertion, and obesity.
Symptoms include a bulge, swelling, or pain. In some cases, there are no symptoms. Some hernia patients may experience abdominal discomfort, groin discomfort, and tenderness.
Treatment is a choice between monitoring the hernia and corrective surgery either by laparoscopic surgery or open surgery. Discuss treatment options with your health care provider to determine an optimal course of action. Hernias do not go away on their own. In rare circumstances a hernia can lead to life-threatening complications. Consequently, surgery is usually recommended for a hernia that is painful or becoming larger.
Recently I spoke with Joe during a follow-up exam. He told me that he had scheduled a surgical procedure in November to repair his hernia. Then he got a phone call from the surgery center telling him how much it would cost. He decided to postpone the procedure until January when he would be in a better financial position to afford it. Watchful waiting can have advantages. Then he told me about his nephew who discovered he had an umbilical hernia. His nephew decided to ignore it and hoped it would go away. His poor nephew ended up with pain so severe he ended up in the emergency department.
If you think you have a hernia, see your healthcare provider to assess the severity and create a plan of action. Don’t kick the can down the road. Watchful waiting is better than nothing.