Hernias

Hernias occur when internal organs slip through tears in tissue walls. There are several types of hernia, including inguinal, femoral, umbilical and incisional. Inguinal is where the intestines slip through the abdominal wall near the groin; it is the most common type. Femoral hernias occur in the upper thigh, umbilical hernias involve the navel and incisional hernias occur after surgery.

Although some people may not experience any hernia symptoms, they can be quite painful. Symptoms often include pain in the affected area that is exacerbated by coughing or straining. Many patients also notice a small tissue bulge when a hernia develops.

Individuals who suspect a hernia should seek medical attention as soon as possible. Doctors can usually diagnose hernias through a physical exam. Treatment typically involves symptom management and changing behaviors to limit irritation of the area. Surgery is the only way to permanently correct the tear that causes a hernia. Hernia repair is among the most common types of surgery performed in the U.S., with over 1 million performed each year. The vast majority of those use hernia mesh.

Common Hernia Types

The majority of hernia cases are inguinal, umbilical or hiatal. Other types, such as femoral and incisional, are less common.

Inguinal hernias occur in the groin region. The most common type of hernia, inguinal hernias occur more frequently in men than women but can affect anyone. There are two subcategories of hernias within the inguinal type: direct and indirect. They are differentiated by when the tear occurs, either over time from wear or at birth, respectively.

If left untreated, inguinal hernias can become incarcerated, or stuck outside of the abdominal cavity. This can lead to a loss of blood flow to the affected organ, a condition known as strangulation. It is very important to have inguinal hernias diagnosed and treated promptly to avoid this progression.

Umbilical hernias occur around the navel, most commonly in babies, when the tissue around the umbilical does not fully close. They are often painless, with the only symptom being a raised area around the navel that bulges when a baby strains. Umbilical hernias often resolve on their own before children reach the age of four. Adults should seek immediate medical intervention for umbilical hernias.

Hiatal hernias involve a tear in the diaphragm separating the abdomen and chest cavities. This allows a small portion of the stomach to bulge into the chest, which can cause pain, discomfort and acid reflux symptoms. The risk of developing a hiatal hernia increases with age, with them being most common in adults over 50.

Incisional hernias occur in a surgical incision, usually within a few months after surgery. Patients suspecting an incisional hernia should discuss their symptoms and concerns with their surgeon.

Muscle and connective tissue weakness are the most common causes of hernias. Most people develop weaknesses as they age; however, some people are born with weak connective tissue. Surgery and certain medical conditions can also contribute to muscle and tissue weakness.

Other hernia causes include activities that put excessive pressure on the abdominal wall, such as chronic cough, strenuous activity and straining during bowel movements.

There are also certain risk factors for hernias. For example, diabetes is a known risk factor because it increases healing time and the risk of infection, both of which can lead to incisional hernias. Pregnancy is another risk factor for hernia because of the pressure a fetus puts on the abdominal wall.

The most common symptoms include pain and a noticeable bulge in the affected area. Hernia symptoms can vary, and some people do not experience any. Specific symptoms may depend on the type of hernia.

Internal or hiatal hernias may also produce heartburn or indigestion. This is a symptom of the opening squeezing the stomach. It contributes to acid buildup in the esophagus and is one of the most common causes of acid reflux.

While hernia symptoms are often mild, some are cause for concern. Hernia patients who experience sudden intense pain, nausea or digestive issues, difficult bowel movements or a hernia bulge that turns red or feels firm or tender should seek immediate medical attention. These could be signs of a trapped hernia, which can lead to strangulation.

Patients can live with a hernia for many years using only monitoring and minor interventions. Many patients opt for conservative hernia treatment options at first. This typically includes lifestyle changes and medications to manage pain and other symptoms. For example, some doctors prescribe proton pump inhibitors to reduce stomach acid. For many, this is sufficient and they need no further treatment.

Some patients whose hernias worsen or interfere with daily activities will opt for surgical intervention. Hernia surgery is the only permanent treatment for the condition. During surgery, doctors close tears, often using a hernia mesh for a long-term fix. There are two main types of hernia surgery: open and laparoscopic. The latter is a minimally invasive procedure that has fewer potential complications.

Understanding Hernia Mesh Surgery

The vast majority of surgeries utilize a hernia mesh to reinforce the torn area. Mesh is a synthetic path that covers the tear. It provides support to the damaged tissue and acts as a scaffold for new tissue growth.

Doctors can also use a pure tissue repair, suturing the damaged tissue to close it. This can involve multiple layers of tissue for strength. Pure tissue repairs are much less common than those using hernia mesh.

The use of mesh appears to reduce hernia recurrence after surgical repair. One review of available data showed that in the study population, mesh surgery reduced the recurrence incidence and many other complications.

Hernia mesh surgery is a very common procedure. Most patients recover in a few days, although a full recovery can take a couple of weeks. It’s important to follow the advice of the surgeon performing the hernia repair for the best postoperative results.

Complications and Considerations

Complications from hernias can include entrapment, incarceration and strangulation. These block blood flow to the herniated organ, which can lead to more serious complications. Anyone experiencing a sudden change in symptoms should seek immediate medical attention to avoid long-term effects.

There are also complications associated with hernia surgery. Recurrence was a common complication, but its likelihood has lessened with the introduction of hernia mesh. Other potential complications include bowel obstruction, infections and mesh adhesion to neighboring tissue.

Some patients have severe reactions to hernia mesh. Additionally, there is a risk of mesh failure, which can cause its own set of complications. Affected patients have filed hernia mesh lawsuits seeking compensation.