The Ins and Outs of Hernias

For many of us, the term hernia conjures up visuals of men engaged in great feats of strength and heavy lifting. But the truth is anyone can get hernias, and they can be brought on by something as simple as sneezing or laughing.

In most cases, a hernia occurs because of a weakness or opening in the muscle or tissue layer that holds your internal organs in place. Pressure within the abdomen brought on by coughing, laughing, a strenuous bowel movement, bending, and, yes, lifting, can force a section of your intestine or other tissue in your abdomen through the weakened area or opening. In many instances—but not all—the hernia will work its way back through the opening. But whether it does or not, a hernia needs to be brought to the attention of your doctor.

Among the things your doctor will want to determine is what type of hernia you have. The most common hernias include:

Abdominal hernias: develop in the area above your groin and below your rib cage. They can occur when the upper part of your stomach bulges through your diaphragm into your chest cavity, or above or around your belly button.

Groin hernias: includes inguinal hernias and femoral hernias. Inguinal hernias account for 75% of all abdominal wall hernias and mostly affect men or people assigned male at birth. Inguinal hernias develop when tissue or organs push through the lower abdominal wall into the groin. A lump may be visible in the groin or scrotum.

Less common femoral hernias can occur in anyone, and are characterized by a small lump in the groin or inner thigh. Because they can occur close to the femoral artery, surgery is often recommended to reduce the risk of complications.

Incisional hernias: this type of hernia may occur if you’ve undergone an abdominal surgery and the incision didn’t heal fully or correctly, leaving a weak spot in your abdominal wall through which organs or tissue can protrude.

While everyone is susceptible to hernias, there are a few risk factors that increase your chances of developing one. You may be more likely to acquire a hernia if you:

• Have a job that involves heavy lifting or many hours of standing
• A history of abdominal or pelvic surgery
• Are pregnant
• Are 50+ years old
• Are diabetic
• Smoke
• Are obese (a body mass index greater than 30) 
• Have chronic constipation
• Have a chronic cough or allergies that cause excessive sneezing

Most hernias aren’t serious, but they can become more serious over time, especially if it gets stuck in the opening that it’s pushed through. Not only is this painful, in severe cases it can cut off from blood supply, leading to tissue death. The good news is most hernias can be effectively treated through surgical repair. Depending upon the size of your hernia and the severity of symptoms, your doctor may opt to simply monitor your hernia for possible complications. A supportive undergarment, called a truss, may be recommended.  However, if your hernia continues to grow or causes pain, surgical repair may be necessary.

Nicholas Wild, MD practices family medicine at SVHC’s Northshire Campus in Manchester, VT.