A hernia is when an organ or tissue pushes through a hole in the cavity that normally holds it in place. They are commonly seen in the abdomen including the groin area, upper thigh, belly button, and internally where the stomach enters the chest. While most hernias are not life threatening, some may require urgent surgical correction to prevent complications.
Inguinal: These hernias are the most common type of hernia, and occur when abdominal fat or bowel push through a spot in the lower abdominal wall. This often occurs into the inguinal canal which in men is where the spermatic cord follows from the abdomen into the scrotum, and holds the testicles. In women, this is where the round ligament holds the uterus in place. Men are more prone to this kind of hernia as the abdominal wall tends to have an area of weakness from the testicles descending from the abdomen to the scrotum during infancy.
Umbilical: This hernia occurs at the umbilicus, also known as the belly button. This is another area of possible weakness since it is where the umbilical cord is present at birth.
Spigelian: At the edge of the six-pack abdominal muscles. Less common but often very painful.
Incisional: These hernias occur at any place where a previous incision was made on the abdomen. Although incisions are closed with suture, any area where the abdominal wall has been cut puts it at risk for weakening and becoming herniated.
Hiatal: This hernia occurs when the stomach slides up through the diaphragm into the chest. Your diaphragm is a muscle that separates your abdomen from your chest. The only opening in it is where the stomach becomes the esophagus, and this is where weakness can occur, causing a hernia.
There is likely a genetic component to hernia formation, though no gene has been identified specifically. They tend to run in families.
- Strain from coughing, lifting, pregnancy, or constipation
- Congenital defect
- Obesity/weight gain/smoking
- Prior incisions/injury
- Chronic acid reflux is believed to play a role. They can also be caused by increased pressure in the abdomen including pregnancy, weight gain, strenuous exercise and car accidents.
- Protrusion at the site of the hernia, often fat or possibly bowel coming through the defect. Often
time this is more prominent standing up and will reduce while lying flat.
- Burning, aching or pressure like pain at the location of the hernia
- Pressure/fullness like chest pain
- Difficulty swallowing
Factors that can increase one’s risk for hernias are:
- Being overweight
- Frequent straining from chronic lifting, constipation, or coughing
- Family history
- Smoking, diabetes, steroid use
Abdominal hernias are commonly diagnosed with physical exam alone, but CT scans or ultrasounds can also be helpful as well. Hiatal hernias cannot be detected on physical exam, but are seen and characterized by studies including CT, barium swallow, and endoscopy. While measures can be taken to try and prevent hernias from worsening, the defect itself cannot close on its own and surgical intervention is required to fix it. This is usually performed with closure of the hole and reinforcement with mesh over the hernia on the inside of the abdomen. Either by open or laparoscopic approach, we identify the defect in the abdominal wall, remove any structures within the hernia, and then place a polyester mesh over the hole and adhere it to the abdominal wall. This stays in the body forever and over time grows into the abdominal wall and acts to reinforce the tissue and prevent recurrence.
One of the most frequently asked questions we hear is "What about the mesh you see on TV? Do you guys use the same one?" The answer is no.
The particular brand of mesh seen on worrisome TV commericials is now off the market and we have never used it. Many of us recognize the poor design from its inception and refused to ever use this product.
Additionally, the placement of mesh is an important factor when considering severe complications. ANY mesh placed around organs and other important structures in the body can be harmful. In the
past this was done for certain gynecological or urologic procedures.
Since safety is our top priority, our mesh placement is always made securely against the abdominal wall or between muscle layers and does not encircle any abdominal organs, avoiding complications.
We encourage patients to research their treatment and bring questions like these for discussion during their appointment.