Graceful Health: What do you know about hernias?

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June is National Hernia Awareness Month, and also Men's Health Month. How much do you know about hernias? Are they dangerous? Do they happen to women as well as men? For answers to these questions, read on.

Hernia is a general term describing a bulge of an organ or tissue through an abnormal opening in a body wall that normally contains it.

Although hernias can occur at various places in the body, this column will discuss abdominal wall hernias, named based on their location.

The most common types of abdominal wall hernias occur in the groin area (also known as inguinal or femoral hernias). This accounts for 75% of abdominal hernias. Men are primarily affected, by a ratio of 9 to 1 compared to women. An estimated 25% of all men will experience an abdominal wall hernia in their lifetime.

A second common type of abdominal wall hernia is called a ventral hernia. It occurs in the umbilicus ('belly button") or above it in the midline over the stomach area (an epigastric hernia). Sometimes these are referred to as incisional hernias because they can occur as a complication of previous surgery, because of a resulting weakness at the incision site. Any surgery of the abdominal wall can leave it vulnerable to a future hernia.

Children may also develop hernias, usually as a result of a congenital (birth) defect in the abdominal wall.

In addition to being male, having had abdominal surgery, and congenital defects, there are other risk factors for developing an abdominal wall hernia. These include chronic cough (often smoking related), heavy lifting, age over 50, or previous hernia repair. Any activity that results in increasing the pressure in the abdominal cavity can result in a hernia.

The symptoms of a hernia may appear gradually or suddenly. In some cases, the first sign will be a painless bulge in the abdomen that appears with standing, lifting or coughing and frequently disappears with lying down. This is referred to as a reducible hernia because the hernia can be reduced or returned to the abdominal cavity. In other cases, symptoms can include a dull pain in the bulge or a feeling of pressure.

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If the hernia cannot be reduced or pushed back into the abdominal cavity it is referred to an incarcerated hernia.

In some cases, the blood supply to the herniated tissue becomes blocked or cut off and is accompanied by increasing pain, nausea, vomiting, discoloration of the hernia and pain on pressing the hernia. This is referred to as a "strangulated hernia" and this is a medical emergency!

The diagnosis of hernia is usually made through review of your medical history and a physical exam by your healthcare provider. Frequently the physical examination is all that is needed to diagnosis a hernia. If the hernia is small and no bulge is visible or palpable the diagnosis can be more difficult and may require imaging tests such as a CT scan or ultrasound of the abdomen. This is only necessary if there is abdominal pain without a clear diagnosis of a hernia on physical examination.

Treatment of the hernia will depend on its size and whether you have symptoms. If you do not have symptoms it may be reasonable to watch you carefully and modify activities that will affect your hernia such as coughing, lifting or straining. If your hernia is large if may be better to have it treated before complications develop. Abdominal wall hernias require surgery, and over 700,000 of these surgeries are performed each year in the United States alone.

Incarcerated hernias tend to require treatment because they are usually symptomatic. Strangulated hernias, as mentioned before, are a medical emergency and need immediate treatment because of serious and progressive symptoms if not treated.

Surgery is the definitive treatment for all hernias. An estimated 3 billion dollars a year is spent on surgical repair and related treatment of abdominal wall hernias, making this one of the most common surgeries performed. The only nonsurgical treatment for a hernia is a truss but there is no evidence for their efficacy and there are concerns that improper use may make symptoms worse.

Surgery for hernias can frequently be done under local anesthetic, which reduces risks of complications from general anesthesia. Returning to work after hernia surgery will vary depending on the type of hernia and the physical level of your work.

Dr. Ron Vallario sees patients at Grace Cottage Family Health and is an assistant professor at UMass Medical School in Worcester, Mass.


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