A hernia occurs when tissue such as intestine or abdominal fat slides through a hole in the abdominal wall, just under the skin.
Some people are actually born with a hernia, such as an umbilical hernia. Others develop a hernia, such as an inguinal hernia, as some of their abdominal tissues stretch enough to allow internal abdominal organs or fat to pop through the abdominal wall.
Hernias occurring in the lower abdomen, near the groin are called inguinal or femoral hernias. Hernias occurring in the front of the abdomen are called ventral or umbilical (if at the belly button).
While some children are born with hernias, most hernias occur in adults of any age. Men are much more likely to get hernias than women by a factor of 10 to 1.
Many hernias only cause a bulge that is painless. Symptoms of a hernia include pressure in the lower abdomen and pain in the groin that goes to the testicles. Some people feel these symptoms after sitting for long periods of time or after exercise. Severe pain, associated with a tender mass in the groin or abdominal wall, could signify an incarcerated hernia and is a surgical emergency.
The hernia is an abnormal opening in the abdominal wall that allows internal abdominal contents to bulge through the hole and just under the skin, so it can generally be felt as a noticeable bump. A hernia is similar to a hole in a tire, where the inner tube bulges through the tire (see figure). While many hernias cause little or no discomfort, many can be uncomfortable. Most people know they have a hernia because they notice a bulge that is bigger when standing, sitting or coughing and often disappears when they lay down in bed.
Typically, hernias are not dangerous. Most hernias cause minor discomfort or mild pain. Emergency situations such as the intestine getting stuck occur infrequently, but can be life-threatening. Still, because of potential problems and complications associated with hernias, anyone suspected of having a hernia should be evaluated by a primary care physician or surgeon.
Whether or not you need surgery if you have a hernia depends on your symptoms. Recent medical research indicates that patients who have either little or no discomfort from their hernias have such a low rate of complications that surgery is not immediately necessary.
If your hernia causes pain, interferes with your daily activities, or prevents you from exercise, it's time to talk to a surgeon about repair options.
Whether or not you get hernia repair surgery without symptoms is a decision between you and your surgeon. Typically, the doctors at Newton-Wellesley Surgeons don't recommend going forward with surgery immediately just because there's a possibility you may need it someday.
With an inguinal hernia, you have two broad treatment options, which each have two methods:
A) Repair the abdominal wall from the outside in
B) Repair the hole in the abdominal wall with a patch on the inside
We typically recommend the last repair because it offers the best of all worlds. It offers the safety of open surgery while allowing for faster recovery and less of the long-term pain for which laparoscopic hernia surgery is known.
You can return to most jobs 1-3 days after hernia repair surgery. If your job requires heavy lifting, you may need up to 2 weeks of time off for recovery from the operation.
While everyone recovers from surgery differently, most people come off of prescription pain medications by the third day after surgery and almost half of all patients do not take prescription pain medications at all!
For the open preperitoneal repair, we can often do the operation under a sedative and local anesthetic, allowing most patients to spend less than 5 hours total in the hospital.
While there is no perfect surgeon or perfect repair yet, 99% of hernias do not come back. The 1% recurrence rate is typically not different, regardless of what method is used: old-fashioned surgery, hernia repair with mesh, or more advanced repairs. The key is to find a surgeon that performs a lot of one kind of repair.
Your primary care doctor is your best source of information about how to choose a hernia repair surgeon. The most important question to ask a prospective surgeon is how many hernia repair surgeries they've done or do per year. While there is no minimum number per year, you should feel comfortable with the answer you get.
There is no hard number that is consistently used to determine when patients can resume physical activity after hernia repair surgery. Once the surgery is done, your body is in better shape than before the surgery, but in the first 2 weeks afterward, you may experience quite a bit of swelling and scarring that could prevent you from some of the activities you're accustomed to. For this reason, I typically recommend a lot of walking or non-weight-bearing exercise for the first 2 weeks before return to full activity.
The most common material used to make a hernia mesh patch is polypropylene. It is safe, resistant to infection and has been used for more than 50 years. Every several years technology improves the material characteristics in order to provide stronger, lighter products that are better tolerated by patients.
Most hernia surgeons refer to sports hernias as Inguinal Pubalgia or Athletic Pubalgia. While there is a lot written online about this subject, the consensus of most hernia surgeons is that a musculoskeletal injury occurs as a result of a sport. Most patient present with Inguinal or lower abdominal pain which is made worse with exercise. Patients often feel discomfort at night and do not have a hernia on physical examination.
Current treatment recommendation is for aggressive physical therapy to treat the injury and core muscle imbalance that caused the injury. If unsuccessful after 6 months, surgery is recommended, though no single approach as been shown to be better than any other approach.
A recurrent hernia is a hernia that comes back sometime after surgery. This occurs in about 1 in 100 patients. A recurrence occurs as a result of poor wound healing, continued stretching or stress on the abdominal wall, or a technical error on the part of the surgeon. Given the 99% success rate of most hernia repairs, hernia surgery has better outcomes than and some of the lowest risk among most elective operations.
Many patients have used hernia belts safely as a bridge to hernia surgery. Some patients may have travel or business plans when their hernia is first diagnosed. When supervised by a physician, the hernia belt can be used to minimize sypmtoms and the need for immediate surgery. These belts are safe and effective; however, surgery is still the best way to avoid an emergency situation.
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