Do You Have a Hernia?

A hernia occurs when part of an internal organ or fatty tissue bulges through a weak area of muscle. In adults, most hernias occur in the abdomen and cause an abnormal bulge under the skin, usually near the groin or navel. They are common and may occur in men or women. Some hernias are present at birth but others develop during adulthood. Hernias may enlarge due to increased pressure inside the abdomen which may occur during straining with a bowel movement, lifting, coughing or pregnancy.

The most common type of hernia is an inguinal hernia, accounting for 75 percent of hernias. These are at least five times more common in men than in women. These occur in the groin area above the inguinal crease – the area where the top of the thigh joins the torso. For men, this type of hernia sometimes protrudes into the scrotum and, if your doctor suspects an inguinal hernia, he or she will probably insert his or her finger deep into the skin of the scrotum.

Umbilical hernias represent 10 to 30 percent of all hernias. They are often present at birth as a protrusion around the umbilicus (navel or belly button). Sometimes these close by themselves, but they often require surgery at two to four years of age. These hernias also appear later in life because this area can remain a weak spot in the abdominal wall. They are particularly common in obese people or women who have been pregnant.

An incisional hernia is a lump that appears in an area of muscle weakness created by surgery that goes through the abdominal wall. It may show up as a lump adjacent to a surgical scar. This occurs after approximately 10 percent of abdominal surgeries.

A reducible hernia appears as a new lump in the groin or in the abdominal wall. The lump increases in size when standing or when abdominal pressure is increased, for example, when coughing. It is easily reduced or pushed back into the abdomen. An irreducible hernia is occasionally painful and cannot be pushed back into the abdomen. It may be associated with symptoms of bowel obstruction, including nausea and vomiting. This may lead to a strangulated hernia which is an irreducible hernia in which the entrapped intestine has had its blood supply cut off. A strangulated hernia is typically painful and tender and may be associated with fever. A strangulated hernia is a surgical emergency and should lead to an immediate trip to the emergency room.

Usually, if you have a reducible hernia, your doctor will refer you to a surgeon who can help you decide if you should have elective surgery to repair the hernia before it becomes irreducible or strangulated. A surgeon may feel that surgery is unsafe if you have pre-existing medical conditions. In addition, if you are obese, the surgeon may not want to repair your hernia because of a high risk of recurrence. Some kinds of hernias have very large openings in the abdominal wall, making surgical repair very complicated. These hernias are often treated by trusses or abdominal binders.

Finally, hiatal hernias are very common but do not involve the abdominal wall muscles. In a hiatal hernia, the stomach bulges up into the chest through an opening (the hiatus) in the diaphragm. People with hiatal hernias often suffer from GERD (gastroesophageal reflux disease) or heartburn and may require medication to control their symptoms. Sometimes the stomach gets stuck above the diaphragm and surgery may be needed. Hiatal hernias are more common in people over 50, people who are overweight and smokers.

Dr. McMahon, a graduate of Yale University and the University of Pittsburgh School of Medicine, is board certified in Internal Medicine. She is a member of the American College of Physicians and the Allegheny and Pennsylvania Medical Societies. She is in solo practice in the North Hills.