Hernias are very common, particularly
in men. Often it is very easy to diagnose a
hernia, and you may have found this page on your own,
without getting a diagnosis from a doctor. If you
have an obvious bulge, you are probably correct in your
diagnosis, but there are some other things that can look
like hernias. And if you just have pain in that
area, without an obvious bulge, the pain may be from
something else.
Look at our hernia data on
Outcomes page
What is a hernia?
What causes a hernia?
How can I tell if I have a hernia?
Should all
hernias be repaired?
Is laparoscopy an option for fixing my hernia?
If
I have my hernia fixed, how long will I be out of work?
What is a hernia?
A hernia is a protrusion of the bowels out through an
area of weakness in the muscular layers surrounding the
abdomen. This most often occurs in the groin area, at
the bellybutton, or along an old surgical scar in the
abdomen. The most common hernia is an inguinal, or
groin, hernia, which is more common in men than
women. Umbilical hernias are also common.
The
intestines and other organs in the abdomen are
completely surrounded by a thin membrane called the
peritoneum. If a weakness in the muscle wall around the
abdomen develops, this membrane can stretch out through
the muscular defect toward the skin. Strictly
speaking, this membrane, extending through the defect,
is the hernia. Anything inside the membrane, such
as intestines or fatty tissue, constitutes the hernia
contents.
What causes a hernia?
Hernias in boys and young men (about 40 years and under)
are usually the result of an enlargement of the opening
where the blood supply to the testicle exits the
abdomen. This usually small opening can be of variable
size, and if it's too large, the bowels can slip out,
too. Women can develop hernias just like boys and
men, in the same areas. There is a related kind of
hernia called a femoral hernia, which bulges out
through a weak area slightly lower in the groin than
where the inguinal hernias develop. This type of hernia
is more common in women. The repair of these hernias is
quite similar to what is done for inguinal hernias.
Older people are more likely to have a different area of
weakness, but the bulge that results is in about the
same place as in the other groin hernias. For patients
with prior abdominal surgery, there may be incomplete
healing of the abdominal wall layers after the initial
surgery. A hernia may be more likely to occur after
abdominal surgery if a patient had any infection in the
incision, if the patient is overweight, or if steroid
medicine is being taken.
How can I tell if I have a hernia?
If you can actually see a "bulge" beneath the skin in
the groin area, or at the bellybutton, or along an old
abdominal incision, chances are, it's a hernia. But a
bulge can signal other things, such as enlarged lymph
nodes, a fatty tumor, or another type of tumor. A bulge
caused by a hernia typically goes away when you lie
down, and it increases in size with coughing or
straining.
Pain in the groin area without any visible bulge might
be a hernia, but can also be due to simple muscle strain
or inflammation. Your surgeon can check for a groin
hernia by placing his finger just under the skin fold
above the scrotum, while asking you to cough or strain.
Sometimes an ultrasound of the area can be helpful.
Should all
hernias be repaired?
Although many surgeons automatically recommend surgical
repair for any hernia, one might consider an option of
"observation only" in certain circumstances. Of
course, if you're having pain or other symptoms from a
hernia, it just makes sense to repair it, unless the
risk for a complication from the surgery, or the risks
of recurrence are too high. But, if you are not
having any symptoms whatsoever, there may be reason to
just wait until you develop symptoms. Now I would not
recommend you make this decision on your own, but rather
after consultation with a surgeon. Be confident that the
surgeons at DeKalb Surgical Associates will consider a
nonsurgical option with you, if appropriate. It is more
likely to be an option the older you are.
If you are very young (and perhaps I can just let you
define what "young" is for you!!), then it probably
makes better sense just to go ahead and fix it, since
you have such a long life ahead of you. But if you are
in your 70s or 80s, and are having no pain, particularly
if you have some active medical problems, it may be
better just to wait to see if you have symptoms. It
might be that you can live out the rest of your life
without ever having to undergo surgery. Now, if you do
not have it fixed, there is always the small possibility
that you will develop an incarceration (that means that
the hernia contents are stuck) at some point. If this
ever happens, you will probably need urgent or emergent
surgery. Fortunately this does not happen often, but of
course if you know you have a hernia and are just
waiting to see if you have symptoms, you are a bit
vulnerable to this possibility.
Is laparoscopy an option for fixing my hernia?
We now have a variety of techniques available for
repairing hernias. One method is to use laparoscopy.
This technique involves placing some instruments behind
the area of weakness, and placing some mesh underneath
the weak area, instead of on top of the weak area. Other
methods involve using mesh as a "plug", or as an
"overlay" to repair the weak area. Each case should be
evaluated individually to determine which alternative
makes the most sense for a given patient. Our surgical
group offers all the various techniques for hernia
repair, and would be happy to discuss with you how your
hernia might best be repaired.
If
I have my hernia fixed, how long will I be out of work?
Your time away from work after hernia surgery depends
very much on the type of work you do, and what your
individual pain threshold is. If you have a very
sedentary job, sitting at a desk all day, your time away
from work might be just a few days. If you do heavy
manual labor all day long on your job, and you will not
be allowed to take any breaks, you may need to be off
work between 4-6 weeks. These estimates are based more
on trying to predict how much pain he will have, and not
because of the possibility of disrupting the repair. It
would be extremely difficult to cough or strain or work
in such a way that the repair would be disrupted. It is
just a matter of how much pain he might have.
So, if you are
someone who can tolerate a lot of pain, and your job is
not too strenuous, you may miss little or no time from
your job. We always recommend avoiding situations
in which you might be vulnerable to injuring yourself if
you do have a sudden jolt of pain in the area of
surgery. For this reason, you should not be up on a
ladder, or do any competitive sports for a few weeks
after surgery. Also, in order to be sure you are a safe
driver, driving is not permitted until you are
reasonably comfortable without the use of pain
medications. |
