The ins and outs of a very common condition: Hernias

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The ins and outs of a very common condition: Hernias

Most of these bulging annoyances are harmless, but pain signals problems.
Katherine Evans

Hernia: It’s something that happens to millions of Americans. A hernia is a condition in which an organ or internal tissue bulges through a weak spot in the muscle or connective tissue that surrounds it. Hernias can occur in several areas of the body including the abdomen, diaphragm, groin, upper stomach and belly button.
While anyone can develop a hernia, they are more common in men than women, according to experts at the UW Medicine Hernia Center. About 23 percent of men will get an inguinal (groin) hernia at some point in their lives compared to just 3 percent of women. The most common hernias, those in the abdominal region, result in approximately 4.7 million outpatient visits each year, according to the U.S. Department of Health and Human Services.
Contrary to popular myth, simply lifting something heavy does not cause a hernia.
“Hernias are typically caused by a combination of genetics and wear and tear on the body, often due to age,” said Dr. Rebecca Petersen of the UW Medicine Hernia Center, which is located at Northwest Hospital. Petersen is a UW assistant professor of surgery.

Clare McLean
Petersen, a UW assistant professor of surgery, checks a patient’s abdomen for a possible hernia.
Petersen examines a patient's abdomen for possible hernia.

Many hernias are present at birth. Over time, they can stretch and grow larger. Lifting, straining and chronic cough can contribute to or enlarge a pre-existing hernia. There also are a number of risk factors for hernia, including obesity, smoking and lung disease, malnutrition and diabetes.
Petersen noted that not all hernias are painful. Some people even have a hernia without realizing it.
“The patients I see usually seek medical attention after noticing a bulge that gradually becomes more and more uncomfortable,” said Petersen. “Your doctor can easily determine if you have a hernia with a simple physical examination.”
In the past, the only available treatment for hernias was to wear a truss or “hernia belt” that helped press the bulge of the hernia back in place, which could relieve some of the discomfort. The earliest hernia operations were done with traditional open surgery. Today, minimally-invasive laparoscopic surgery to repair hernias shortens post-surgery hospital stays and recovery time.
Many hernias do not require immediate intervention, however.
“I usually don’t operate on patients with groin hernias who don’t have any discomfort. There’s very little risk of anything going wrong when they don’t have any pain symptoms. I tell them to keep an eye on the hernia and make an appointment to see me if it becomes uncomfortable,” said Petersen. “When surgery becomes necessary, I prefer to take advantage of minimally-invasive techniques to decrease recovery time and pain. I always try to individualize the hernia repair, depending on the patient’s risk factors and symptoms.”
Though bothersome, most hernias are essentially harmless. However, a rare complication called strangulation can occur when part of the patient’s intestine gets trapped within the hernia. Blood flow to the intestine can become cut off, thereby causing the tissue to die. The consequences can be life-threatening.
“All hernia patients should be aware of the possibility of bowel strangulation. If you start to feel a painful hardened bulge associated with nausea, vomiting, worsening abdominal pain or notice changes in your bowel movements, you should seek emergency care immediately,” said Petersen.
Although most hernias will not develop into a strangulation and may remain a mere annoyance for years, hernias do not heal on their own. The only way to permanently eliminate a hernia is through surgery. The prospect of surgery may be daunting to some, but hernia repair is a routine and common procedure. The U.S. Department of Health and Human Services records some 600,000 inguinal hernia surgeries per year. Most experts, including those at the UW Medicine Hernia Center, agree that when a hernia begins to interfere with your quality of life, it’s time to consider getting it fixed.