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Hernias

Aria Health Center for Gynecology & Women's Health

A hernia is a protrusion of a section of an organ - typically the intestines - through a weakness in the surrounding wall, especially the abdominal wall. A soft bulge is often visible underneath the skin where the hernia has occurred. The abdominal weakening may be present at birth or may develop later in life. Hernias differ primarily by their location:

  • An inguinal hernia occurs in the lower pelvis, groin, or scrotum area, and is the most common type of hernia.
  • A femoral hernia appears in the thigh.
  • An incisional hernia can occur through or near the area of incision from a previous abdominal surgery.
  • An umbilical hernia occurs around the belly button.

If hernias are left untreated, they can enlarge and become more serious. Potential for inflammation, disruption, or strangulation of the GI tract is present in severe cases.


Causes/risk factors

Each type of hernia has a different basis:

  • Inguinal hernia. Men have a greater chance of experiencing one of these types of hernias, and the risk is greater at middle age. After birth the abdominal area called the inguinal canal is more likely to have an incomplete closure in men. This is the area through which the testes descend after birth. Thus, inguinal hernias are sometimes seen in infants. More typically the wall weakness that creates a predisposition to inguinal hernia lies latent until later in life. Thereafter, obesity, pregnancy, heavy lifting, and straining to pass stool - all of which create pressure in the lower abdomen ? can result in a hernia.
  • Femoral hernia. Women are more likely to develop this type of hernia, which occurs where the leg meets the body.
  • Incisional hernia. If the abdominal wall was previously been cut, as part of a surgical procedure, it may be left weaker than normal. Outpouching can occur through, near, or under the scar in that location.
  • Umbilical hernia. A bulge around the belly button may occur if the muscle around the navel has not closed completely; thus, this type of hernia is most common in newborns.

Risk of herniation can be increased as a result of such factors as family history of hernias, obesity, poor muscle tone, multiple pregnancies, and chronic cough or constipation.


Signs & symptoms

Inguinal hernias are by far the most common type of intestinal-wall hernia, and the symptoms include:

  • lump in the groin near the thigh, at the top of the thigh, or near the navel, which may change shape depending on the person's position or activity;
  • pain in the groin or pelvis, which may be worse on exertion;
  • or, in more severe cases, a partial or complete blockage of the intestine.


Diagnosis

Hernias are primarily diagnosed by physical examination.

Treatment

The primary treatment for hernias is surgery. The surgeon creates a surgical opening, pushes the intestine back in place, and repairs the muscle wall so that the intestine stays in its normal position. Sometimes the weak area is reinforced with mesh or wire.

Often the surgeon can repair the hernia with minimally invasive laparoscopic surgery (surgery using tiny incisions and long, thin endoscopes), eliminating the need for a large abdominal incision.

If the protruding intestine becomes twisted or traps stool, a bowel resection may need to be performed. In this procedure, part of the intestine, or bowel, is removed.

Surgeons in Aria's Division of General Surgery are experts in providing surgery for hernias.