Hernia

A hernia is a hole or weakness in the muscles of the abdomen, allowing either fat or an organ to push through. Some hernias are normally occurring holes in our bodies that have become too wide or large enabling organs, fatty tissue, or intestines to protrude through. 

These holes allow arteries, veins, bowels, and nerves to travel from one part of the body to another. For example, if we did not have a hole in our diaphragm muscle, then the esophagus would never connect to the stomach, and we would be unable to eat by swallowing our food. If the hole through which the esophagus travels becomes wide over time, then the stomach can migrate up above the diaphragm into the chest causing a hiatal hernia. Symptoms include, food regurgitation, heartburn (acid reflux), chest pain, and bad breath.

Types of Hernias:

Inguinal – The most common type of hernia, occurring when tissue, typically the intestine, protrudes through the inguinal canal in the groin. More common in men than women.

Incisional – Often a complication of abdominal surgery, these hernias develop at the site of a previous surgical incision where the abdominal muscles have weakened. 

Umbilical – A common hernia in infants, but can also affect adults. Develops when tissue pushes through a weak spot in the belly button (umbilicus). 

Hiatal – Develops when part of the stomach pushes up through the diaphragm into the chest cavity often causing acid reflux, regurgitation, chest pain, and other symptoms.

Femoral – A less common type of hernia, forming when tissue protrudes through the femoral canal near the upper thigh and groin. Femoral hernias are seen more often in women

Epigastric – Contains fat rather than intestine and forms between the belly button and the lower chest. Epigastric hernias develop due to abdominal muscle weakness and are not as common as other types. 

Spigelian – A rare type of hernia, found in the thin layer of tissue that forms a section of the abdominal wall, where the lateral muscles meet the abs or rectus muscles. This area is called the circa semilunaris. Difficult to detect, Spigelian hernias may go unnoticed until they cause swelling and pain in the lower abdomen.

Obturator – Difficult to diagnose and the rarest type of  hernia. Affecting mostly elderly women, it develops when tissue pushes through an opening in the pelvis (obturator foramen). Obturator hernias may cause bowel obstruction.

Hernia Symptoms:

• Pain in the affected area 
• Visible bulge 
• Feeling of weakness or pressure
• Heartburn or difficulty swallowing (hiatal hernia)

Some patients present with multiple hernias—weak tissue in several different areas, and there are some who develop, or acquire, hernias more acutely—such as a diaphragmatic hernia from trauma, as in a car accident or a very bad fall. Muscles can rupture from trauma and cause protrusions. People who have had prior abdominal surgery may end up with a breakdown of the abdominal closure, even many years later: we call these incisional hernias, whether they be from an old appendix scar, an open colon or stomach surgery, or even a laparoscopic incision.

It May Not Be Hernia

Important to note, a bulge in the upper abdominal wall, that many people have when they do a sit-up, may not be a hernia at all, but rather a separation of the two abs (six pack muscles) which run vertically along the front of the abdomen. Plastic surgeons may fix this in a tummy tuck procedure, but it is not a hernia. Pain in the groin does not necessarily mean you have a hernia either. Other conditions such as musculoskeletal strain, a herniated lumbar disc or even hip issues can cause groin pain.

When To Seek Medical Help

Dr. Anthony Vine has treated many patients with emergent and non-emergent hernias. If you have a painful or red lump or bulge on the abdominal wall that does not recede or get better when you are lying down, seek medical attention as this may be a true surgical emergency. The tissue or organ trapped in the hernia may have become “stuck” or incarcerated and is no longer able to move back into its normal position. This could lead to a strangulated hernia in which the blood supply to the incarcerated tissue or organ is completely cut off. 

Learn more about Dr. Vine’s laparoscopic hernia surgical repair options.

Dr. Anthony Vine is an Attending Surgeon and Clinical Professor of Surgery at the Icahn School of Medicine at Mount Sinai Hospital. His office is located at 1010 5th Avenue at the Laparoscopic Surgical Center of New York.

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