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Hernias: What You Need To Know

A hernia, a hole in the tough layer of the abdominal wall (fascia) is caused by a combination of pressure and an opening/ weakness of muscle or fascia, pushing an organ or tissue through the opening or weak spot.

The most common hernias, inguinal hernias, occur in the groin near the belly button. In many people, the abdominal wall weakness leading to an inguinal hernia occurs prior to birth. Other inguinal hernias develop later in life when muscles weaken or deteriorate due to aging, strenuous physical activity or coughing that accompanies smoking. Weaknesses can also occur in the abdominal wall later in life, especially after an injury or abdominal surgery.

While you can't prevent the congenital defect which makes you susceptible to an inguinal hernia, you can reduce strain on your abdominal muscles and tissues. Proactive steps include: maintaining a healthy weight, emphasizing high-fiber foods like fruits, vegetables and whole grains (which contain fiber and can help prevent constipation and straining), lift heavy objects carefully or avoid heavy lifting (if you must lift something heavy, always bend from your knees, not at the waist), and avoid smoking (smoking often causes a chronic cough that can lead to or aggravate an inguinal hernia).

The telltale sign of a hernia is a bulge in the abdomen area that becomes more pronounced with coughing, sneezing, straining to urinate or to have a bowel movement, lifting something heavy, or standing for prolonged periods. Over time, hernias can become larger and more difficult to repair. Some hernias are achy or painful.

An inguinal hernia isn't necessarily dangerous, however, they don’t improve on their own, and can lead to life-threatening complications. Surgical repair is performed on hernias to relieve the pain, and with over 700,000 repairs performed on inguinal hernias every year, it is one of the most common surgical procedures in the U.S.

Surgical repair is also recommended for most patients to prevent an emergent condition known as incarceration, in which the small intestine or other abdominal contents get trapped within the hole in the fascia. This can pinch the intestine to the point of obstruction (blockage of the intestines), perforation (rupture of the intestines) or strangulation (poor blood flow to the intestines).

To repair different types of hernias, a surgeon may use different approaches including: sewing the hole in the fascia closed, patching the hole with mesh, or both. Different approaches may also be used depending upon the type and extent of the hernia and your age and other medical conditions. 
In many cases, a minimally invasive approach, using laparoscopy or robotics, can be performed with small incisions and a camera. In other cases, especially in an emergency, a quicker, more direct approach through a larger incision may be required.

If you notice a bulge of the abdominal wall that you think may be a hernia, it is important to bring this to the attention of your primary care physician. 

Dr. Sandra Taylor is a board-certified surgeon with Barton General Surgery in South Lake Tahoe, CA. Talk with your primary care physician about the different methods of repair to find out which is the best approach for you. Or learn more about surgical treatments at BartonHealth.org/GeneralSurgery.