Martha Jefferson HealthWise--June 4th

Dr. Katie Trahan, a Surgeon with Martha Jefferson Hospital explains, there are many reasons why people do not seek treatment for a hernia. For many, the hernia is not a problem—it is soft, reducible, causes no pain and is “just there”-groin hernias can often safely be watched for years. For others, avoidance of surgery can be influenced by things such as fear of pain, loss of time from work, expense or even a bad prior experience with surgery or anesthesia.

There are several types of hernias but all occur because of a weakness or defect in the fascia of the muscles of the main part of the body or abdomen. The intraabominal contents, usually the intestines can protrude through these weak spots causing discomfort, cosmetic changes and can even cause obstructions. The most common kind is groin or inguinal hernia and these occur through a natural weak spot in our bodies. Many people have small hernia at their belly buttons. Others occur at sites of prior surgeries where the muscles or fascia has been cut in the past….thus being a weaker spot in the body wall.

Surgery is the only way to fix or cure a hernia….but many don’t have to be “fixed” and can be safely watched--- but this should really be determined by a surgeon. There are abdominal binders or groin trusses that act almost like girdles to reduce the symptoms of a hernia, but these are often uncomfortable. The best way to avoid symptoms or creating a hernia is to maintain a safe body weight, lift correctly to avoid strain on the back or abdomen, avoid smoking which can weaken surgical incisions and of course see your doctor or surgeon to evalutate whether or not you have a “risky hernia.”

The majority of hernias can be repaired with same day surgery, you go home that same night. Patients can expect to be sore for several days but many activities such as work can be resumed in 3-5 days. Heavy lifting, running types of activity should probably be avoided for several weeks but surgical techniques now involve the use of mesh and laproscopic techniques that are less painful, easier to recover from and allow quicker return to daily life.

For many, there is little risk in watchful waiting but they usually don’t go away…an exception may be the belly button hernia in a pregnant woman or in a child less than age 4. Over time with weight gain or straining, the hernia may get bigger. The biggest risks of not having a hernia at least followed closely or repaired is bowel becoming stuck in the defect. This is called incarceration (the hernia doesn’t go away or cant be push back in). Once a hernia is incarcerated it can become obstructed (so food doesn’t pass thru the digestive tract), or even strangulated which means it losses its blood supply to where the bowel can die and perforated.

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