Hernias
A hernia occurs when an organ or tissue protrudes through a weakened area in the surrounding muscle or connective tissue (fascia). In the digestive system, common hernias include hiatal hernias (stomach protruding through the diaphragm), inguinal hernias (intestine protruding through the abdominal wall in the groin), umbilical hernias (around the navel), and incisional hernias (at the site of previous surgery). Hernias can cause discomfort, digestive symptoms, and in some cases, serious complications if they become strangulated. At Blume Health, our gastroenterologists and surgeons provide comprehensive care for all types of hernias, from diagnosis to surgical repair using advanced minimally invasive techniques.
Causes
- Hiatal hernia: Weakening of the diaphragm muscle due to age, injury, or congenital factors
- Inguinal hernia: Weakness in the lower abdominal wall, often at birth (congenital) or developing later in life
- Umbilical hernia: Incomplete closure of the abdominal wall at the umbilicus during development
- Incisional hernia: Weakness at the site of previous abdominal surgery
- Increased abdominal pressure from chronic coughing, straining during bowel movements, or heavy lifting
- Pregnancy and childbirth, which can strain abdominal muscles
- Obesity, which increases pressure on abdominal tissues
- Age-related muscle weakness
- Chronic constipation causing repeated straining
- Chronic obstructive pulmonary disease (COPD) causing persistent coughing
- Ascites (fluid in the abdomen) creating pressure on the abdominal wall
- Genetic factors affecting connective tissue strength (e.g., Ehlers-Danlos syndrome)
Signs and Symptoms
- Hiatal hernia: Heartburn, regurgitation, chest pain, difficulty swallowing, and feeling full quickly
- Inguinal hernia: Bulge in the groin area that may disappear when lying down, pain or discomfort, especially when bending, coughing, or lifting
- Umbilical hernia: Visible bulge near the navel that may be more prominent when coughing or straining
- Incisional hernia: Bulge near or at the site of a previous surgical scar, pain or discomfort in the area
- General hernia symptoms: Feeling of heaviness, pressure, or weakness in the affected area
- Pain or discomfort that worsens with physical activity
- Burning or aching sensation at the site of the bulge
- Digestive issues including nausea, vomiting, or constipation (particularly with hiatal hernias)
- Signs of emergency (strangulation): Severe pain, nausea, vomiting, fever, rapid heart rate, or a hernia bulge that becomes red, purple, or dark
- Some hernias may be asymptomatic and discovered during routine examinations
Diagnosis
Physical Examination
For many hernias, particularly inguinal, umbilical, and incisional hernias, a physical examination is the primary diagnostic method. The doctor may feel for a bulge in the affected area and may ask you to cough or strain to make the hernia more visible or palpable.
Upper Endoscopy
For hiatal hernias, an upper endoscopy (EGD) may be performed to visualize the stomach's position relative to the diaphragm and assess for complications like esophagitis or Barrett's esophagus. This involves passing a flexible tube with a camera down the throat into the esophagus and stomach.
Barium Swallow or Upper GI Series
A contrast X-ray study where you swallow a solution containing barium that coats the digestive tract, making it visible on X-rays. This can help identify hiatal hernias and other structural abnormalities of the upper digestive tract.
Imaging Studies
CT scans, MRI, or ultrasound may be used to confirm the diagnosis, assess the size and contents of the hernia, and plan for surgical repair, particularly for complex or recurrent hernias.
Treatment Options
Watchful Waiting
For small, asymptomatic hernias with low risk of complications, your doctor may recommend monitoring the condition rather than immediate intervention. Regular check-ups will help ensure the hernia isn't enlarging or becoming problematic. This approach is commonly used for small hiatal hernias and some inguinal hernias.
Lifestyle Modifications
For hiatal hernias, lifestyle changes similar to those for GERD are often recommended, including dietary modifications, weight loss, avoiding eating before lying down, and elevating the head of the bed. For other hernias, avoiding heavy lifting and straining may help prevent enlargement.
Medications for Symptoms
While medications don't repair hernias, they may help manage symptoms. For hiatal hernias, acid-reducing medications like proton pump inhibitors or H2 blockers can alleviate reflux symptoms. Pain medications may provide temporary relief for discomfort from other hernia types.
External Support
In some cases, particularly for patients who are poor surgical candidates, a truss or binder may be used to hold the hernia in place and prevent it from enlarging. This is generally a temporary measure or used when surgery isn't an option.
Home Remedies
Dietary Modifications for Hiatal Hernia
Avoiding foods that trigger reflux symptoms, eating smaller meals, avoiding lying down after eating, and maintaining a healthy weight can help manage hiatal hernia symptoms. Spicy foods, acidic foods, chocolate, and caffeine are common triggers to avoid.
Core-Strengthening Exercises
Gentle exercises to strengthen abdominal muscles may help support the area around some hernias, but should only be done under professional guidance to avoid worsening the condition. Improper exercises can increase abdominal pressure and aggravate hernias.
Avoiding Constipation
Maintaining regular bowel movements helps prevent straining, which can worsen hernias. A high-fiber diet, adequate hydration, and regular physical activity can help prevent constipation. Over-the-counter fiber supplements may also be beneficial.
Proper Lifting Techniques
When lifting is necessary, use proper technique: bend at the knees, not the waist; keep the object close to your body; avoid twisting while lifting; and exhale during the lift rather than holding your breath, which increases abdominal pressure.
Symptom Management
For minor discomfort, applying an ice pack to the hernia site may provide temporary relief. However, persistent or increasing pain should prompt medical evaluation, as it may indicate complications requiring immediate attention.
Preventive Care
- Maintain a healthy weight to reduce pressure on abdominal tissues
- Lift heavy objects properly, using leg muscles rather than abdominal muscles
- Strengthen core muscles through appropriate exercises recommended by healthcare providers
- Avoid or manage chronic coughing by treating the underlying cause
- Prevent constipation through high-fiber diet, adequate hydration, and regular exercise
- Quit smoking, which can lead to chronic coughing and weaken tissues
- Manage conditions that increase abdominal pressure (like COPD or chronic constipation)
- Use proper form during strength training exercises
- For patients with previous hernias, follow post-surgical instructions carefully to prevent recurrence
- Consider wearing an abdominal binder during activities that increase intra-abdominal pressure if recommended by your doctor
Surgical Options
Open Hernia Repair
Traditional surgical approach involving a single incision over the hernia site to push the protruding tissue back into place and strengthen the weakened area with stitches or synthetic mesh. This approach may be preferred for certain complex or large hernias, or when minimally invasive approaches aren't suitable.
Laparoscopic Hernia Repair
Minimally invasive approach using several small incisions through which a camera and specialized instruments are inserted to repair the hernia. This technique typically results in less pain, faster recovery, and smaller scars compared to open surgery. Our surgeons are experienced in advanced laparoscopic techniques for various hernia types.
Robotic-Assisted Hernia Repair
Advanced minimally invasive technique using robotic technology to enhance precision and control during the procedure. This approach combines the benefits of laparoscopic surgery with improved visualization and maneuverability, particularly beneficial for complex hernias requiring intricate dissection and repair.
Hiatal Hernia Repair with Fundoplication
For symptomatic hiatal hernias, surgical repair involves returning the stomach to its proper position below the diaphragm, repairing the diaphragmatic opening, and often performing a fundoplication (wrapping the upper part of the stomach around the lower esophagus) to prevent reflux. This can be performed using open, laparoscopic, or robotic approaches.
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If you're experiencing symptoms of hernias, our expert team is here to help you find the right treatment approach for your specific needs.