How do I know if I have a hernia?

Andrew Schneider, MD

General Surgery

If you’ve had pain or noticed a strange bulge in your abdomen or groin or near a scar, you might have a hernia. General surgeon Andrew Schneider, MD, explained why it’s best to get it checked out by your doctor.

What is a hernia?

“A hernia in its most basic sense is a hole, and something’s going through that hole that shouldn’t be,” Dr. Schneider said. “The exact medical definition would be when a part of an organ is displaced or protrudes through the wall of the cavity containing it.”

According to the National Institutes of Health, hernias are common, affecting men, women and children.

Some common hernias include:

• Inguinal hernia – when tissue protrudes through a weakened area in the groin. This is the most common type of hernia, and it mainly affects men.
• Ventral hernia – when there’s a hole within the fascia of the abdominal wall and something protrudes, whether that be intra-abdominal fat or intestine or some other organ.
• Umbilical hernia – when part of the intestines poke through an opening in the abdominal wall near the belly button.
• Hiatal hernia – where the stomach herniates into the chest, through the diaphragm.

“Unfortunately, a lot of hernias are from other surgeries,” Dr. Schneider said. “Anytime we make an incision, it’s never going to be quite as strong as before that incision. The best thing people can do to lower their risk is to ask if their surgery can be done with smaller incisions in a minimally invasive fashion.”

What does a hernia feel like?

Dr. Schneider said pain at the bulge or in the groin can be a symptom, but hernias are often painless. “People usually notice a bulge. Maybe they had flat scar and now it’s kind of swollen or bulging out, particularly when they’re increasing their intra-abdominal pressure by coughing, exercising, straining or lifting.”

Even if you’re not experiencing pain, it’s important to see a doctor if you notice a bulge or swelling.

“If the intestine is getting pushed through a hole, it could get pinched or kinked, and that could create an obstruction which would lead to nausea or vomiting and possibly be a surgical emergency,” he said.

How is a hernia treated?

Hernias can be repaired through surgery, including minimally invasive robotic surgery.

“Our goal is to close the hole and then reinforce that hole with mesh,” Dr. Schneider said. “Robotic surgery allows us to use very small incisions to fix hernias. It allows excellent 3D visualization with wristed instruments to be able to close the hole in a very particular fashion, so it doesn’t come back.”

There are also situations when surgery is not recommended. “The patient may have too many other medical problems going on to justify the risk of surgery,” Dr. Schneider said. “Sometimes hernias are extremely small and are completely asymptomatic or they don’t cause any pain, so surgery wouldn’t be needed. Deciding whether to proceed with a hernia repair requires some in-depth conversation between the patient and the doctor about everything going on, both medically and with the hernia itself.”

How can you prevent a hernia from coming back?

If you decide to proceed with surgery, make sure you have a solid plan with your surgeon about the surgical approach and whether to use a mesh. “Mesh is very safe and can significantly reduce the risk of recurrence,” Dr. Schneider said.

Also, it’s important to make sure you’re as healthy as you can be – stop smoking, maintain a healthy weight and control your blood sugar. After the repair, slowly increase your activity based on your doctor’s instructions.