Most hernias cause no symptoms or only mild discomfort. Many people don't even know that they have one until it is discovered during tests for other problems. Some hernias, however, cause nausea, heart burn or abdominal or testicular pain. Some can be life-threatening.
A hernia is the protrusion of an internal organ into an area where it's not supposed to be. For example, part of the intestine can poke through the diaphragm or protrude into the groin or through the abdominal wall.
The most common types of hernia and best treatments...
A hiatal hernia occurs at the opening in the diaphragm (the hiatus), where the esophagus passes through to join the stomach. If the opening is larger than it should be or the surrounding tissue is weak, the upper portion of the stomach can bulge through the diaphragm into the chest cavity.
One-quarter to one-half of Americans have hiatal hernias. They are four times more common in women than men. Most cause no symptoms. In a minority of cases, they result in gastroesophageal reflux disease (GERD), which causes heartburn and occasionally nausea or cramping. Two main types...
Sliding hiatal hernias, which account for at least 90% of cases, occur when the hiatal junction—the area where the esophagus meets the stomach—slides into the chest cavity. These require treatment only when they cause severe or persistent GERD.
Paraesophageal hiatal hernias account for less than 10% of cases, but they are more dangerous. Part of the stomach protrudes into the chest, but the hiatal junction remains in the abdomen. There's a risk that the stomach and junction will twist and block circulation, causing stomach or esophageal tissues to die.
Warning: See your doctor immediately if you have severe pain in the upper abdominal or lower chest areas...suddenly have trouble swallowing...or can't eat more than a few bites at a time. These are signs that the stomach has twisted. You may need emergency surgery.
Patients without symptoms don't need treatment. If you're experiencing GERD, lifestyle approaches, such as eating smaller meals, avoiding fatty foods and not lying down within three hours of eating, can help relieve it. If these steps don't work, try…
- Over-the-counter antacids, which neutralize acidity in the esophagus and reduce heartburn in most patients. If they don't work, your doctor may prescribe…
- H2 blockers, such as famotidine (Pepcid), cimetidine (Tagamet) and ranitidine (Zantac), which reduce stomach acid and usually are taken before meals. These are available over-the-counter and in stronger prescription strengths.
- Prescription and over-the-counter proton pump inhibitors, such as lansoprazole (Prevacid) and omeprazole (Prilosec), which reduce stomach acid secretion and are taken once a day.
You may need surgery if medications and lifestyle changes don't control GERD...or if the stomach has twisted...or there's pressure on the esophagus that is causing bleeding or obstruction.
The surgery Nissen fundoplication, usually is done laparoscopically through small incisions in the abdomen.
The top of the stomach is wrapped around the esophagus, and the opening in the diaphragm is sutured or stapled to make it smaller so the stomach can't protrude.
Most patients who have this procedure spend one or two nights in the hospital and recover fully within a month. GERD symptoms disappear in more than 90% of cases.
This type of hernia occurs when an organ pokes through a weak point in the groin. It can be painful, especially when you cough or lift a heavy object.
In men, the weak spot often occurs along the inguinal canal. This is where the spermatic cord enters the scrotum. Men are almost 10 times more likely to develop these hernias than women. In women, the inguinal canal carries a ligament that helps hold the uterus in place. Hernias may occur where connective tissue from the uterus attaches to tissue surrounding the pubic bone.
Most inguinal hernias get larger over time. Though they can be excruciatingly painful, they aren't dangerous. However, a loop of intestine may get trapped in the weak point in the groin and obstruct the bowel or block circulation to the intestine. This condition—strangulation—can kill bowel tissue and is a life-threatening emergency. Warning signs include severe pain at the hernia site, skin redness and vomiting.
You may notice a bulge in the groin or the scrotum from the protruding intestine. You also may experience groin or scrotal pain when bending over, coughing or lifting. You can temporarily relieve mild discomfort by...
- Lying on your back and gently pushing the bulge into the abdominal cavity.
- Sleeping with your hips higher than your abdomen to make the intestine less likely to protrude.
If the hernia is painful or growing larger, your doctor may recommend surgery. There are two main types...
- Herniorrhaphy. The surgeon makes an incision in your groin and pushes the protruding intestine back into your abdomen, then repairs the weakened area by sewing it together. It may take as long as six weeks before you're able to resume normal activities.
- Hernioplasty. This is like patching a tire—a piece of synthetic mesh is sutured or stapled over the weak area. It closes the opening and prevents the intestine from protruding. It can be performed conventionally with a single long incision or laparoscopically with several small incisions. With laparoscopic repair,most people are back to work within a few days. Laparoscopy might not be an option if you have a very large hernia or if your intestine is pushed down into the scrotum.
Some hernias are caused by congenital (inborn) weakness in the tissue walls. Other hernias are caused by "wear and tear." To reduce your risk...
- Maintain a healthy weight. Obesity puts extra pressure on weakened tissue.
- Treat a cough. A chronic cough increases abdominal pressure. This is another reason to quit smoking.
- Avoid heavy lifting to reduce pressure on the abdomen.
- Eat a high-fiber diet and drink water to avoid constipation. Straining can worsen hernias.