You shouldn't ignore pain or a new bulge. But if your hernia is small and pain-free, you might be able to wait and see.
Posted
on Wednesday, May 12, 2021
Most people’s idea of a hernia goes something like this: A painful bulge pops out of your stomach. The pain is so intense that you feel sick and can hardly move.
Sometimes that’s exactly what happens. Most of the time, though, it’s a completely different experience. The symptoms vary from person to person, between men and women and among the different types of hernias.
But one thing is consistent. When a hernia becomes painful or problematic, surgery is the only solution.
What exactly is a hernia?
It’s one of your organs bulging out through the muscles.
Normally, your muscles hold everything inside. It’s part of their job. When the muscles are weak, strained or injured, the muscle wall fails and allows the internal organs or tissues behind it to protrude out.
While a vital organ pushing through your muscle sounds quite painful, that isn’t always the case. A hernia can be small and painless and never bulge out far enough to cause a noticeable bump. You can have a hernia for years without noticing it. Or you may know it’s there but never have any problems.
What are the other signs of a hernia then?
Bulges and pain are obvious signs. Without those, it's much more difficult to tell if you have a hernia. You might have:
- A dull, achy sensation
- Discomfort only when you lift or strain
- A sense of fullness in your bowels
- Heartburn
- Difficulty swallowing
- A burning or heavy sensation
Women may not experience any of those “traditional” hernia symptoms. They often have a hernia deeper in the body, where it’s less visible and harder to pinpoint to an exact area. When pain is present, it feels different too. Women may experience chronic pelvic pain, bouts of stabbing pain that come on quickly or more of a pinching feeling.
Which types of hernia are most common?
You have muscles all over your body. So you can get a hernia in almost any place. The majority of hernias develop in the groin, abdomen or stomach and fall into five categories:
1. Inguinal Hernias
Seventy-five percent of all hernias are inguinal, where the small intestine bulges out in the groin or, in men, the scrotum. They are much more common in men — one in four men will develop one in their lifetime.
Inguinal hernias can develop at birth in baby boys. The inguinal canals in the lower abdomen may never fully close after the testicles descend. When one develops later in life, it’s from the weakening of your abdominal muscles over time due to pressure from lifting, straining and constipation.
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2. Umbilical Hernias
Umbilical hernias are also most likely to happen at birth. One in six children develops a hernia in their belly button when their abdomen fails to close properly where the umbilical cord was connected. Most umbilical hernias heal on their own and are gone by age four.
Adults can get them too. Weight gain, due to obesity or multiple pregnancies, can strain the abdominal wall and cause an umbilical hernia. If you get one after carrying a baby, your doctor will probably advise you to wait on a fix until you’re done having children to prevent a hernia from returning with a future pregnancy.
3. Hiatal Hernias
When the hiatus, a small opening in your diaphragm, is obstructed by a portion of your stomach, you have a hiatal, or diaphragmatic, hernia. The opening is small so most hernias are small. If the bulge grows, it can affect both your breathing and digestion, causing heartburn, acid reflux, chest pain and shortness of breath.
Hiatal hernias are quite common as you get older. By the time you turn 60, there’s a 60 percent chance you have a hiatal hernia to some degree. If you’re obese, your risk is even higher.
4. Incisional Hernias
Cutting into the skin forces the muscles to heal and grow back together. If they don’t heal properly, you’re left with an incisional hernia in addition to a scar. Incisional hernias can affect any area where you have surgery but it primarily happens with abdominal surgery, where up to 33 percent of all surgical incisions lead to a hernia.
5. Femoral Hernias
Femoral hernias also occur in the groin, developing when fatty tissue or part of your intestines protrude through the muscles. As you get older, your muscles loosen and have trouble holding back everything on the inside.
This type of hernia primarily affects women in old age but is pretty rare overall. Less than three percent of all hernias are femoral.
How do you fix a hernia?
Many people find that pushing or holding the hernia back in makes the symptoms disappear. That’s not a long-term solution. The relief is only temporary. As soon as the hernia bulges out again, your problems return.
With the exception of umbilical hernias in infants, once you have a hernia, it never goes away. And the only way to fix it is hernia repair surgery.
A general surgeon repairs and reinforces the weakened muscle wall. After surgery, the bulge goes away, as does the pain, discomfort and other symptoms.
Do I have to have surgery?
Not always. Many hernias cause no issues. As long as it’s small and not presenting other symptoms, you may be able to take a wait-and-see approach to treatment. You might even be able to strengthen your muscles through physical therapy to relieve mild symptoms.
If the symptoms don’t bother you, you may be able to delay surgery for several months — even years — as you and your doctor keep an eye on your hernia. Eventually, you’ll probably have to get that surgery.
Hernias, inguinal hernias especially, tend to get bigger over time. Your muscles get weaker and the pressure and strain from the hernia can weaken them even further. More of your insides start to bulge out, creating a larger hernia that causes bigger problems.
Hernia surgery is one of the most common forms of surgery. Not only does it repair your hernia, but it also saves you from serious complications if your tissue causes an obstruction or gets cut off from your blood supply.
Talk to your doctor about your hernia-related symptoms or concerns to see if surgery is recommended or if you can wait it out a little longer.