ASK DR. BAUGHAN                                             March 3, 2000

YEP, THAT’S A HERNIA

I had a patient come to the office this week who thought he had a hernia.  Bless his heart, he reviewed a bunch of my columns and could not find any on hernias, so he came in to get my opinion on whether he had a hernia or not.  I examined him and said, “Well, there’s not much to say about hernias other than - ‘Yep, you have a hernia.’”  That wasn’t true.  There are actually a lot of things to be said about hernias.  One reason I write this column is to say some things I should have said and to have my thoughts better organized the next time I should say them.  (It was true that he did have a hernia.)

Hernias occur when stuff in one part of the body protrudes into a part of the body where it is not supposed to be.  Usually that protrusion is of innards sticking out through a weak spot in the abdominal wall, causing a bulge that did not used to be there.  The most common place is in the groin in a male (inguinal hernia).  This can occur in infants, children or adults of all ages.  It occurs because the testes develop in the fetus inside the abdomen, then take an interesting migration down into the scrotum before birth (except when there is an “undescended testicle”).  This migration leaves an opening where there are fewer layers of tissue to hold the guts inside the abdomen.  Sometimes the bulge is there at birth.  Usually it gradually develops, with or without straining or lifting something heavy.

Other places hernias can develop include the belly button (umbilical hernias), where the nerves and arteries from the abdomen go into the legs (femoral hernias), where scar tissue has been stretched thin or at the edges of the bands of muscles at different angles in the abdomen (ventral hernias).  When the stomach protrudes through the opening (hiatus) of the diaphragm into the chest, you have a hiatal hernia.  When the gelatinous center of one of the discs of the spine ruptures through the tough  exterior of the disc, you have a herniated disc.

How can you prevent the various abdominal hernias?  Sometimes you can’t.  You may reduce your risk, though, by keeping your weight down, keeping good abdominal muscle tone, and avoiding repetitive straining over the years.

When does a hernia need to be surgically repaired?  If the innards can easily slide in and out of the opening, it is called a reducible hernia.  These can be fixed when and if they bother you enough, either in appearance or discomfort.  There is no hurry.  If the hernia protrudes and will not slide back in by lying flat, relaxing, and applying gentle pressure, then it is an incarcerated hernia.  There is usually a goodly amount of pain.  These should be attended to within a day.  If the opening is tight enough that the blood flow to the protruding tissue is compromised, then the hernia is said to be “strangulated.”  Here the pain is almost always intense.  This is a surgical emergency, because if the blood flow is restricted long enough, the protruding guts may die and develop gangrene, and the whole mess becomes life-threatening.  So don’t try to be a tough guy and wait until after the weekend.

Surgery nowadays may be same day or overnight stay in the hospital.  It may or may not involve placing a mesh under the skin to shore up the weak spot.  Recovery may take only a few days for non-strenuous activity, or several weeks for heavy labor.

‘Nuff said about hernias.