Monday, January 27, 2014

The Battle of the (Hernia) Bulge

By: Matt Reed, M.D. _General surgery at Medical West Hospital

Pressure in your groin area doesn't always mean that you've got to go to the bathroom. Sometimes something can be out of place, causing discomfort. If you've experienced pressure or weakness in your groin, or noticed a bulge on either side of your pubic bone - you could have an inguinal hernia.

In general, a hernia is a protuberance of an organ through a cavity wall in the body. Inguinal is the medical term for the groin area. Inguinal hernias can be felt when bending, coughing, or lifting heavy objects. And they don't feel good - usually a burning, aching sensation.

Guys - remember getting those sports physicals as a kid? This is what they were checking for.

There is no singular cause of inguinal hernias. As you may know, heavy lifting, constipation, excessive coughing, etc. can be contributing factors. Family history can also be an indicator.

Besides the discomfort, there some serious complications possible with inguinal hernias:

1) Put tension on tissues around the hernia. If not repaired, inguinal hernias can get larger, resulting in pressure being placed on tissue/organs in the area. This causes further pain and swelling in the area.

2) Stangulation can occur, where blood flow has been greatly diminished or even halted completely to the protruding area of the organ. Because of the lack of blood, this tissue may in fact die, creating a serious, life-threatening situation. Surgery would be needed immediately.


There are two most common treatments for an inguinal hernia:

1) Open Repair. A simple explanation is that an incision is made in the groin and the surgeon pushes the protruding organ back to where it should be. Then he/she sews up the tear.

With an open surgery, surgeons can opt to use a surgical mesh to reinforce the torn area. Most of the time patients do very well and recover quickly. Complications can arise, rarely, including intestinal adhesion to the mesh, but the risk of this is usually outweighed by the risk of hernia recurrence if mesh is not used in the repair.

2) Laparoscopic Treatment. Instead of a one big incision, the surgeon will make three to four incisions, each about one centimeter in length. The surgeon then inserts a tiny camera into the area through one opening while the surgical instruments are inserted through other incisions. The video camera then guides the surgeon through the operation. The surgical mesh is always used here.

There's less discomfort for the patient with laparoscopic treatment, and they are even quicker to return to their routines. However, laparoscopic treatments can lead to a slightly higher rate of recurrence of the hernia compared to open surgery. 


It can depend on how bad the hernia was, of course, but in general, the patient has to take things relatively easy for about a month. Immediately after surgery, rest is important as the patient has been under anesthesia. It is also during this time that pain killers may be required.

Stitches take a little more than a week to dissolve, so the patient shouldn't be involved in any activity that will risk the stitches opening up.

And eat right. For real, it's important. For two weeks after surgery, the patient will need to be heavy on fiber, fruits, and vegetables and avoid constipation. And for at least a month - NO HEAVY LIFTING.

About 10% of the time, the hernia will have to be repaired again. The tissue will either heal poorly or the area experienced trauma from the procedure.

Inguinal hernias are something that needs to be quickly addressed. Should you ever experience the symptoms or suspect that you have a hernia - GO SEE YOUR DOCTOR. This is one of those things that doesn't need to wait until the next checkup. Call their office and go.

Live pain-free and win the battle of the bulge.


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