According to the National Center for Health Statistics nearly five million Americans suffer from hernias, but only 700,000 seek treatment every year.
Kent Choi, M.D., surgeon at University of Iowa Hospitals and Clinics, said a hernia is a protrusion of the internal tissue or organs beyond the natural boundary through an abnormal opening. "The most common types of hernias are groin hernias or abdominal wall hernias, " says Choi, "in which case, mesenteric fat or the bowel may herniate, or protrude through an abnormal opening outside of the abdominal cavity."
People at risk of developing a hernia are those performing chronic lifting or activities that require straining, which increased intra-abdominal pressure. "By the same token," Choi says, "those patients with chronic constipation also are at increased risk of developing a hernia. Morbid obesity is definitely associated with high risk of hernia formation."
Choi says a typical sign is a visible bulging at the site of herniation. "The typical symptom is pain at the site of the herniation or may transfer to adjacent areas. When the hernia becomes stuck outside its natural boundary and is no longer capable of being returned to its origin, we call this an incarcerated hernia. An incarcerated hernia is at increased risk of strangulation, which means blood supply to the hernia contents has been compromised. When strangulation occurs, ischemic pain can become severe and excruciating; it is often intolerable for most patients."
People should seek medical help whenever a hernia is suspected and should have further evaluation by a medical professional, especially, when pain or discomfort persisted.
Definitive treatment for a hernia is usually surgical in nature, Choi says. "Non-definitive treatment, or temporizing measures, may include simply pushing the hernia content back into the abdomen, then applying pressure to the defect to prevent it from recurring. For this measure, people commonly use an athletic truss, as well as supportive garments to help hold the hernia content in the abdominal cavity.
"However, this measure is not very effective in preventing hernia recurrence. Surgical intervention is usually required to either primarily close the defect with suture, or more commonly these days, using synthetic or tissue graft material positioned in the area of defect to help prevent the hernia from recurring. We have developed a number of different means of hernia repair using the traditional open technique as well as laparoscopic techniques, where the repair patches can be applied from the outside or inside," says Choi.
"The recovery from a hernia surgery these days typically involves a shorter time period than in the past, says Choi. "These changes are basically through improved anesthetic techniques, surgical techniques and nursing care. Also, in general, our population's nutritional status has improved; therefore tissue healing tends to be quicker. Regarding anesthesia, our patients now typically suffer fewer post-anesthesia complications such as persistent drowsiness, nausea, or vomiting than only 10 or 15 years ago.
"We have make advancement in surgical techniques with better understanding of tissue strength and the healing process. We have developed minimally invasive procedures for hernia repair. This significantly reduces post-operative pain and helps mobilize the patient earlier. This permits the patient to become involved in deep breathing and coughing exercises earlier on, which shortens the recovery time and avoids many potential complications," he says.
A hernia can reoccur after treatment. "The risk of recurrence is multi-factorial. One is the quality of repair--that is, how well the initial surgery was performed. Second is how well the patient healed following the surgery. This latter condition is determined to a certain degree by how well the patient followed postoperative instructions to avoid heavy lifting or strenuous physical activity for the defined period of time to allow adequate healing before stretching the tissues in the area of the repair.
"Of course, the other issue would be the quality of the patient's tissues. In patients with very poorly developed tissue or those on chronic steroids with poor wound healing, they would be at increased risk of recurrence. Morbid obesity will also contribute to high risk of recurrence," Choi says.
"If a hernia is identified and left untreated, in general it will only get worse," says Choi, "with the exception of small children or infants with small umbilical hernias. They can sometimes heal their hernia defects spontaneously.
"It is recommended that all hernias be evaluated by a doctor and surgical repair should be considered unless underlying health conditions prohibit this. If a hernia is left untreated it may become incarcerated or subsequently strangulated. This could lead to loss of tissue or organs and can even lives," says Choi.
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