Why do hernias occur?

Top Doctors’ questions about this common and troublesome condition are answered by experienced endocrine and general surgeon Mr Michael Stechman.

What are the different types of hernias that exist?

Groin hernias may either be inguinal or femoral. Inguinal hernias are the most common problem because of the natural openings in the abdominal wall which pass by the blood vessels to the testicle, but they may also occur in women.

Femoral hernias manifest at the point where the blood vessels leave the abdomen and pass by the leg. They are quite uncommon but are more common in women than men.

Umbilical hernias appear at the belly button. The umbilicus is a natural scar from the umbilical cord in new born babies and so it is susceptible to the development of hernias in childhood and also in adulthood. This may happen following pregnancy or putting on weight.

Incisional hernias exist at the site of scars from abdominal surgery, even keyhole surgery. This is because surgical scars are always slightly weaker than our natural muscles and sinew. They are particularly prone if there has been a wound infection after surgery, or if the patient is on certain medications such as steroids. It is also recognised that smoking is a risk factor for incisional hernia formation.

How can hernias be avoided?

Several factors that lead to hernia formation are beyond our control. For instance, we cannot help the anatomical design of humans. But problems such as chronic cough from smoking, untreated constipation or prostate problems can also lead to the development and enlargement of hernias. Being overweight can also make patients susceptible to hernias either because of the extra strain it puts on healing scars or because of diseases that may accompany obesity such as diabetes, which increases the risk of infection.

Can hernias go away by themselves?

Unfortunately, once hernia has developed, it will not resolve or disappear without surgery. However, not all hernias will need treatment. For example, small hernias without symptoms can be safely observed and only treated if they enlarge significantly or start to cause symptoms.

How are hernias detected?

Most commonly, hernias will become apparent as a swelling at certain sites (e.g., the groin, the belly button or at an old surgical scar) which is easy to discern by the patient and their doctor.

Characteristically, the swelling will enlarge on standing and usually disappear on lying down (known as reduction of the hernia). A hernia that does not disappear on lying down may be more likely to cause symptoms or get stuck (irreducible). Sometimes, patients may get symptoms that sound like they are due to have a hernia, when there is no obvious swelling at the site. In this scenario, other tests such as an ultrasound scan may be useful.

How are hernias treated?

Hernias that go back in easily and do not cause symptoms may not require any treatment apart from observation by your GP. Some patients find hernia belts or support hosiery helpful if they can be fitted correctly and cover the hernia defect.

However, if the hernia is symptomatic, surgery is recommended in the vast majority of cases. Depending on patient factors such as fitness, body type and category of hernia, this may be feasible/necessary under local anaesthesia, spinal or general anaesthetic. Mesh will often be used to reduce chances of the hernia returning in the future. Keyhole surgery is often possible and is known to be associated with less post-operative pain and a quicker return to normal activity. The best approach for your hernia will depend on its site, size and your general fitness for surgery.

Are hernias dangerous?

The majority of hernias are not dangerous and simply cause discomfort.

However, when the defect is small, fatty tissue or even intestine can get stuck and if it is not released within a few hours, its blood supply will be cut off and the bowel will die. This can lead to blood poisoning (sepsis) without emergency surgery. This is most likely to happen with groin hernias, especially of the femoral type. In order to prevent this serious complication, surgery is advised for hernias that cause symptoms, particularly if they do not disappear on lying down, and in older patients where emergency surgery may be riskier.

Do you have further questions about hernias? Get in touch with Mr Michael Stechman for comprehensive advice via his Top Doctors profile, here.