What is a Hernia?

That nagging, heavy sensation you have in your groin or abdomen area may be a sign of something more serious that requires medical — or even surgical — attention. For men, this may seem like just another ache or pain, but it could indicate you have a hernia.

One in four men will develop a groin hernia at some point in their life, according to the National Institute of Diabetes and Digestive and Kidney Diseases. As part of Hernia Awareness Month and Men’s Health Month, we put together a guide on how to know if you have a hernia and treatment options to relieve your symptoms.

Types of hernias

A hernia is a broad term to describe a weakness or gap in your abdominal fascia (the strength layer of your abdominal wall) that allows tissues to bulge or protrude through. In healthy adults, this layer remains strong and helps protect your organs.

In general, a hernia can occur near your groin, abdomen or diaphragm. Here is an overview of the varying types of hernias.

Inguinal hernia: Found mostly in men, this common hernia affects the groin area where the inguinal canal is found. This passageway contains the spermatic cord and blood vessels that lead to the testicles.

Femoral hernia: Also found in the groin area near the upper thigh, this hernia isn’t common in men and mostly affects older women.

Hiatal hernia: This hernia occurs when your upper stomach protrudes through the diaphragm into the chest. As a result, stomach acid can leak into the esophagus, causing acid reflux. This type of hernia mainly affects women.

Umbilical hernia: In addition to the groin and diaphragm, hernias can also occur in the abdominal wall, known as a ventral hernia. An umbilical hernia is a type of ventral hernia that occurs near your belly button and is commonly found in babies less than 6 months old. The abdominal wall is especially thin near the umbilical cord, which helps explain why these hernias are more common than others.

Incisional hernia: Another type of abdominal hernia, tissue at the site of a surgical scar can form a hernia after surgery in the abdomen area. This mainly occurs due to muscle weakness. About 30% of abdominal surgery patients end up having an incisional hernia.

Epigastric hernia: In this type of hernia, tissue protrudes through the abdominal area between the navel and breastbone.

Diaphragmatic hernia: Caused by a birth defect, this hernia occurs when the diaphragm doesn’t fuse with the chest wall correctly and can allow space for the stomach to protrude into your chest.

Inguinal and femoral hernias are the most common type, accounting for 75% to 80% of cases. Umbilical hernias can occur in anywhere from 3% to 10% of cases, with 10% to 20% of newborns. Incisional hernias are less common, accounting for 2 percent.

What does a hernia feel like?

Hernia symptoms depend on the type of hernia you have. Symptoms tend to become worse or more noticeable when performing activities that put strain on that area, such as sports or lifting. Something as simple as coughing or squeezing may also cause pain.

In more severe cases the hernia can become trapped and cut off the blood supply to the tissue that is trapped. This can cause pain and tenderness, vomiting, constipation, fever or bulging that is dark in color.

Inguinal hernia symptoms

Most commonly found in men, you can usually see or feel this type of hernia. You may experience aches and pains or pressure in the groin. Since inguinal hernias affect the lower groin, you may notice a pulling or heavy feeling near your testicles. You may also notice a bulge in the groin area. Pain and swelling could extend into the testicles if the hernia protrudes that far down.

Abdominal hernia symptoms

Ventral hernia symptoms also include achy pain or localized pressure. Visually, you may see a bulge protruding. Digestive issues, such as constipation or vomiting, may also occur.

Hiatal hernia symptoms

Unlike hernias in the groin or abdomen, smaller hernias in your chest wall may not produce symptoms. If the hernia grows bigger, it can produce acid reflux, heartburn, issues swallowing, or cause you to regurgitate food or liquids back into your mouth. You may also experience chest pain, shortness of breath or a feeling of fullness after meals. You can’t see physical change from this type of hernia.

What causes hernias in men?

There are many risk factors for why people develop hernias, but gender is the most common variable. Men are eight times more likely than women to develop an inguinal hernia. This risk factor is anatomical, as men have a natural gap in the inguinal canal where the spermatic cord enters the scrotum. While this is necessary as a pathway for blood vessels, it also creates a weak area more prone to hernias.

By comparison, women have a different anatomy made for childbirth, one that equates to a stronger groin area to keep the uterus in place.

Hernias are either direct (degenerative) or indirect (congenital). Indirect hernias that form before birth occur when the abdominal wall structures don’t develop properly. Later in life, the abdominal wall naturally weakens with age, deteriorates with physical activity or loses strength due to controllable factors.

Behavioral habits, such as smoking or a poor diet, can increase your hernia risk. Statistically, more men smoke than women. Smoking can cause a chronic cough that strains muscles and tissues, while not eating a nutrient-rich diet can cause constipation that strains the abdomen wall. Being obese can also cause more fat to accumulate that can lead to a hernia. Seventy-four percent of men are considered to be overweight or have obesity, compared to 67% of women, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

What is a hernia repair?

At first, a hernia may not pose much of a problem and you may be able to live with a reducible hernia — when you can push the hernia sac back in the opening — if symptoms are mild. But the unfortunate reality is you’ll likely need surgery at some point. Hernias don’t heal on their own. Surgery is a recommended option due to the potential future complications that may occur.

A hernia repair involves a general surgeon removing or pushing the hernia back in place before suturing the weakened abdominal wall, sometimes with the use of mesh as a reinforcement. They will either perform a minimally invasive surgery (laparoscopically or robotically) or open surgery.

Laparoscopic surgery: This minimally invasive surgery is typically done using tiny incisions to insert a small camera and surgical tools to allow for the insertion of surgical tools to complete the procedure. Recovery takes about two weeks.

Robotic hernia repair: Also a type of minimally invasive surgery, the surgeon uses a robotic device to control surgical instruments. Robotic hernia repairs provide surgeons with more control once they’re inside the body. Recovery takes about two weeks.

Open surgery: The most invasive surgery of the three, a larger incision is made at the hernia site to perform the repair. Recovery takes four to six weeks.

Many hernia repairs are minimally invasive or done robotically due to the shorter recovery time. Surgeons can also perform an open surgery for larger hernias to lower the risk of recurrence. Laparoscopic groin surgery (inguinal and femoral) has a 10% recurrence rate compared to 5% for an open surgery repair, according to the American College of Surgeons (ACS).

If the hernia is large or more advanced, the surgeon can place surgical mesh at the hernia site to reduce the risk of a future hernia recurrence. Surgical mesh can either be temporary or permanent. Temporary mesh dissolves after a certain amount of time, just like dissolvable stitches do. Permanent mesh can provide sustained support.

Hernia repairs using surgical mesh have half the recurrent rates compared to non-mesh repairs. In the case of recurrent hernias that require surgery, the ACS recommends laparoscopic repair to avoid previous scar tissue.

If you’re interested in learning more about hernia surgical procedures, visit INTEGRIS General Surgery Baptist. You can also schedule an appointment with your Primary Care provider to learn more about treatment options.