Hernia

Symptoms and Complications

If you have a hiatus hernia, you usually don't have any symptoms unless the sphincter muscles around the lower end of the esophagus become weak. When this occurs, the valve between the stomach and esophagus (gullet) won't stay closed, and stomach acids will spill into the esophagus. As a result, you may experience heartburn, sharp pain, regurgitation, belching, and sometimes bleeding. At night, you may experience coughing, breathlessness, or a choking sensation.

Signs and symptoms of an inguinal (groin) hernia include discomfort while bending over or during lifting. You may feel a small egg-like lump in your groin that may become more prominent with certain activities such as coughing. It will usually not hurt at first and will disappear when you lie down. If the bulge persists and is accompanied by nausea and vomiting or abdominal pain, this can be a sign that the hernia has become obstructed or strangulated.

Although a rare occurrence, an untreated hernia that strangulates may result in gangrene (death of tissue), a life-threatening condition and requires emergency surgical attention. Symptoms of strangulation include pain, swelling, discolored bluish or red skin, vomiting, and an inability to urinate.

Children with strangulated inguinal hernias may have fever and vomiting and should be seen immediately by a doctor.

Inguinal hernias may not make themselves known until your abdominal wall is weakened after years of straining during bowel movements or from heavy coughing or lifting. Smokers are prone to such hernias. Physical exertion such as lifting may exacerbate a hernia by suddenly causing the weakened abdominal lining to give way.

Paraesophageal hernias usually have no symptoms, but if symptoms do occur, the most common are pain, indigestion, nausea, and retching.

Making the Diagnosis

A hiatus hernia may be diagnosed using X-rays and diagnostic tests such as endoscopy (looking at the stomach via a fiberoptic tube), esophageal manometry (using a special instrument to measure your sphincter pressure), and tests to measure your esophageal acidity.

During a routine physical examination your doctor may discover an inguinal hernia. Your doctor will usually diagnose it by feeling the area of the internal inguinal ring, deep in the groin. If there's a bulge in the area, then there's a good possibility that it's due to a hernia.

Treatment and Prevention

General hernia prevention strategies include avoiding activities that cause abdominal strain (e.g., lifting heavy weights), and if you're overweight, losing weight.

In 85% to 95% of hiatus hernia cases, treatment consists of relieving the accompanying heartburn with medication and modifying the diet. Losing weight is also recommended as a way to help relieve pressure. If you experience discomfort at night, it may help to sleep with the upper part of your body propped up on pillows or with the head of your bed raised. It is important not to eat for several hours before lying down, so that the stomach has time to empty. Standing straight rather than slouching is also a good idea. Surgery is uncommon and is reserved as a last resort for severe cases if medical and dietary management hasn't helped.

If you have an inguinal or umbilical hernia, it is generally repaired by surgery that places the protruding mass back where it belongs and reinforces the weakened area by sewing the muscles together. This is a simple operation that is sometimes performed under local anesthetic.

It's important to go for regular medical follow-up after surgery because of possible complications. Some surgeons recommend restricting exercise; however, most will encourage a speedy return to activities. Hospital stays of two or three days for surgery have been reduced in the last few years to a same-day discharge.

Laparoscopic hernia repair is done through a tiny incision and avoids the need for invasive open surgery. A television screen enables the surgeon to clearly see inside the person's body. Studies have shown that this method of treatment promotes faster healing with less likelihood of recurrence.

Wearing a truss was sometimes used in the past to avoid surgery. It is no longer considered an acceptable form of treatment for hernias. In fact, it can even make your hernia worse by weakening tissues.

Paraesophageal hernias are generally treated with surgery.

Jenifer K. Lehrer, MD, Department of Gastroenterology, Frankford-Torresdale Hospital, Aria Health System, Philadelphia, PA. Review provided by VeriMed Healthcare Network.