Dear Doctor: If you’ve got an abdominal hernia and it doesn’t bother you, can you just leave it alone? How is it treated? I’ve read about using mesh, but apparently some of them have turned out to be defective.
Dear Reader: The muscles that surround the abdominal cavity play a number of important roles. They support upright posture and controlled movement; aid in breathing; and play a role in urination, bowel movements, coughing, singing, vomiting and childbirth. They also keep the abdominal organs, tissues and intestines safely in place. When these muscles develop an opening that allows fatty tissue or a portion of the intestine to protrude, it’s known as a hernia. Although the majority of hernias develop in the abdominal area, they can also occur in the region of the groin and the upper thigh.
Abdominal hernias are common. They can occur in anyone, including babies, children and women, but are most often seen in men over the age of 40. When a hernia develops, you will notice a swelling or lump that is present when you’re standing up or using your abdominal muscles. The swelling will often vanish when you lie down. The condition is usually pain-free in its early stages. Some people report feeling pressure, or a tugging sensation, at the site of the hernia. None of the different types of hernia will heal on its own.
When a hernia is small and painless, some doctors recommend watchful waiting, perhaps with the use of supportive garments. But studies have shown that when left untreated, a hernia will often continue to grow in size and eventually begin to cause pain. In the most severe cases, a hernia can become strangulated. This occurs when the surrounding muscle contracts and cuts off the blood supply to the protruding tissue. That means that a portion of intestines inside the body are also starved of blood. Symptoms of a strangulated hernia include sudden and severe pain, bloody stool, fever, nausea and vomiting, inability to pass gas, constipation and exhaustion. A strangulated hernia is a serious and life-threatening condition that requires immediate medical treatment.
Hernias that grow larger over time or begin to cause pain require surgical repair. The procedure involves first returning the displaced tissues to their proper place in the abdomen, and then repairing the gap in the muscles. This is done by either sewing a patch of surgical mesh over the weakened area or with stitches.
The procedure can be a laparoscopic surgery, which is a minimally invasive technique performed through tiny incisions in the abdomen, or via open surgery. This involves the same series of repairs, but through a larger incision. In most cases, a hernia repair is an outpatient procedure and doesn’t require an overnight hospital stay.
Hernias have a high rate of recurrence, and surgical mesh is most effective at strengthening the weakened area. And, while it’s true that some brands of surgical mesh have been subject to recalls, those products are no longer on the market. Be sure to share your concerns with your surgeon, who will help you choose the best treatment for your specific situation.
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.
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