Hernias: How they occur, how they can be repaired

Men or women can develop hernias. When they do, an organ or tissue can squeeze through a weak spot in a muscle wall. When surgery is called for, several options are available.

A hernia is a weak spot, defect, or hole in the muscle layers of the abdomen, through which a part of an organ or piece of fatty tissue can poke. Hernias most often occur in the groin or at the umbilicus (belly button). But they can also occur elsewhere, such as the sites of previous surgical incisions.

What Causes Hernias?

The belly button, for instance, is where our umbilical cord attached us to our mother when we were in her womb. After birth and the cord’s cutting, the hole usually will close itself. But some people have a persistent opening that eventually can enlarge to become a hernia.

People sometimes develop an “inguinal hernia” in the groin. This can happen with strenuous activity, or sometimes after birth, a baby’s inguinal canal does not close behind them, leaving a weak spot, which eventually can become a hernia.

Other hernias can occur at weak spots like old incisions, from strenuous activities or incomplete healing.

Dr. Ivanesa Pardo discusses hernias further on the Medical Intel podcast.

What about Activities such as Lifting Heavy Items?

Physical activity, especially strenuous and high-intensity exercise, can exacerbate or even cause a hernia. There are definitely some stories about people who exercise a lot and do a lot of heavy lifting, and they suddenly feel a “pop” and have a hernia. Those are acute cases; however, there is no need to put strict limits on how much someone should exercise, rather to be smart about it. When lifting heavy things or exercising, everyone should know -- and observe -- their limits. Anyone with signs of a hernia should be careful when straining or lifting, because the hernia can become “symptomatic,” which means it requires medical attention.

An “incarceration” occurs when something – such as a piece of intestine or fatty tissue – gets stuck in an opening (hernia) and can’t be pushed back in. A more serious situation is “strangulation.” That’s when the stuck piece of tissue or organ is losing its blood supply and starting to die. That requires emergency surgery.

When Should I Seek Medical Help?

Pay attention if you feel a lump that gets larger, or more tender, when you sneeze, cough or strain. If this occurs, see your primary care physician, or a specialist, for a diagnosis.

I recommend elective surgery when the defect (hernia) is large enough that, even if it’s reducible, a segment of intestine could get stuck, which could lead to incarceration or strangulation. We can repair hernias in several ways. There’s the old-fashioned “open repair” approach, which involves a larger incision. Then, there are more modern “minimally invasive” repairs. They can be laparoscopic or robotic. Their appropriateness will depend on the particular patient, the availability of the medical facility in question, and the skills of the surgeon.

Most hernia repairs today involve implanting a mesh. This is a screen that is made of synthetic material that reinforces the muscle layers where the defect, or hernia, is. The advent of the mesh has reduced the chances of a hernia coming back after it’s been repaired.

You should talk with your surgeon about whether you need a repair, and whether mesh is appropriate.

Robotic Repair

Robotic Hernia Repair

Robotic-assisted surgery is a cutting-edge state-of-the-art technology offered at MedStar Washington Hospital Center. Robotic techniques have been applied with great success to treat a wide variety of conditions. Now, surgeons are applying these same revolutionary techniques to hernia repair.

Why Robotic Hernia Repair Is Performed

A hernia is a gap in the abdominal wall that develops from a weakness in the muscles. This weakness allows abdominal tissues, or sometimes the intestines, to protrude into the opening. If left untreated, hernias can cause serious health complications, such as infection and/or loss of blood to the intestine.

Patients with the following types of hernias may be good candidates for robotic repair:

What to Expect During a Robotic Hernia Repair Procedure

Robotic hernia repair is performed under general anesthesia. During the surgery, the surgeon will control the robotic arms while sitting at a console a few feet from the patient. The surgeon will make three small incisions, each one smaller than one inch, where the endoscopic tools will be inserted. One of these tools is a 3D camera that is attached to the tips of a flexible tube.

Risks Associated with Robotic Hernia Repair

The nature of robotic hernia repair as a minimally invasive, minimal incision surgery means that, when applied to appropriate situations, robotic repair is as safe as open repair procedures. However, as with any surgical procedure, there is a risk of certain complications. Some of these risks include:

Benefits of Robotic Hernia Repair

Robotic surgery gives surgeons the dexterity and range of motion possible in an open surgery while maintaining the benefits of laparoscopic approaches for the patient. While laparoscopic repair can be performed using smaller incisions, it offers limited visibility and mobility for the surgeon. Robotic surgery uses a 3D camera that increases visibility for the surgeon.

Minimally invasive procedures provide multiple benefits to patients, such as:

  • Smaller incision size
  • Less blood loss
  • Lower infection rates
  • Shorter operating room times
  • Quicker return to work and daily activities
  • Some patients experience significantly less postoperative pain

How to Prepare for Robotic Hernia Repair

Pre-procedure instructions will be explained to patients by the surgeon. Since the surgery will be performed under general anesthesia, it will be necessary to stop eating and drinking at least eight hours before surgery.

Patients taking medications should ask their doctor if they should continue taking their prescriptions as usual on the days leading up to surgery. This is because certain medications can affect the body’s ability to clot blood, which can lead to complications during and/or after surgery.

Post Robotic Hernia Repair Treatment

Most patients are able to go home the same day of a robotic hernia repair procedure. Typically, patients can return to work within one week of surgery and can go back to their daily activities within one to two weeks.

Patients will be given postoperative instructions by the surgeon. It is important to adhere to these instructions as well as schedule and attend all necessary follow-up appointments.

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Hernia

Learn more about the top hernia treatment options we provide.

Hiatal or Paraesophageal Hernia

Hiatal or Paraesophageal Hernia

The diaphragm is a muscular structure that separates the abdominal cavity from the chest cavity. The esophagus passes through the diaphragm via an opening called the esophageal hiatus.

Sometimes a portion of the stomach protrudes up through the esophageal hiatus into the chest cavity. When this happens, this is referred as a paraesophageal hernia or hiatal hernia. The majority of hiatal or paraesophageal hernia diagnoses are given to adults. However, infants can also form a hiatal hernia.

Symptoms of Hiatal or Paraesophageal Hernia

For many patients, a paraesophageal hernia may not cause any symptoms and therefore, can often go unnoticed. However, once symptoms present themselves, this may indicate that the hernia is progressing. Common symptoms experienced by individuals with a hiatal hernia include:

  • Pain in the upper abdomen and/or chest
  • Difficult swallowing
  • Feeling short of breath

Hiatal hernias may place individuals at an increased risk of gastroesophageal reflux disease or GERD. Sometimes, the stomach can become stuck in the hiatal opening. If this happens, surgery will need to be performed as soon as possible.

Causes of Hiatal or Paraesophageal Hernia

Common causes of hiatal hernia include:

  • Older age that predisposes individuals to muscle weakness
  • Obesity
  • Pregnancy
  • Trauma to the area, such as blunt force

What to Expect at Your Appointment

Individuals with a hiatal hernia will see a doctor for related symptoms, such as GERD. Typically, a hiatal hernia is discovered during diagnostic procedures for upper gastrointestinal symptoms, such as x-ray or endoscopy. Endoscopy allows your doctor to see the inside of the stomach and esophagus and take a small tissue sample using an endoscope, a flexible tube with a light and camera on the tip that is inserted through the mouth.

Non-surgical Treatments for Hiatal or Paraesophageal Hernia

Hiatal hernias that do not cause symptoms do not require immediate treatment. However, symptom-producing hiatal hernias may need to be treated. Hiatal hernias do not heal on their own and require surgical intervention. 

Surgical Treatment for Hiatal or Paraesophageal Hernia and Post-Treatment

The majority of paraesophageal hernias can be successfully repaired using laparoscopic techniques. A laparoscope is a flexible tube with a camera on the tip that provides real-time imaging to the surgeon. During a laparoscopic hiatal hernia repair, the surgeon will make five small incisions in the abdomen. The stomach is carefully placed back into its natural position, and the esophageal hiatus in the diaphragm is closed to prevent the stomach from moving back up to the chest cavity. In some cases, the surgeon may place mesh over the opening to reinforce the closure.

The nature of laparoscopic repair as a minimally invasive, minimal incision surgery allows patients to return to work and daily activities sooner than with open surgical procedures. This technique also reduces the amount of time in the operating room, reduces the risk of infection, and patients typically experience less postoperative pain.

Patients may need to stay in the hospital for one to two days after the procedure. Some individuals may experience difficulty swallowing and/or bloating for some time after surgery. These side effects generally resolve with time. Patients may be instructed to follow a diet of liquid foods, and then a transition to soft foods, before reestablishing a normal diet. Additionally, strenuous activities should be avoided for at least six weeks. It is important to follow all postoperative instructions given by the surgeon as well as scheduling and attending all follow-up visits.

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Recurrent Hernia

Recurrent Hernia

One of the risks associated with hernia repair surgery is that the hernia can return. If the hernia repair fails and the hernia reappears, this is referred to as a recurrent hernia.

Symptoms of Recurrent Hernia

A recurrent hernia is recognized as a bulge, sometimes painful, that appears at or near the site of the original hernia. If the hernia progresses and the intestines protrude into the hernia, this can cause severe health complications, such as:

  • Infection
  • Constipation
  • Nausea/vomiting
  • Loss of blood supply to the intestines

Causes of Recurrent Hernia

A hernia can reappear for a variety of reasons, some of which may not always be clear. The following circumstances can place patients at an increased risk of a recurrent hernia:

  • Infection of wound from initial hernia surgery
  • Being too active too soon after surgery
  • Chronic use of steroids
  • Chronic acute cough
  • Smoking
  • Obesity

What to Expect at Your Appointment

During your appointment, your doctor will perform a physical examination and ask you about your symptoms. In order to fully understand the extent of the recurrence, your doctor may prescribe an imaging test, such as:

  • A CT scan
  • An MRI scan
  • Ultrasound imaging

Non-surgical Treatments for Recurrent Hernia

Surgical intervention is necessary in order to repair a recurrent hernia.

Surgical Treatment for Recurrent Hernia and Post-Treatment

Recurrent hernias can be the most challenging type of hernia to repair.

Laparoscopic recurrent hernia repair - Individuals with a recurrent hernia are good candidates for laparoscopic repair. This is because the muscles of the abdomen are weak and laparoscopic surgical techniques can maintain the integrity of the muscles more so than an open hernia repair procedure. Additionally, scar tissue from a previous surgery can be avoided when using laparoscopic equipment.

Open recurrent hernia repair - If the recurrent hernia is complex, open repair may be necessary in order to properly restore the functionality of the abdominal wall. Open repair allows surgeons to carefully move abdominal tissues to their original position and place mesh on both sides of the weakened muscle in order to provide additional reinforcement.

Depending on the type of surgery performed and the overall health of the individual, patients may be able to go home the same day of the operation. When the individual can return to daily activities can range from one to three weeks after the surgery. It is important to schedule and attend all recommended follow-up appointments.

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Groin Hernia

Groin Hernia

A hernia is a bulge that develops as a result of weakened muscles in the abdomen. When the abdominal muscles are compromised, abdominal tissues and/or organs such as the intestines can protrude into this weakened area. When a hernia occurs in the lower abdominal wall in the area of the groin, this is referred to as a groin hernia or an inguinal hernia. A groin hernia can develop in both females and males, but it is more common in males.  

Symptoms of Groin Hernia

If you experience any of the following symptoms, contact a doctor:

  • A bulge in the lower abdomen in the groin area
  • Increased pain in the groin when straining, such as coughing and lifting heavy objects
  • In men, swelling and/or pain around the testicles

Causes of Groin Hernia

In males, a groin hernia, also known as an inguinal hernia, can develop very early in life. As male fetuses develop, the testicles drop into the scrotum through a pathway called the inguinal canal. After birth, the inguinal canal closes in order to prevent the testicles from moving back up through this channel. If the canal does not close completely or properly, it leaves a weakness in the abdominal muscles and can lead to a hernia.

Factors that place individuals at risk of developing a groin hernia include:

  • Pregnancy
  • Fluid in the abdomen
  • Obesity
  • Frequent straining during bowel movements
  • Chronic acute cough

Patients who suspect groin hernia should call a doctor. If the hernia begins to grow, or if experiencing nausea and/or vomiting, this may require immediate attention.

What to Expect at Your Appointment

During your appointment, your doctor will ask you questions about your symptoms and will perform a physical examination. In order to make a definitive diagnosis and assess the severity of the hernia, your doctor may prescribe one of the following diagnostic techniques:

  • MRI scan
  • CT scan
  • Ultrasound imaging

Additionally, your doctor may want to check for any signs of infection by prescribing a blood test or a urine test.

Non-surgical Treatments for Groin Hernia

Groin hernias do not heal on their own and can cause serious health complications if left untreated. Patients may not need surgery to repair a groin hernia right away. However, once the hernia begins to grow and cause more pain, this may indicate the need for surgical intervention.

Surgical Treatment for Groin Hernia and Post-Treatment

The goal of groin hernia surgery is to repair the gap in the abdominal wall and return the protruding tissues and organs to their natural position. Groin hernia can be repaired using a variety of surgical techniques. The surgeon will determine which procedure is likely to be most successful by considering the size and complexity of the hernia in addition to the patient’s symptoms.

Laparoscopic groin hernia repair - If the hernia is smaller in size, laparoscopic groin hernia repair may be an option. Laparoscopic repair uses three to four smaller incisions and an instrument called a laparoscope, a small tube with a camera on the tip, to guide surgeons. The nature of laparoscopic repair as a minimally invasive procedure generally allows patients to go home the same day of the procedure and return to daily activities within one to two weeks.

Open groin hernia repair - If the hernia is larger in size and more complex, open groin hernia repair may be necessary. Open repair requires one long incision which allows for greater visibility and dexterity for the surgeon. Some patients may need to stay in the hospital for a few days after an open repair, depending on the complexity of the surgery, and can return to daily activities one to three weeks after the procedure.

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Umbilical Hernia

Umbilical Hernia

When a weakness in the abdominal muscles in the area of the belly button (umbilicus) allow abdominal tissues and/or organs to protrude, this is referred to as an umbilical hernia. Umbilical hernias typically occur in babies, especially newborns who have low birth weight or who were born prematurely. However, umbilical hernias can also occur in adults.  

Symptoms of Umbilical Hernia

In newborns, an umbilical hernia may become noticeable when the baby:  

  • Cries
  • Strains while making a bowel movement
  • Coughs  

Adults may experience more severe symptoms, such as:  

  • A noticeable bulge in the abdomen that gets bigger when coughing or straining
  • Pain at the area of the bulge  

Contact a doctor if the bulge is red, hardened, swollen, and/or extremely painful. Vomiting and/or constipation may be signs of a more serious condition called strangulated umbilical hernia. This occurs when the intestine has significantly protruded into the bulge and blood circulation is restricted. Strangulated umbilical hernias may need immediate medical attention.  

Causes of Umbilical Hernia

The umbilical cord is connected to the baby through a small opening in the abdomen and transfers nutrients from the mother to the fetus during pregnancy. After birth, the umbilical cord is disconnected and the abdomen begins to heal. Sometimes, the abdominal wall does not heal completely and a gap is left in the abdominal wall. This gap places the child at risk of developing an umbilical hernia.  

In adults, umbilical hernias can develop due to:  

  • Straining during childbirth
  • Obesity
  • Intense vomiting
  • Chronic constipation  
  • Persistent, severe coughing ●
  • Frequent pregnancies

What to Expect at Your Appointment

During your baby’s appointment, your doctor will press on the abdomen and observe the behavior of the bulge. He/she will ask you questions about the symptoms you have noticed in your child.  

For adult patients, your doctor will ask you questions about your symptoms and will perform a physical examination.

In order to make a definitive diagnosis and assess the severity of the hernia, your doctor may prescribe one of the following diagnostic techniques:  

  • MRI scan
  • CT scan
  • Ultrasound imaging  

Additionally, your doctor may want to check for signs of infection by prescribing a blood test or a urine test.

Non-surgical Treatments for Umbilical Hernia

Roughly 90 percent of cases of newborn umbilical hernias will heal on their own, before the age of five. If the hernia does not heal by the age of four, it is important to schedule an evaluation. This may indicate the need for surgical intervention. In adult cases of umbilical hernia, surgical intervention is required to repair the hernia.

Surgical Treatment for Umbilical Hernia and Post-Treatment

Open repair is typically recommended for umbilical hernias. During open umbilical hernia repair, the surgeon will make an incision at the belly button, gently push the protruding tissues to their natural position, and stitch the opening closed. In adults, surgeons may reinforce the abdominal muscles with mesh.  

This procedure typically takes about one hour and patients can usually go home the same day of the procedure, depending on their overall health and the complexity of the surgery. Adults can generally return to work within two to three days, but should avoid strenuous activities for as long as four to six weeks following surgery.  

Make an Appointment

For an appointment with a specialist, call  

202-877-3627.


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Hernia

Hernias occur when a weak abdominal wall allows a piece of the intestine or other tissue to slip through, often creating a noticeable lump. They either develop slowly over months or years or develop very suddenly.

Often, hernias occur after overexertion, such as lifting heavy objects or playing sports, but they also can develop after a simple cough or sneeze. Some areas of the body, such as the groin, are prone to hernias because they are naturally weak.

Hernias often are named by where they are located. Learn more about the Hernia conditions our doctors treat.