You might think that only men can get hernias, or that they’re only caused by physical strain. Not so, explains Mark Sherman, MD, who specializes in minimally invasive robotic surgery at Scripps Memorial Hospital La Jolla.
Hernias can affect anyone. Hernias can also be easily diagnosed during a routine exam with your physician, says Dr. Sherman, who shares his insights on hernias with San Diego Health host Susan Taylor.
In your abdominal cavity, muscles surround your stomach and other vital organs. A hernia occurs when a hole in that muscle allows the tissue on the inside to push through to the outside.
Genetics, age, and level of physical activity can affect your chances of developing a hernia, but most often, they’re caused by explosive movements that strain the abdominal muscles.
In addition to strenuous exercise or heavy lifting, you could develop a hernia during pregnancy or from respiratory illnesses like bronchitis that cause vigorous coughing and sneezing.
Unfortunately, says Dr. Sherman, hernias can’t be treated with rest, exercises, or medications. The best treatment is an operative procedure. Robotic surgery is minimally invasive, and some cases only require outpatient procedures. Even with more extensive operations, patients recover in just a few days or weeks.
In this episode of San Diego Health, Dr. Sherman reviews the three types of hernias and their causes, then dives into the robotic surgery process.
In its most basic sense, when we talk about a hernia in the abdomen, we’re talking about the entire abdominal cavity, which has the stomach and all the organs inside. The abdomen is surrounded and contained by muscle. A hernia is when there’s a hole in that muscle that allows tissue on the inside to push out through to the outside.
Yes. Technically a hernia in the groin, which is an inguinal hernia, is still in part of the abdominal wall. It’s one of the three most common types of hernias.
Then there are hernias on the abdominal wall itself, in the front of the abdomen, which can be incisional hernias stemming from a previous incision from an operation somebody may have had.
Then there are hiatal hernias, which is in the area through the diaphragm, which is what separates the chest from the abdomen. Some of the stomach that’s below the diaphragm actually pushes up into the chest. People who have that tend to have reflux and different symptoms than those with hernias elsewhere on the abdominal wall.
The natural thing is you see a lump and you think, I could have a cancer. But in most cases if it’s on the abdominal wall itself, it’s going to be a hernia. It is particularly so if it’s in one of those locations, like in the groin or in the middle of the abdomen.
There are many different causes. More often than not it’s a combination of features. One is just genetics. If your mom and dad both had hernias, there’s a good chance you might develop a hernia. But the other thing is strenuous effort. A lot of times we think about heavy lifting, but it’s really that kind of burst of energy. When somebody lifts something heavy, they do that kind of explosive movement to try to lift and move something. And it’s those explosive movements that put tremendous strain and cause some of the tissues to start to give a little bit. And once it starts to give, it slowly stretches day by day until you see the hernia.
One of the most common things that I see in my office is people who say they had a really bad allergy attack last spring, or had a bad episode of bronchitis a couple of months ago. If that sneezing and coughing, those kinds of tremendous efforts with the muscles of the abdominal wall put enough strain, that’s a very common cause for hernias.
In some cases they can be. But more often than not, hernias are not painful. In fact, I often have people come into my office, worried about pain in the groin, and they often don’t have a hernia. It’s usually the individual who says I was in the shower washing, I looked down and said, what the heck is that? And they can see a bulge and a protrusion.
As people get older, the tissue in their body becomes a little bit more stretchy and pliable. As you get older, those muscles can stretch a little bit more.Even if there was a small little weakness, it becomes more and more pronounced as time goes on. If you’re very physically active, doing those kinds of physical activities that will strain the abdominal wall, your risk for hernia is definitely going to be higher.
The best treatment for a hernia is an operative procedure. Sometimes we think that if we just wait, it will get better. Are there other things you can do such as exercises or medications? Unfortunately not. There are no exercises that will make hernias get better. You really need an operative procedure to fix the hernia.
In very rare cases, and that rare case being in pregnancy when there are changes in the body. Sometimes small little hernias develop with all that strain, but they go away after pregnancy. Those are the only ones I’ve ever seen go away on their own. All other hernias, they need an operation.
Previously we had to do large incisions. We’d have to open up areas of the muscle to get to where we needed to do the repair. Now with robotic procedures and minimally invasive procedures, we can make small little incisions and insert certain instruments inside the abdomen, which actually gives us an even better view because we have a video camera that looks inside. It can give a three-dimensional view of the abdominal wall. It allows us to not just see the hernia, but even inspect other areas.
There are times that we look inside and can find additional small hernias that we couldn’t feel from the outside. By doing this minimally invasive robotic technique, it allows us to repair all of those at the same time.
One of the great advantages of minimally invasive robotic techniques is that it uses small incisions. The recovery is easier. There’s less discomfort. In many cases, we’re doing these procedures as outpatients. Somebody comes in, has the procedure and goes home the same day. In the more extensive kind of hernia repairs, we certainly decrease the amount of time that people need to be in the hospital. And because there is less pain, their recovery is definitely much faster. In some cases, a few days. In some cases, a few weeks.
One of the advantages of doing these procedures with these minimally invasive robotic techniques is that there is a little bit less pain, so people can get back to their activities quicker.
Unlike in the past, when we used to say no heavy lifting for three months, now, we really let the body be your guide. If it doesn’t hurt, you can do slow, steadily, progressive activity. The main thing is avoiding those big burst of energy activities.
There are two parts to that. Can a hernia come back in the same place where it was fixed? Unfortunately that does happen. It’s called a recurrent hernia.
One of the advantages of minimally invasive robotic techniques is that it allows us to identify more areas and perhaps identify hernias that weren’t suspected beforehand and fix them so people don’t have those kinds of recurrent hernias. Now, in a similar vein, if somebody has had a hernia before, they are a little bit more susceptible to developing hernias in other locations in the future.
If anybody is concerned that they have a hernia, they should definitely see their physician. They shouldn’t be afraid of the operative procedures or the recovery because some of these techniques really make this much easier.
The most important thing is let your doctor take a look and examine you because more than any kind of X-ray or CT scan, in most cases, it’s really just a good exam by your physician that will tell you whether you have a hernia or not.
Watch the San Diego Health video with host Susan Taylor and Dr. Sherman discussing how hernias are diagnosed and treated.