The word hernia means “a rupture” in Latin. In medicine, we use the word hernia to describe many different conditions, all of which refer to an abnormally large hole in a part of your body, most commonly, the abdominal wall. Although we typically point to the contents of the abdomen (small intestine, colon, bladder) when referring to a hernia, technically, it is the hole in the tissue that is the true “hernia.” The contents of the hernia are contained within a thin layer of tissue, also known as a “hernia sac.” Most hernias can be easily “reduced,” meaning that the contents that protrude out can be pushed back into the abdomen. If the hernia contents cannot be pushed back into the abdomen, we refer to this hernia as “incarcerated,” and typically, an urgent surgical consultation is recommended to repair the hernia. Although most hernias are not very painful, incarcerated hernias can be extremely painful. In rare circumstances, the contents of the hernia sac can become stuck in a way that blocks off the blood supply to the contents of the hernia sac, causing severe pain, intestinal obstruction – this is known as a “strangulated hernia” and requires a trip to the emergency room for immediate surgery.
There are many causes of hernia – some are acquired over time, frequently from lifting heavy ojects, while others have been present since birth and slowly expand over time as the tissue ages and looses its strength. There are many specific causes, however they can all be categorized as either weakening tissue or increasing the pressure inside the abdomen.
Age: Over time, our tissue weakens, predisposing us to hernia formation
Obesity: Increased abdominal fat results in higher pressure in the abdomen, pushing out on the hernia, causing it to expand
Connective Tissue Disorders: Disorders such as Marfan’s Syndrome, Ehlers-Danlos Syndrome and many others cause a weakening of the abdominal wall tissue, predisposing patients to hernia formation
Smoking: Smoking causes two problems, the first is a chronic cough which repeatedly increases the pressue inside the abdomen, pushing against the hernia. The second is that smoking weakens tissues by injuring the small blood vessels that supply nutrients.
Pregnancy: Many women first notice a hernia during pregnancy. The enlarged uterus increases the pressure inside the abdomen predisposing pregnant women to hernia formation.
Benign Prostatic Hypertrophy (BPH): enlargement of the prostate forces men to increase the pressure inside their abdomen in order to force urine through the smaller hole in the prostate. This increased pressure can cause hernias to form, or enlarge in size. In most situations, we try to treat BPH before fixing the hernia to prevent recurrence after surgery.
Despite all these conditions that predispose people to hernias, many patients develop hernias without any of the above risk factors. If you think you may have a hernia, you can schedule a consultation with Dr. Weiner by calling: (248) 413-2670.