When Does Hernia Pain Become a Problem?

March 19, 2020

Hernias come in different forms and locations in the abdomen. Some have lower risk of complications while others require immediate care. All symptomatic hernias will eventually need to be repaired surgically – the operative word here is symptomatic. Why? Because not all hernias cause noticeable problems. For the purposes of this blog, we will primarily focus on inguinal or groin hernias; the most commonly repaired defects in the United States and around the world. About 90 to 95% of inguinal hernias occur in men, but only a small proportion become symptomatic and require treatment. As a result, it is estimated that upwards of 25% of men have or will have an inguinal hernia but only a small portion of them will ever know it.

To quickly touch on other hernias, there are umbilical or bellybutton hernias, femoral hernias in the upper thigh, incisional hernias from previous surgeries and hiatal hernias which do not occur in the abdomen, but rather at the diaphragm. Of the hernias listed above, femoral are the most prone to complications, occur most often than women and require immediate treatment to avoid a potentially life-threatening situation.

Pain is a symptom of hernias

When we think of hernias we often think of a bulge, but varying degrees and types of pain can also be a symptom. This pain can be dull and aching or alternately relatively sharp, but quick to dissipate. This is usually normal and often prompts a visit to the primary care doctor. Using medical history and some physical tests to determine whether a hernia may be present, a diagnosis is often made on the spot. In the case of an inguinal hernia, the nature of the nerve bundles near the groin means that pain may also be felt in the back, in the testicles or further up in the abdomen.

When pain becomes an emergency

The biggest concern when it comes to hernias is the risk of incarceration or strangulation. Incarceration occurs when the contents of the abdomen push through the hernia defect, but do not drop back into the abdomen when the patient lies down or changes position. Patients will usually feel stronger more constant pain no matter what position they are in and they will likely continue to see a bulge in the abdomen even when they lie down. Incarceration of a hernia in and of itself is not dangerous since blood flow remains to the entrapped abdominal contents, however, it can lead to the truly dangerous possibility of strangulation.

Strangulation occurs when the incarcerated hernia contents have blood flow limited or blocked completely by the hernia defect. This is an emergency situation as the tissue trapped in the hernia can eventually die. If, for example, the colon or large intestine becomes trapped or strangulated within the hernia defect it will likely require an additional surgical procedure to resect or cut away the portion of the colon that has been damaged by the lack of blood flow. This not only increases the risk of surgery substantially but can also lead to complications such as a temporary or permanent colostomy.

How to prevent it from getting too far

While the risk of strangulation for an inguinal hernia, for example, is very low at about 1 to 2% per year, it is important to have the hernia checked by a specialist who can determine if treatment is needed or if watchful waiting is appropriate. Patients who are young and in good health are usually indicated for surgery because their stronger abdominal musculature increases the risk of strangulation. Older patients may be able to postpone the procedure if a) their surgeon believes that there is an extremely low risk of strangulation, b) their lifestyle is not being impeded by the hernia and/or c) that their surgical risk is too high.

The most important thing to understand is that hernia surgery is performed over 1 million times per year in the United States. In the hands of an experienced surgeon, hernia surgery is extremely safe. Any concerns that you may have about mesh repairs should be discussed during your consultation with one of our surgeons, however the quality of abdominal mesh has increased tremendously over the past decade and many of the concerns of prior generations of mesh are no longer applicable. Please contact our office for more information and to learn more about hernia surgery and repair.

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