Hernias and the Battle of the Bulge
A newly discovered bulge that has suddenly surfaced in the abdomen or groin area accompanied by pain could be the first sign of a hernia. Dr. John Millili of Shore Physicians Group in Somers Point, New Jersey said while hernias are quite common, you should not ignore them.
What is a Hernia?
Dr. Millili explained a hernia is when an organ such as the intestine or even fat will push through an opening or weakness in the muscle wall or tissue of the abdomen. Typically, the first symptom of a hernia is a bulge accompanied by tenderness or pain in that area. Sometimes the bulge will appear to get smaller when they lay down. That is misleading, according to Dr. Millili who said the bulge itself does not get smaller. Instead, the forces on it decrease when they recline. It is not going away. Over time that bulge will likely increase in size and be accompanied by a dull ache. Someone with a hernia will often complain of pain while lifting or experience a sense of feeling full. Occasionally hernias will not have any symptoms and will be discovered during a routine physical exam for an unrelated problem.
Types of Hernias
Although there are many different types of hernias, Dr. Millili explained that 95% of them fall into four categories:
- Inguinal hernia- An inguinal hernia is a bulging of the abdominal contents through a weak area in the lower abdominal wall. Inguinal hernias can occur on either side of the groin, according to Dr. Millili, at the inguinal canals, which are the two passages through the lower abdominal wall. Although hernias are more common in men, a small percentage of women may develop inguinal hernias as well. An inguinal hernia in women may contain part of the female reproductive system, such as an ovary. When this occurs, the peritoneum, the abdominal cavity lining, bulges through a weak area in the abdominal wall.
- Incisional hernia-An incisional hernia may develop after any type of abdominal surgery when there is a weakness in the abdominal wall. The weakness could allow tissue or an organ to push through and form a hernia. The first symptom of an incisional hernia might be a bulge near the previous incision accompanied by pain, according to Dr. Millili.
- Umbilical hernia-As its name indicates, the umbilical hernia occurs in the belly button area, where the umbilical cord passed through. Here fat or occasionally intestine will protrude through. The first indication of the hernia will be a bulge near or below the belly button. The bulge, along with the discomfort, is most often noticed when straining or coughing.
- Ventral hernia-Dr. Millili explained a ventral hernia might occur anywhere along the abdominal wall. He added that surgery to repair the ventral hernia can be complex due to the other organs along the abdominal wall.
What to do first
At the first sign of a bulge, Dr. Millili suggests that patients contact their primary care physician who will assess the bulge and then direct the patient to a specialist or a surgeon. “The primary care physician will determine if their patient has a hernia that may need surgery,” said Dr. Millili. “Don’t wait for the pain to go away or for the bulge to go away on its own. It is not going to. If it is a hernia, the patient will need surgery to resolve it.” Surgery for a hernia can be either laparoscopic or open. Dr. Millili said it depends on several factors including the size of the hernia and any other organs that might be near the hernia.
Dr. Millili said the surgery typically can be completed on an outpatient basis, with a return to normal activities in several weeks. One of the complications of not addressing the hernia quickly, aside from the discomfort of the hernia, is the onset of sudden pain from an incarcerated or strangulation hernia. “This is when the organ, normally the intestine, pushes the wall of the abdomen and the blood flow to that portion of the protruding organ is cut off,” said Dr. Millili. “This is an emergency when it occurs. The organ can suffer necrosis if the blood flow is cut off. This is a “middle of the night” type of emergency surgery when there is an incarcerated or strangulation hernia.”
Contributing Factors to Hernias
Dr. Millili said anyone could get a hernia. However, several contributing factors make it more likely for someone to develop a hernia. Examples include, athletes or people whose jobs require them to routinely lift a lot of weight; people with obesity; and smokers and people with COPD. He did add that having one hernia does not mean the person is necessarily prone to have another. There are complications for not taking care of a hernia while it is smaller, such as a bowel obstruction.
Other factors that make the hernia more uncomfortable include straining while in the bathroom, coughing or lifting anything heavy. Dr. Millili suggested avoiding those things that will cause any more discomfort.
The good news is that the hernia can be repaired. Dr. Millili said on average a person will be out of work for two weeks and back to their normal activities within a month.
To schedule an appointment with general surgeon Dr. Millili at his 649 Shore Road office in Somers Point, visit or call 609-365-6239