US Pharm
. 2020;45(6):13-14.

A Bulge Through the Abdominal Wall

A hernia happens when part of the contents of the abdomen bulges through a weak area or tear in the wall of muscle that holds the intestines in place. Although there are several types of hernias, the most common is an inguinal hernia, an intestinal bulge through the abdominal wall muscle in the groin area. These hernias may slide in and out of the tear in the abdominal wall. Inguinal hernias are about 10 times more common in men than women, in older adults, in those with a family history of inguinal hernias, and in overweight individuals.

Significantly More Common in Males

Inguinal hernias can be present at birth, especially in boys, if the abdominal muscle wall does not develop correctly. Often, the hernia is visible while the infant or small child is coughing, crying, or straining during a bowel movement.

An inguinal hernia may not cause noticeable symptoms. It may be discovered during a routine physical exam of the abdomen. In most cases, however, these hernias are apparent when standing up straight, coughing, or straining while lifting or going to the bathroom. The most common symptoms are a bulge from the area of the lower abdomen, accompanied by pain or a feeling of heaviness in the groin area.

Conditions That Strain the Abdominal Muscles Increase Risk

Any condition that causes a chronic cough, such as smoking, bronchitis, or cystic fibrosis, increases the chance of inguinal hernias. Frequent straining during urination or bowel movements is another risk factor, as are excess weight and pregnancy, which increase the pressure on the abdominal wall muscles. Jobs that require significant lifting can also increase the risk of hernia development.

Although patients with an inguinal hernia can usually push the bulging tissue back through the muscle wall, most inguinal hernias eventually require treatment with a minor surgical procedure. If a segment of the intestines pushes through the muscle wall and becomes “strangled,” that is, the blood supply to the tissue is cut off, that part of the intestinal tissue can die. This situation is a medical emergency, requiring immediate surgical repair. If the herniated tissue can no longer be pushed back behind the muscle wall, if symptoms of nausea and vomiting develop, or if the hernia becomes dark red or purple, it is necessary to seek immediate medical attention.

Surgery Is the Most Common Treatment for Hernia

Each year, an estimated five million Americans develop hernias, but less than one million undergo hernia-repair surgery. Although hernia repair was once a major surgical procedure, modern techniques mean that in almost all cases, this surgery is done on an outpatient basis.

There are two types of hernia operations: open hernia surgery and laparoscopic hernia surgery. Open surgery is when a surgeon makes a cut in the groin to view and repair the hernia. In laparoscopic hernia surgery, smaller incisions are made and special tools are used to view and repair the hernia.

During the procedure, the surgeon repositions the herniated intestine behind the abdominal muscle wall and closes the tear or weak area in the wall to keep the intestine in place. The surgery itself usually lasts about 1 hour, and the patient is allowed to go home a few hours later. Return to everyday activities after surgery is often within a week or so, with certain activities restricted for a month or 6 weeks. In general, hernia surgery is a very successful procedure with few risks.

Protect Yourself to Prevent Inguinal Hernias

Hernias may be prevented by avoiding strain on the abdominal muscle tissue. Lifestyle changes such as avoiding heavy lifting, maintaining a healthy weight, eating a diet rich in fiber to avoid constipation, and smoking cessation to prevent a chronic cough are all ways to help prevent the development of hernias. Most doctors do not recommend the use of truss supports to treat inguinal hernias; if support is needed to prevent a hernia from bulging, surgery is the best solution.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.