What’s a Hernia, Doc?
By Dr. Tim Fargo, Chiropractor
Good question. As some of you may know, I have been on medical leave for the past four weeks after having had surgery for a bilateral (both sided) hernia repair. I thought it an opportune time to explain what a hernia is, who is most susceptible to them, how you might know you have one, and how they are treated.
First of all, a hernia is, by definition, a condition when an organ pushes through a weak spot in the surrounding area. The major sign of a hernia is a bulging of the affected area; this usually occurs in the abdomen and groin. Your abdominal organs, like your intestines, are contained in an abdominal cavity which is lined with a membrane known as the “peritoneum”. On the outside of the membrane, we have things like fat and the abdominal muscles. It is sometimes the case that a person will develop or have a congenital (from birth) weakness in the abdominal muscles. When the abdomen is pressurized, like when you are lifting something or straining, the intestines can start to move into and through the weak spot in the abdominal wall and this can then cause a bulging that is visible and/or palpable. Abdominal hernias can occur in the midline, such as after childbirth or abdominal surgery. They also commonly occur in the groin area and are then known as “sports” hernias.
People with a family history of such a condition have an increased likelihood of a hernia occurring as they get older. Men are more susceptible to sports (more accurately known as “inguinal”) hernias. This is because the testicles of baby boys have to descend from the abdomen into the scrotum along a canal that is often a source of persistent weakness in the abdominal wall. Sorry for giving you too much information here. Anyway, for this reason boys and men are more susceptible to this type of hernia. Such hernias can bulge straight out through the abdominal wall in the groin, or they can bulge down toward the scrotum. Common symptoms are a bulge or lump in the affected area often accompanied by pain. If an abdominal or inguinal hernia persists and enlarges, the intestines and overlying fat tissue that are bulging through the defect can become trapped or “incarcerated”. In such a case there is a risk of the trapped tissue dying (developing gangrene). Such a situation would present the person with a surgical emergency.
As already mentioned, hernias are caused by muscle weakness and strain, and sometimes a congenital defect. Other risk factors are aging, gender, family history, pregnancy, chronic cough, weightlifting, and straining too much.
In many circumstances there is not much that one can do to prevent hernias from occurring. Maintaining healthy body weight is one significant means of minimizing the risk of hernia development. If you already have a susceptibility or a small identifiable hernia, then avoiding extreme physical activities that put pressure on the lower part of the body, such as lifting heavy objects, would be a good idea.
Detecting hernias is generally done by physical examination, including simple observation of the area, and also observing and feeling what happens when the person coughs. You and the doctor might well be able to feel the hernia bulging even more when you cough.
Speaking for myself, I knew I had one, albeit small, for over 20 years. As is typical of me, I chose to ignore it. Over the years, and particularly more recently, I began having more discomfort and was concerned about complications. At the end of October I had bilateral hernia repair surgery. The surgery is done laparoscopically, which means that they use a scope and make small incisions in the abdominal musculature, never piercing the peritoneum, and place a mesh product across the defect in the abdominal wall. This should, in future, prevent a reoccurrence of the hernia.
While I have never been overly impressed by the ability of medical doctors to keep people healthy, I must say that I was very impressed by their ability to perform this relatively complex operation and get me back on my feet pretty quickly. I do very much appreciate the skill that Dr. Eric Johnson and his team at Abbott Northwestern brought to the procedure. I had a 10-pound lifting restriction for four weeks that prevented me from working on patients, but, by the time you read this, I should be back and adjusting patients. One of the things that struck me was the critical importance of creating alliances and relationships with other healthcare providers who are capable of delivering other services far beyond what we do as chiropractors. Over the years, I have carefully cultivated such relationships and am happy to share what I have learned, if you have the need for a medical specialist. Please let me know if you have any questions about the procedure and if I can help you with a referral to other healthcare providers.