As the Hernia Specialists of Minnesota we see time and time again that patients are offered only a single option for repair of their hernia. We do not believe in this “one size fits all approach”. Instead, we favor a shared decision making process. This process starts with patient education. Please browse the resources below and be sure to bring plenty of questions to your appointment.
A hernia is a gap or space in the strong tissue that holds muscles in place. A hernia occurs when the inside layers of the abdominal wall have weakened, resulting in a bulge or tear. In the same way that an inner tube pushes through a damaged tire, the inner lining of the abdomen pushes through the weakened area of the abdominal wall to form a small balloon like sac. This can allow a loop of intestine or abdominal tissue to push into the sac. The hernia can cause discomfort, severe pain, or other potentially serious problems that could require emergency surgery. Both men and women can get a hernia. Hernias may also occur in children. You may be born with a hernia (congenital) or develop one over time.
Inguinal and femoral hernias are due to weakened muscles that may have been present since birth, or are associated with aging and repeated strains on the abdominal and groin areas. Such strain may come from physical exertion, obesity, pregnancy, frequent coughing, or straining on the toilet due to constipation. Adults may get an umbilical hernia by straining the abdominal area, being overweight, having a long-lasting heavy cough or after giving birth. The cause of hiatal hernias is not fully understood, but a weakening of the diaphragm with age or pressure on the abdomen could play a part.
The common areas where hernias occur are in the groin (inguinal), belly button (umbilical), and the site of a previous operation (incisional). Other types include outer groin (femoral) and upper stomach (hiatal). Most hernias are external hernias. This means that the protrusion is toward the outside of the body and creates a bulge you can see.
It is usually easy to recognize a hernia.
Other times a hernia may be detected by your doctor on a routine physical examination. The pain may be sharp and immediate or a dull ache that gets worse toward the end of the day. Severe, continuous pain, redness, and tenderness are signs that the hernia may be entrapped or strangulated. Another sign of this is if the bulge used to come and go, but now is stuck out. These symptoms are cause for concern and you should immediately contact your physician or surgeon.
The most common way to diagnose a hernia is by history and physical exam with your healthcare provider or surgeon. Often the signs are very classic and can even be determined by a telehealth visit. Sometimes additional studies are necessary. If this is the case your surgeon can help determine whether an ultrasound or CT scan will be best to help confirm the diagnosis.
Most hernias are NOT dangerous, however, some can contain bowel or other intra-abdominal contents that can become stuck out (incarcerated) or twisted (strangulated). Especially concerning is if the area around the hernia becomes red, hot, or extremely tender. If this occurs you should go to your nearest emergency department. We do not typically recommend you limit your activity because of a hernia. A general recommendation is, if it hurts, don’t do it. Many people with hernias do have to limit their activities due to discomfort. The best fix for this is repair of the hernia. There are also support systems that can be temporary solutions. These are known as abdominal binders and hernia “truss” belts and can be found at medical supply stores. A hernia does not get better over time, nor will it go away by itself. There are no exercises or physical therapy regimen that can help. While it may be safe to watch some hernias, the only way a hernia can truly be repaired is with surgery. If you and your surgeon decide that a surgical hernia repair is right for you, ask about all of your options, including a traditional open procedure with a large incision versus a minimally invasive procedure. A minimally invasive procedure is performed through several smaller incisions and leads to less pain and quicker recovery.
Following a minimally invasive or robotic hernia repair operation, you will be transferred to the recovery room where you will be monitored for 1-2 hours until you are fully awake. Once you are awake and able to walk, drink liquids, and your pain is controlled you will be sent home. With any hernia operation, you can expect some soreness, mostly during the first 24 to 48 hours. You are encouraged to be up and about the day of surgery and slowly get back to your usual activities. With minimally invasive or robot-assisted hernia repair, most patients are able to get back to their normal activities within a week. These activities include showering, driving, walking up stairs, lifting, working and engaging in sexual intercourse
Return to work can be highly dependent on your particular work situation and hernia repair. The best advice is to ask your surgeon. Generally, return to work is rapid following minimally invasive repair. Patients with desk jobs may return 2-3 days following repair. Those who perform light, physical labor should plan for 7-10 days off from work. Patients with jobs requiring heavy labor may need to take up to 3-6 weeks off from work, however, we find that most can return much sooner with some restrictions.
The use of mesh has revolutionized hernia repair over the last several decades. By using mesh we can drastically reduced the chance of the hernia coming back (recurrence). That being said, we are open and understanding about the criticism that some mesh has received and now offer a variety of options including no mesh repair, biologic reinforced repair and traditional mesh repair. Ultimately this will be a choice made between your surgeon and you. Please see our section All About Mesh for more details.