When to Worry About Hernia Pain? Symptom, Causes, Treatment

Table of content

1. When to worry about hernia pain and what is it?

From blinking (an eye) to running (a marathon), every movement (in the human body) is controlled by muscle functions.

Moreover, the muscles help hold the organs in their right position. A weak spot in a muscle wall can squeeze and yield to allow displacement and protrusion. One such condition is Hernia.

A hernia looks like a lump. One may not feel it while in the lying position. But it gets prominent and, as such, can be strongly felt when one moves the body with different postures. It occurs when an organ squeezes through a weak spot in a muscle.

Hernias are mostly found in the abdomen (known as abdominal wall hernias. They are generally visible and look like a lump or bulge beneath the skin. They do not cause any symptom except for mild pain during strain).

If symptoms of nausea, vomiting, and fever are present, you should worry about hernia pain. In this case, meet a doctor immediately.

However, a hernia can also occur on the upper thigh/belly/ buttock/ groin areas. Most hernias are not Deadly. Sometimes, they may require surgical treatment to avoid potentially dangerous complications.

2. Hernia Symptom

One may experience symptoms depending on the type of Hernia. The common symptoms experienced are discussed below.

2.1) The most prominent symptom is the visible bulge. It is located in the affected area on both sides of the pubic bone. It is one of the three main bones that make up the pelvis. The bulge becomes more prominent when the patient is upright (especially while coughing, bending, or straining). A burning or aching sensation is felt in the bulge

2.2) Sometimes, in the groin area, pain, discomfort, and even heavy dragging sensations are felt. Weakness and pressure may also be felt in the groin area.

2.3) Occasional pain/ swelling (around the testicles) may arise when the protruding intestine descends into the scrotum. It's a male reproductive structure. It consists of a suspended dual-chambered sack of skin and smooth muscle. It is present in most terrestrial male mammals and is located under the penis.

2.4) Severe hernia symptoms are shooting pain/vomiting/constipation. Other symptoms are: the organ or the tissue becomes infected /blocked/ strangled.

2.5) Symptom among the children is inguinal Hernia resulting from weakness in the abdominal wall (detected at birth). Sometimes, the Hernia (among the children) becomes visible only when the infant is crying /coughing /straining during a bowel movement. Under the condition, the infant may feel irritated and less hungry (than usual).

2.6) In the case of strangulated Hernia, the following symptoms may be experienced.

• Nausea and vomiting
• Sudden pain (that quickly intensifies)
• Fever
• Hernia bulge (that quickly turns red/ purple/ dark)
• Disability to move bowels (or pass gas)

3. Pain in hernia

Most hernias are not painful. However, sometimes the area around the hernia may feel tender (having a sharp pulling sensation). The pain may be intermittent (or constant).

Again, a hernia can also be painless and only appears as a bulge (with swelling). And the swelling may decrease (or disappear) depending on the pressure in the abdomen. The constant intense pain (at the bulge site) may be a cautionary signal for a medical emergency.

4. Complications of hernia

A. Complications in Inguinal Hernia

Heavy pressure is felt in the surrounding tissues. Most inguinal hernias get enlarged over time (if not removed surgically). In men, large hernias can extend into the scrotum (causing pain and swelling).

B. Complications in Incarnated (trapped) Hernia 

If the contents of Hernia become trapped (in the weak part of the abdominal wall). It can obstruct the bowel leading to severe complications (such as disability to move bowels and pass gas).

C. Complications in Strangulated Hernia:

Under this condition, blood flow to a part of the intestine can be obstructed. Ultimately, strangulation can lead to the death of the affected tissue. A strangulated hernia is lethal and needs a medical emergency.

5. Causes and risk factors

Causes are the agents directly responsible for the occurrence of a disease. On the other hand, a risk factor is not necessarily a cause. A risk factor may be anything that increases the likelihood of a patient developing the disease. For instance, age is a vital risk factor for most diseases, including Hernia but it cannot be a cause.

It is not clear what specific agent is causing the disease in most cases. For a particular disease to occur, the organized effects of a host of factors play a key role. such as age

• environment
• body weight
• lifestyle including food habits
• physical activity
• type of job involving strain
• seasonal characteristics
• medication and surgery
• undertaken to cure other diseases

5.1) Causes of Hernia

Hernias are caused by a combination of muscle weakness and strain. Depending on the causes, a hernia can develop quickly (or gradually over a longer period). Common causes of muscle weakness include failure of the abdominal wall to close properly in the womb.

Ultimately, all hernias are caused by a combination of pressure and weakness of muscle. Sometimes, the weakened muscle starts at the very birth.

To sum up, anything that causes an increase in pressure in the abdomen can cause a hernia.

5.2) Risk factors of hernia

The risk factors contributing to an increase in pressure include

• Age: Age is a great risk factor for a hernia. Muscles become weaker with age.
• Being Male: Males are eight times more likely to develop Hernia (than females).
• Family history: People with close relatives who have the disease are more likely to develop a hernia.
• Chronic cough: Smokers suffering from a chronic cough are more likely to develop hernias.
• Chronic constipation: Constipation causes straining during a bowel movement.  
• Pregnancy: Being pregnant can weaken the abdominal muscles causing increased pressure inside the abdomen.
• Lifting heavy load: Lifting heavy baggage without stabilizing the abdominal muscles makes it easy to develop a hernia. 

Other risk factors include:

• Diarrhea
• Obesity
• Poor nutrition
• Premature birth
• Low birth weight
• Previous hernia treatment.

6. Type of Hernia

The treatment procedure is influenced by type. The causes, risk factors, signs, and feelings of the patient determine the type of disease. There are five types of hernia.

A. Inguinal Hernia (located in the inner groin)

In such a hernia, the intestine protrudes through the abdominal wall (or through the inguinal canal of the groin). About 90% of the groin hernias are inguinal. They mostly occur in males (because of the natural weakness of the area)

B. Femoral Hernia (located in the outer groin)

occurs when the intestine enters the canal (running through the artery into the upper thigh). Femoral Hernia is common among women (especially those who are pregnant and obese).

C. Incisional Hernia (resulting from an incision)

The Hernia, in such a case, pushes through the abdominal wall. This mostly occurs among old obese people (who become inactive after abdominal surgery).

D. Umbilical Hernia (located in the belly buttock)

An umbilical hernia is a part of the small intestine that passes through the abdominal wall (near the navel). It is found common among newborns and obese women (having many children).

E. Hiatal Hernia (located in the upper stomach)

occurs when the upper stomach squeezes through the hiatus (an opening in the diaphragm through which the esophagus passes).

7. Diagnosis of Hernia

Diagnosis identifies the root problem by applying various tests. Such as observing the symptoms, questioning the patient about his feelings and observations, genetic history, and personal history (including his lifestyle) (R).

During the tests, the doctor will typically feel the presence of a hernia. This procedure is applied because Hernia gets prominent during coughing (in addition to standing/ straining). Among the various tests applied, the following tests are important

• An ultrasound test (using a sound wave through scanning the body) is conducted to detect Hernia.
• Another test conducted is a barium X-ray (taking images of the digestive area, including the intestine).
• A CT scan (Computed Tomography scan using an X-ray) can get a picture to detect the presence of a hernia.
• An endoscopy examines the esophagus and the stomach (using a small camera at the end of a flexible tube).

8. Hernia Treatment and repair

Surgery is the only option to cure Hernia. A surgical repair involves pushing the bulge back inside the body part (where it originally lies). The doctor will usually recommend surgery if anyone of the following conditions occurs.

• Tissues (such as in the intestines) become trapped.
• The Hernia becomes strangulated. This can cause permanent damage, which needs a surgical emergency.
• The Hernia is growing larger, attended with increasing pain and discomfort. The following two surgical procedures are usually conducted to cure Hernia.

8.1) Nontension (or mesh) repair

In the procedure, a piece of mesh is placed to reinforce the area with sutures or staples. Instead of pulling the tissue around the Hernia together. A mesh is made of flexible material that stays in the abdomen and helps the tissue to grow).

Conclusively, mesh (or non-tension) repair has a lower incidence of recurrence (than tension repair).

8.2) Laparoscopic (or closed) repair

Laparoscopic or closed procedures can be used to repair inguinal hernias, especially when the hernia is small. With the help of this, the surgeon can visualize to perform the procedure correctly. The procedure entails placing special instruments through tiny incisions in the abdomen.

The instruments include a laparoscope, a fiber-optic tube, and a tiny camera at the end. In the procedure, the surgeon makes 4 small incisions in the abdomen, one near the navel and the others lying down.

Conclusively,

• Since the Laparoscopic procedure uses mesh (for reinforcement), it has a lower recurrence rate. Moreover, a smaller incision means less discomfort. In addition, little or no scarring/ quicker return to normal activity within a few days.
• The laparoscopic procedure is always done under general anesthesia.
• Before surgery, the surgeon may recommend a pre-operation exam. Such as Blood tests, ECG, and Chest X-rays. These tests are done to make sure the lungs and heart are in good condition.
• The patient may be asked to stop taking over-the-counter (which needs no prescription) medications.
• Before surgery, the patent should always disclose to the surgeon all medicines (regularly and occasionally taken)
• After surgery, the doctor may also prescribe some pain medications.

9. Prevention of hernia

It is not possible to prevent Hernia (especially caused by genetics). Further, a congenital diaphragmatic hernia is a birth defect (which is inevitable). One born with weak muscles makes it easier to get a hernia later in life.

However, one can reduce the chances of developing a hernia (later in life) by following a healthy lifestyle.

• Eat smaller meals (One needs to avoid large meals and instead should consume small meals at short intervals)
• Avoid spicy foods and consume high-fiber foods (fruits/ vegetables/whole grains contain fiber that can help prevent constipation and straining).
• Avoid smoking and alcohol (these two expensive bad habits have no social recognition. They invite early death as they are a major risk factor for most malignancies, including Hernia).
• Maintain an ideal and healthy weight for obese people. Obese people need to talk to the doctor for advice to reduce weight through suitable diets and exercise effectively.
• Maintain a proper balance (while lifting heavy objects) to prevent strain if one needs lifting. It is advised not to lift objects heavy enough beyond one’s ability.

10. Should I go to the emergency room for a hernia? 

When the hernia is very painful. it may mean that the bowel is stuck inside the Hernia, blocking blood flow to the bowel. This is unusual but can be deadly and quickly go to the emergency department for repairs.

11. Key global information

• Males are 8 times more likely (than women) to develop an inguinal hernia
• Globally, at least 2% of males develop abdominal wall hernia (in the USA, it is 1.5%).
• Every year around the world, more than 20 million hernias are repaired (0.3% of the total world population).
• Abdominal wall hernias are most common (followed by inguinal;/ femoral /umbilical types).      

12. Concluding remarks

There is no medicine to cure Hernia. A hole, tear or weakened part in the body tissue through which another body part may protrude, causing a bulge. Surgery is the only option to cure Hernia. However, taking certain medications might help prevent the Hernia from worsening further.

13. TIPS

• H= HERNIA (occurs when an organ squeezes through a weak spot in a surrounding muscle)
• E = EMERGENCY (treatment is needed in case of strangulated Hernia)
• R= Risk (of Hernia is great for old obese people)
• N = NOT (life-threatening is most of the hernias)
• I = Inguinal (Hernia occurs mostly among the males)
• A = Abdominal (wall hernias are most common)