Many people live with a hernia for months or years without much hardship. They may feel a small lump in the groin or abdomen that pops out when they stand, cough or lift heavy things and goes away when they lie down.
Hernias are often dismissed as innocuous because they are initially painless. Not every hernia is a medical emergency; however, every hernia requires medical attention. Sometimes, delaying treatment might lead to serious, even life-threatening problems.
What is a hernia?
A hernia develops when an organ or part of one squeezes through a weak point in the muscle or connective tissue that is supposed to contain it. The most common type of hernia is inguinal (groin), followed by umbilical, incisional and femoral hernias. Risk factors include advancing age, obesity, chronic cough, constipation, pregnancy, previous abdominal surgery and repetitive heavy lifting.
At first, a hernia may present as a visible swelling or a sensation of heaviness, especially after prolonged standing or exercise. Some mild discomfort is normal, but pain isn’t. Troubles start when the hernia is trapped and cannot be moved back into the abdomen. This is known as an incarcerated hernia. This is where a condition that seems harmless can become deadly very fast.
One of the most critical warning signals is a painful bulge that abruptly becomes firm, sensitive and does not go in. If the swelling is accompanied by severe abdominal pain, nausea, vomiting or abdominal bloating, it could be a sign that part of the intestine has become trapped within the hernia. This can restrict the regular transit of food and waste and requires prompt assessment by a doctor.
More serious is strangulation, in which the blood supply to the trapped intestine is cut off. Untreated, the afflicted bowel might be damaged or die, leading to infection, perforation and sepsis. Warning signs include intense, ongoing pain, redness or dark discolouration over the swelling, fever, vomiting and inability to pass stool or gas. This is a surgical emergency that should never be disregarded.
Unfortunately, many patients try to manage their symptoms at home with medicines or just wait for the discomfort to subside. Medications may offer temporary relief from discomfort, but they do not treat the root problem. In fact, treatment delay may result in surgery being more difficult and riskier.
Fortunately, most hernias can be safely corrected with planned surgery before they become emergencies. Advances in laparoscopic and minimally invasive procedures have made hernia surgery easier for many people, requiring smaller incisions, a faster recovery, and a quicker return to normal activities. The results of elective surgery are typically better than the results of emergency surgery once complications have happened.
A hernia doesn’t necessarily require emergency surgery, but it should never be neglected. If there is a lump in the groin or abdomen which persists or is increasing in size, painful or changing in character, seek surgical advice. Early action prevents complications and enables treatment to be planned in safer, more controlled circumstances.
The biggest mistake with hernias is thinking that just because it’s not hurting today, tomorrow it won’t be an emergency. An early assessment can be very helpful.
(The author is a general surgeon, Department of General Surgery & Surgical Gastroenterology at HOSMAT Hospital, Bengaluru)
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.
