What is a hernia and how do you repair it?

Lifting heavy weights, as seen in this filepic, in continuous gym sessions is a risk factor for a hernia.

I go to the gym quite often, and lately, I engaged a personal trainer. I am trying to bulk my muscles up to have a six-pack. Unfortunately, the other day, after I lifted a particularly new set of weights, I felt something ‘let go’ in the lower part of my abdomen. Looking down at myself in the shower afterwards, I noticed a bulge on my right side.

You probably have a hernia, which is a part of a body organ or fatty tissue that squeezes out through a weak spot in the surrounding or encapsulating muscles or connective tissues.

There are many types of hernias – and they are named after the anatomical spots from which they protrude.

Oh? I thought that hernias only occurred in the lower abdomen or groin.

No, the inguinal hernia is the one that occurs in your inner groin and it’s certainly the most common. However, there are other types of hernia.

A femoral hernia, for instance, happens in your outer groin.

An incisional hernia is what happens when your organ or tissue protrudes from an incisional or surgical scar. This happens most often after abdominal surgery, but can also occur in other places that have undergone surgery. It happens mostly in patients who are obese or inactive after surgery, or in the elderly, whose muscles and tissues are generally weaker.

An umbilical hernia happens in the weak spot that forms your umbilicus. This one is common in newborn babies who just had their umbilicus detached. But it can also happen in women who have had a lot of pregnancies and/or who are obese.

A hiatal hernia happens in your upper stomach, through the passage in where your oesophagus passes through your diaphragm. More often or not, you can’t ‘see’ this one, but you can certainly feel its symptoms.

Which hernia is more common? Inguinal or femoral? And how can I tell them apart?

An inguinal hernia is certainly far more common than a femoral one. It occurs in 96% of all groin hernia cases.

In an inguinal hernia, your small intestine or bladder comes out through your abdominal wall into the inguinal canal in your groin. There is a natural anatomical weakness in this area for all men.

You will see the hernia as a small bulge on either side of your pubic bone. This bulge becomes worse when you cough or strain, or when you stand up.

Sometimes, you don’t see the bulge, but can feel a heavy or aching sensation in your groin, especially when you cough or lift heavy weights. (Weightlifters, beware!)

Your testicles can sometimes be swollen and painful too, when your intestine actually goes into your scrotum. But this is usually quite an advanced case.

In a femoral hernia, your small intestine goes into a tunnel or passage carrying your femoral artery – right into your upper thigh.

Femoral hernias are more common in women than men, and often occur during pregnancy or if the lady is very obese.

I’m sensing a pattern here. Lifting heavy weights... obesity... having many children. Are all these risk factors for getting a hernia?

Yes. Anything that increases pressure inside your abdomen or that causes the muscles or tissues enveloping your organs to be weak in any way has the potential to cause you a hernia.

Most of the time, it’s a combination of all these factors.

If you have high abdominal pressure, it pushes your organs outward. Combine that with a weak spot somewhere and that is naturally where your organ will “escape” through. It’s simple physics.

Sometimes, when you are born, the weakness is already present. Other times, you acquire that weakness through your lifestyle, e.g. having heavy gym sessions, becoming obese or having many children.

Sometimes, it is even a bad habit like straining at the toilet to defecate.Some people don’t eat enough fibre and fruits. Thus, they have frequent constipation, resulting in them straining on the toilet to get it all out. However, doing this too much can also give rise to a hernia.

It is the same with the reverse, i.e.. diarrhoea. With this, you don’t strain, but you go to the toilet very often, until there is repetitive stress on your abdominal and groin muscles.

If you have a persistent cough (like a smoker’s cough) or sneeze, this can also cause your intraabdominal pressure to go up. So you should get that cough seen to, or don’t smoke!

Is surgery the only way to repair a hernia? Or will it go away by itself?

Well, surgery is the best way to repair a hernia, but it is not the only way. Hernias don’t go away on their own, so it’s a matter of deciding whether you can live with one or not.

Some people are too frail for surgery, such as if you are very old. Or sometimes, there is a long wait for surgery and you need to have something to relieve you during the wait.

In this case, the doctor can prescribe a corset, truss or binder to be worn, which keeps the hernia in check and helps relieve the discomfort.

If it is a very small hernia, you might have no need of surgery at all.

Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health, computers and entertainment. For further information, email starhealth@thestar.com.my. The information contained in this column is for general educational purposes only. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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