Rajon Jernigan's pain was getting more predictable. Whenever he used his abdominal muscles in any task, he felt extreme tightness and squeezing in his abdomen.
"We put in a hardwood floor at our house and, being bent over and pulling and
pushing, I could really feel it," said the 36-year-old East Pennsboro Township man.
He was feeling an umbilical hernia that he had been watching for about five years, waiting to have surgery when necessary.
"I was keeping a good eye on it, but you never know. I decided it was time. The recovery time would have been longer had I waited," said Jernigan, who had hernia surgery in January.
The danger in waiting too long, he knew, was the possibility of a strangulated hernia, where the blood flow to the surrounding tissue would be cut off and emergency surgery would be needed.
About 5 million Americans every year are affected by hernias
About 5 million Americans every year are affected by hernias, which go by many different names depending on where they are located. Initial symptoms are pain and often a bulge that can be felt. Hernias frequently show up in the groin, the navel or at a previous surgical site.
Hernias occur when a force too strong for the body's tissue to withstand ends up causing part of an internal organ or tissue to bulge through the weakened area, said Dr. Joseph Esposito, general surgeon with PinnacleHealth Surgical Associates.
"This results in a hole in, usually, the abdominal wall, but it can happen anywhere, even through the diaphragm, which is called a hiatal hernia," Esposito said.
Bulge a common symptom
The most common kind is an inguinal hernia, which is mostly found in men. It typically appears in the groin area above the inguinal ligament and causes the omentum (the fatty apron surrounding the abdominal organs) or intestines to protrude through the abdominal wall, said Dr. Paul Kunkel, surgeon with Holy Spirit General Surgery, a Geisinger Affiliate
Dr. Paul Kunkel, surgeon with Holy Spirit General Surgery says there's not much that can be done to avoid a hernia. When lifting something heavy, he advises lifting from the butt and using your whole body for better leverage, bending at the knees.Provided photo
A femoral hernia, which is more common in women, is a bulging located near the groin and thigh that occurs when a small part of intestine pushes through the wall of the femoral canal, which is located below the inguinal ligament.
"They can be more dangerous because there is a higher likelihood of the tissue being trapped and people develop a bowel obstruction. The bowel can die and that portion must be removed," Esposito said.
Umbilical hernias are most common in babies and usually close on their own. However, adults can get them as well and sometimes, as in Jernigan's case, surgery is needed to repair them.
In a ventral hernia, the intestine pushes through the abdominal wall, often at the site of a previous abdominal surgery, Kunkel said. This type of hernia is most common in overweight people who are inactive after abdominal surgery and in smokers.
"Obesity puts more pressure on your abdominal wall and it's harder to heal after surgery," Kunkel said. "Also, smoking decreases oxygen levels so the tissues don't heal as well."
A hiatal hernia is different from the other types in that it involves the stomach, which can bulge up through the diaphragm into the chest. Many people have small hiatal hernias and never know it, however, heartburn can be one cue that a hiatal hernia is brewing.
"If you have a lot of heartburn or difficulty swallowing, you should get it checked," Esposito said. "You can also have pressure in the chest, which a lot of people confuse with a heart attack."
If a hiatal hernia is large, surgery may be needed to pull the stomach back into place and make the opening of the diaphragm smaller.
While Jernigan was having his umbilical hernia repaired, he decided to have a repair made to a second hernia he had known about since childhood. When he was 9, Jernigan had surgery for an epigastic hernia located in the middle of his abdomen between the breastbone and the belly button. Recently, he had begun to feel a bulge in his abdominal wall that suggested repair was needed again.
"I didn't have pain, but if I got too dehydrated, I began feel discomfort," he said. "I knew that once you have this type of hernia, you are at risk for having it again."
Complications can arise
While watchful waiting is fine for some hernias that don't cause pain, there are complications that can arise. If the tissue or intestine gets stuck and cannot be pushed back, an incarcerated hernia can occur. If the intestine becomes incarcerated, it can twist and obstruct the bowel. An incarcerated hernia becomes strangulated if it loses blood supply, which is a definite surgical emergency, Kunkel said.
Hernias are generally fixed in one of two ways, either open surgery or laparoscopically. Robotic surgery is sometimes an option as well.
"With the patient completely asleep or just sedated, we make a small incision in the groin and dissect down to the defect and patch it with a polypropylene mesh and sew the patient back up," Kunkel said. "With laparscopic repair, the patient has general anesthesia and we patch the defect from the inside through three tiny incisions. This method is less painful and speeds the healing process by two to three weeks."
Robotic surgery is also an option for some hernia repairs. It offers a three-dimensional camera that helps the surgeon see better, but it may not always be the most cost-effective surgery, Esposito said.
Jernigan had robotic surgery and said he would recommend it. He has memories of a months-long, painful recovery from his first hernia surgery as a child.
"Dr. Esposito wondered if I was interested in robotic. He promised me the recovery time was significantly less and he was right. I was back to work in two weeks," said Jernigan, who works in law enforcement. "I still have two months of lifting restrictions - nothing more than 20 pounds - but just the fact that I'm mobile and can function normally without any discomfort is great."
Prevention not easy
There isn't much that can be done to prevent hernias.
"Use good judgment. Don't overdo things. Don't smoke," Kunkel said. "Don't lift massive amounts unless you have to and when lifting, lift from the butt and use your whole body for better leverage, bending at the knees."
If a bulge is noticed, don't wait more than a day or so to have it checked, Kunkel said.
"The more you ignore it, the worse the problem can become,'' Esposito said. "The larger a hernia becomes, the greater the likelihood of complications."