Women’s Health: Hernias, not just a man’s problem

For the Gazette
Published: 6/12/2017 4:18:18 PM

June is hernia awareness month. While a common myth persists that hernias occur only in men, about 3 percent of women also will develop hernias in their lifetimes, and many are very surprised by the diagnosis. With high-intensity workouts and weight training on the rise with women, it is especially important for us all to be aware of the possibility of our being affected by this condition.

What exactly is a hernia? To put it bluntly, it’s a hole, which occurs in the strongest layer of the abdominal wall called the fascia. Hernias occur at natural weak spots including seams or nexuses like groins or umbilical regions, but also ones resulting from past trauma or surgery. With enough pressure over time, the tissue in a weak spot thins until it finally breaks down. Eventually, contents of the abdominal cavity can protrude through the tear that’s created, being noticeable as a bulge under the skin.

We all have a layer of fat that lines our bellies. This fat layer most commonly plugs the hole of a hernia, but intestine and other abdominal organs can also protrude (and can sometimes lead to complications if squeezed by surrounding muscle).

The most common site for a hernia to occur is just to either side of the pubic bone in the groin, called the inguinal region. The belly button or umbilicus (where the umbilical cord entered us when we were in utero), is also a natural weak location. Incisions from prior abdominal surgeries (e.g. Cesarean sections, gastric bypass or other abdominal cavity surgeries) can create weak spots as well.

Though comparatively rare, femoral hernias can occur below the groin crease near the upper thigh. These occur almost exclusively in women, largely due to the wider bone structure of the female pelvis.

Causes and symptoms

Most hernias are caused in some way or another by excessive strain on the weak spots in a person’s fascia. Typically, hernias are the result of injury from strenuous exercise and heavy weight lifting, or over-extension of abdominal muscles for an extended period of time. However, hernias can also result from chronic coughing, or excessive straining with bowel movements.

Pregnancy brings many changes to the body that can result in hernias. Carrying extra body weight puts a lot of pressure on the abdominal wall — it will stretch to accommodate the growing baby, and the elasticity of the tissues and skin can be permanently compromised. This can cause previously strong tissue to weaken and become more prone to developing a hernial tear.

Umbilical hernias resulting from pregnancy are not common, but are more so in women who are obese or who have been through multiple pregnancies. If you are affected by a postnatal umbilical hernia you should take extra care in any activities that involve lifting or straining, and pursue repair options as soon as your OB-GYN provider allows, depending on the circumstances of your childbirth.

In very rare cases, an episiotomy during childbirth can result in a perineal hernia between a woman’s vagina and anus, or internally.

In some instances, hernias may cause no symptoms at all, but many people feel a burning and aching pain at the site.

Diagnosis and repair

Hernias cannot go away on their own, but instead often grow. As the bulge becomes larger, it can get in the way of everyday activities. When you are lying down, a hernia may sink back into the abdomen, or you may be able to gently massage it back in.

Small hernias that are not bothersome are safe to live with. Most people have hernia repairs because of pain and growth of the bulge. Repair can relieve discomfort and prevent the serious complication of having the intestine get stuck in the hernia, a relatively uncommon situation, but one that requires emergency attention. Hernia repairs take about an hour and you go home the same day.

After a few days of discomfort, most people start getting back to normal life. On average, people take one to two weeks off from work. You have to restrict your activity and can’t lift anything heavy for one month after surgery to ensure your abdominal wall is not stressed as it heals.

If you are experiencing symptoms that could be related to a hernia, ask your healthcare provider to check you out. A simple physical exam is often enough for diagnosis.

Michelle Helms, MD, is a surgeon at Cooley Dickinson Medical Group General Surgical Care in Northampton, a surgical practice run entirely by women.

Women’s Health is written by health care professionals affiliated with Cooley Dickinson Hospital in Northampton. It appears here monthly.

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