Pelvic or abdominal bulge could be a sign of a hernia

By Lee Farber, DO  |  3/6/2018

About 1 million hernia repairs are performed each year in the United States, according to the U.S. Food and Drug Administration. A hernia occurs when an internal part of the body pushes through a weakness in the tissues that hold muscles together. Symptoms include a visible bulge that may or not be reducible, swelling, pain and nausea.

Hernias can develop at these sites due to heavy straining, aging, obesity, pushing from constipation, pregnancy, coughing, injury or a surgical site infection. Hernias can appear immediately following surgery or years later.

A person might have weakness in the abdominal wall because of a congenital defect. The common areas where these hernias occur are in the groin (inguinal), belly button (umbilical) as well as through the diaphragm (hiatal). Hernias that are not congenital occur at the site of a previous operation (incisional).

It's important to recognize the early signs of a hernia. To diagnosis a groin hernia, your doctor may feel for a bulge that gets larger when you stand, cough or strain. An abdominal wall hernia may also present as a bulge or pain with increased activity. These hernias may reduce easily or cause pain during reduction, when you retract the hernia back into place.

A hiatal hernia is when the stomach protrudes into the chest cavity. People may experience gastroesophageal reflex, or GERD, when the stomach acid goes back up into the esophagus. Patients may also experience vomiting, bloating or difficulty swallowing. A barium X-ray or endoscopy is used to diagnose a hiatal hernia.

Hernias that are untreated can be dangerous or life-threatening. The discomfort may be sharp or a dull ache that gets worse towards the end of the day. Continuous or severe discomfort, redness, nausea or vomiting along with a bulge that isn't reducible (you can't push it back in) are signs that the hernia may be entrapped or strangulated. A strangulated hernia is a medical emergency.

When a hernia grows in size or is painful, a surgeon may want to operate. Surgery can be done open, with a large incision, as well as minimally invasively. With robotic-assisted surgery, the surgeon uses small instruments through small incisions to reduce the hernia and close the defect. He'll stitch the weak area of the muscle, and if necessary, he'll use a flexible mesh for extra support. Usually, the patient can go home the same day and is able to return to light-duty activities very quickly. Your surgeon will discuss your risks and which technique may be best for your type of hernia.

If you suspect you have a hernia, speak to your doctor about your symptoms. Inquire about being referred to a hernia specialist who is a surgeon with a special interest and experience in treating a variety of both simple and complicated hernias.

Dr. Lee Farber is a board-certified, fellowship-trained upper gastrointestinal and complex hernia surgeon with Health Quest Medical Practice. He has office hours in Poughkeepsie, and operates at Vassar Brothers Medical Center and Northern Dutchess Hospital. Reach his office at 845-214-1800.