1. Are my symptoms from a hernia or something else?
In our practice, one out of every six patients who has previously been diagnosed with a hernia is actually found to have a core muscle injury instead. These patients should NOT have surgery. Musculoskeletal injury is caused by overuse of certain core muscles. Overuse can occur in daily life as well as in more strenuous activity. This problem cannot be fixed surgically, but instead requires strengthening and learning to use other core muscles to offload the ones that are being overused. These injuries require treatment with PHYSICAL THERAPY and ongoing strength training. In our opinion, surgery is unnecessary, unhelpful, and should be avoided for patients with a core muscle injury.
It is important to be evaluated by a hernia surgeon, as the symptom of a hernia and a core muscle injury can be similar in nature. There are some nuanced differences between typical hernia symptoms (discomfort with prolonged standing or straining) and muscle injury symptom (pain with rolling over in bed at night, getting in and our of the car). An experienced hernia surgeon will help tease out these differences in your symptoms and can tell on physical exam if this is a muscle injury versus a hernia. Imaging such as CT scan or ultrasound is often unnecessary and can actually misdiagnose a hernia.
Evaluation by a hernia specialist is the best way to get an accurate diagnosis. It is very important to get this step right as the treatment is drastically different! Unnecessary surgery risks complications without any benefit or improvement of symptoms.
2. Do I need to have hernia surgery now?
Not necessarily! Whether or not you need hernia surgery depends on your hernia symptoms. Recent medical research indicates that patients who have either little or no discomfort from their hernias have such a low rate of complications (such as strangulation) that surgery is not immediately necessary. In our practice, we advise about 1 in 3 patients that they can delay surgery because their hernia symptoms do not yet interfere with their lifestyle. We often counsel our patients that many hernias eventually require intervention, so they should proceed with surgery when is convenient for them or if their hernia is changing in size or symptoms.
Evaluation by an experienced hernia surgeon allows for your questions to be answered and your care to be guided towards your individual best interest. Assessment of your hernia symptoms, your quality of life with a hernia, your outside obligations including work and family, and your future goals should all be considered in the decision to proceed with surgery and when. The thought of surgery can be anxiety provoking for many, and some information on the internet can increase that anxiety during this process. Getting an expert opinion can help to alleviate the anxiety surrounding hernia surgery and help each individual patient make a plan for if and when surgery is right for them.
3. Are there non-surgical treatments for my hernia?
Maybe. You and your hernia are unique. Your care should be individualized to you. Patients who have a groin strain and not a hernia need physical therapy to improve their core imbalance. Patients who have a hernia with minimal symptoms can often safely wait to have surgery. Some patients with a hernia can use a hernia belt or truss to delay hernia surgery until the timing is better for them. Other patients need hernia surgery soon to relieve symptoms and reduce the risk of an incarcerated hernia.
At Boston Hernia, we are committed to guiding our patients toward the best outcomes with attention to achieving their own individual goals for their health. We work with our patients to tailor care for their unique needs.