What causes a hernia?

Some people are actually born with a hernia, called a congenital hernia. Others develop a hernia over time. Hernias commonly occur in the belly button (umbilical hernia) or in the groin (inguinal hernia). Both umbilical and inguinal hernias develop as abdominal tissues stretch enough to allow internal abdominal organs or fat to pop through the abdominal wall. This occurs in areas of inherent weakness in the abdominal wall. In men, there is a weakness in the groin which allows abdominal contents to leave the abdominal cavity through a defect in the groin. Typically, all of our tissues stretch as we get older and the abdominal wall is no different. Being overweight, frequent heavy lifting, and prior surgery can all increase the risk of developing a hernia. Events that increase the abdominal pressure quickly, can contribute to the formation of a hernia, or cause a hernia to appear sooner than it would have done naturally. Car accidents, falls, or work related injuries may increase abdominal pressure enough to contribute to a hernia. There are some people that have a genetic predisposition to get hernias, as the genetic makeup of their tissues allows for more stretching, and therefore an increased risk of hernia. 

In the diagram we have drawn here, the normal inguinal canal is depicted in the top image in blue. As men age, the inguinal canal stretches as shown in the lower diagram in blue. The change in the geometry of the inguinal canal, creates a situation where intestine can herniate into the inguinal canal or scrotum, which leads to an indirect inguinal hernia – the most common type of inguinal hernia. A direct inguinal hernia can also occur, and results from stretching of tranversalis fascia in the groin.

Once fat or intestine herniate into the inguinal canal or scrotum, symptoms can develop and the hernia should be repaired. Since 2001, Dr. Reinhorn has been repairing inguinal hernias for people from New England. Using an innovative technique, Dr. Reinhorn is able to repair an inguinal hernia with mesh, under all the layers of the abdominal wall, while avoiding general anesthesia. He also has experience with the Shouldice technique, a non-mesh repair for inguinal hernia.



About Dr. Reinhorn & Dr. Fullington

Dr. Michael Reinhorn is a specialist in inguinal hernia and umbilical hernia. He started his practice as a general surgeon in 2001, and in 2012 he transitioned to focus on the care of hernia patients. In 2018, he co-founded Boston Hernia, an ambulatory surgery practice focused exclusively on hernia surgery. In 2020, Dr. Nora Fullington was recruited from her work as a general surgeon, where she performed hundreds of laparoscopic hernia repairs, to Boston Hernia where she was intensively trained by Dr. Reinhorn in the open preperitoneal and Shouldice techniques. Together with their physician assistant team, they perform approximately 800 hernia surgeries every year. Both surgeons offer a tailored approach for each patient, taking into account individual patient factors to decide if surgery is recommended or not, what type of repair (open, laparoscopic, mesh, non-mesh) is best, and what type of anesthesia is safest. At Boston Hernia, our focus is on each individual patient and continuously improving our own surgical techniques and outcomes. We do this by participating in various hernia societies, studying our own outcomes through a national database, and publishing our data to influence the care of hernia patients nationally and internationally. Boston Hernia is an affiliate practice of the Mass General Brigham system. In addition to operating at Newton-Wellesley Hospital, a Mass General Brigham Hospital, we offer care at ambulatory surgery centers in Waltham, MA and Derry, NH.