By Nora Fullington, MD, FACS
The internet is a scary place! A lot of patients come to see us for their hernia after doing some internet research first. Patients are often terrified about their intestine being stuck in the hernia and their bowel “exploding” because of this. Like anything else, when people write about their experiences on the internet, we have to take their interpretation with a grain of salt. For the vast majority of patients with hernias, their risk is EXTRAORDINARILY low that they will end up with an emergency like those they have read about on the internet – and in many cases, what’s written on the internet can be a misrepresentation of what is at risk.
So, what is a hernia and what is the risk?
A hernia is a hole in the strength layer (fascia) of the abdominal wall. The resultant bulge is caused by abdominal contents bulging through this hole to the space outside the abdominal cavity. Most of the time, fat bulges through this hole. This bulging fat can get compressed and cause pain. Pain or discomfort from a hernia is typically caused by irritation from something bulging where it should not be. Hernias do not hurt when nothing is bulging, which is why most people have no pain when they are laying down and their hernia is reduced back inside their abdominal cavity. Sometimes, this fat gets stuck in the area – we call this “incarcerated.” If this fat swells and the blood flow is reduced – we say it is “strangulated.” This commonly results in worsened pain. Even so, when fat is bulging, this is NOT unsafe. It can hurt, but you are not in danger.
Much less frequently, and only once this hernia hole gets to a large enough size, intestine can bulge into this space. If intestine gets incarcerated and strangulated, this is an emergency and medical care is needed urgently. A doctor can help push this intestine back in in most cases but if this is not possible, surgery can be required. Fortunately this is NOT common – for inguinal hernias for example, the risk among all people with hernias is 0.2%. That means it’s not going to happen in 99.8% of cases!
How can I tell if it’s an emergency?
Remember that a hernia is only risky when something is stuck in it. That means there would be a bulge in the area that can’t be pushed in. In addition to this, what is stuck is only at risk if it is getting cut off from its blood supply which causes significant tenderness in the area. The next part of diagnosing whether or not this is a risky situation is determining if intestine is the structure that is stuck. If you imagine the intestine is a long hose, being stuck in a hernia would be the equivalent of a kink that doesn’t allow anything to pass through – it results in nausea, vomiting, and inability to keep any food or drink down. Also, you are not likely to be passing any gas from below.
In summary, a hernia is dangerous when it has all three of the following characteristics:
- The lump can’t be pushed back in
- Severe tenderness is present in the area of the lump
- You also have nausea, vomiting, inability to keep any food down
All of these symptoms together suggest you need to seek medical care urgently.
If you are experiencing a painful lump but are unsure about the other symptoms, it is recommended that you consult with your primary care provider about whether you need urgent care or not.
If you have a bulge that is intermittently painful, and pops in and out, you should make an appointment to see a hernia specialist. It is important to consider a hernia repair to treat the associated symptoms and avoid it getting worse over time. It is not likely that you will have an emergency situation occur and waiting a week or two to be seen is absolutely safe so long as you don’t have the concerning symptoms described above. At Boston Hernia, we typically have availability within 5-7 business days. Call today to see one of our specialists!
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