A hernia can be a serious problem—or not. For example, the average hernia causes little or no discomfort…and may not get any worse. Nevertheless, doctors often recommend surgery due to the risks that hernias can pose.

When is a hernia about to change from “harmless” to “extremely dangerous?” Are you getting the latest and most effective therapies?

Bottom Line Health spoke with Hien Tan Nguyen, MD, a nationally recognized expert on hernias.

WHAT IS A HERNIA?

A hernia is a protrusion of tissue, such as intestine, through a weak spot in the abdominal muscles. Types of hernias…

Both inguinal and umbilical hernias are easy to diagnose and rarely require an imaging test because your doctor can see and feel them. The bulge can cause discomfort or even severe pain.

Where to look: Inguinal hernias appear on either side of the groin or, in men, within the scrotum. Umbilical hernias appear near the belly button. Both types tend to get larger and more tender during activities that increase abdominal pressure, such as while straining with a bowel movement, during a sneezing or coughing fit or just from standing up.

A special warning for women: Women are more prone than men to occult (hidden) hernias—too small to be seen or felt by touch—that can press on nerves and cause pain. Often, these hernias get misdiagnosed as endometriosis or another gynecological problem. A woman with pelvic pain should start by consulting with her gynecologist and make sure to ask whether a hernia could be the cause.

What you can do: The size and discomfort of inguinal or umbilical hernias can vary over time. What helps…

• A cold compress. Encourage protruding tissue to retreat back into the abdomen or groin, thus “reducing” a hernia, by lying down and applying a cold compress for about 10 minutes. Use gentle pressure to slowly press downward on the bulge.

• Wear a truss. Some people wear a truss (hernia belt). While this may help, it isn’t a cure, and wearing a truss can cause the wearer to forget about the hernia and overexert, making a small hernia larger.

• Try yoga. A study found that men with reducible inguinal hernias (they readily retract) who practiced a daily one-hour program of yoga followed by relaxation for three months rated their pain up to five points lower on a 10-point scale compared with before starting yoga. Yoga and other gentle workouts won’t cure a hernia but can help to minimize symptoms, such as pain and cramps.

Hernias tend to get bigger over time, so to avoid possible future complications, many doctors recommend surgery to minimize the risk for complications. But painless inguinal or umbilical hernias are unlikely to need emergency surgery.

My advice: Consult your doctor if you are concerned that you have a hernia. Don’t delay too long—you’ll have fewer surgical complications when a hernia is repaired before the symptoms are severe.

Latest treatment options: Most surgeries for inguinal or umbilical hernias can be performed on an outpatient basis with minimally invasive surgery, using small incisions that allow for faster recovery and less pain following surgery. You’ll be sore for about two weeks, and able to resume normal activities in about a month.

Caution: Hernias can come back. Reduce risk by maintaining a healthy weight, not smoking and exercising to strengthen abdominal muscles. Best exercise: Cardio helps manage weight, especially abdominal weight.

With a hiatal hernia, the upper part of the stomach pushes through an opening in the diaphragm. You can’t see or feel a bulge, but you might notice heartburn—or have no discomfort at all.

Most people only discover their hiatal hernia from an imaging test done for another condition. In severe cases, the hernia protrudes into the chest and interferes with normal function of the lungs or heart, causing symptoms that include shortness of breath.

If your doctor suspects a hiatal hernia, he/she will order an upper endoscopy to check your stomach and esophagus for inflammation and/or ulcers. A manometry test to measure pressure inside the esophagus…an esophogram to look for abnormalities…a pH test to measure the amount of acid flowing into your esophagus…or a CT scan to see how much of the stomach protrudes into the chest cavity also may be done.

What you can do: If you have heartburn that is mild/occasional and your hiatal hernia is small, your doctor is likely to prescribe medication rather than recommend surgery. Acid-blocking drugs such as omeprazole (Prilosec) or cimetidine (Tagamet) can reduce discomfort. Lifestyle changes, such as eating smaller, more frequent meals, not lying down immediately after eating and avoiding foods that trigger heartburn, won’t heal the hernia but can alleviate symptoms.

Caution: Acid-suppressing drugs can have side effects such as increased risk for pneumonia and nutritional deficiencies, including vitamin B-12. Your doctor should supervise your use of these drugs.

Hiatal hernias that require surgery usually can be repaired with a minimally invasive procedure, but larger incisions may be needed in some cases. Surgery commonly involves pulling the stomach down through the diaphragm and narrowing the esophageal opening…and wrapping the stomach around the lower end of the esophagus, a procedure called Nissen fundoplication. The tighter fit keeps the stomach where it belongs and increases pressure on the esophagus—important for relieving heartburn. Most patients spend a night in the hospital and resume their regular activities within a few weeks.

WHEN ANY HERNIA “GOES BAD”

Whether it’s an inguinal, umbilical or hiatal hernia, if your doctor believes that there is a risk for strangulation (twisting), in which the protruding tissue gets trapped between the muscle layers, you’ll need surgery. With strangulation, the blood supply to the twisted tissue is cut off, causing it to become damaged or to die, leading to sepsis or gangrene—both life-threatening complications.

Critical symptoms: With an inguinal or umbilical hernia, sudden, worsening pain, nausea, vomiting, fever, inability to move bowels or pass gas…with a hiatal hernia, hoarseness or difficulty breathing.