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Could You Have a Hidden Hernia?

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Imagine living for years with debilitating pelvic pain that often worsens when you exercise, stand for a while or bend over… or get your period… or even just sneeze or cough. Imagine undergoing numerous tests and treatments for suspected gynecological problems, from ovarian cysts to pelvic inflammatory disease to endometriosis, only to have your gynecologist and other specialists shrug in confusion when all test results turn up negative and no treatment seems to help.

This is a scenario that female patients frequently describe to Shirin Towfigh, MD, an associate professor of surgery at Cedars-Sinai Medical Center in Los Angeles. Patients come to her, desperate to learn what is causing their mysterious symptoms—yet the answer turns out to be rather straightforward. These women are suffering from hernias.

The condition is vastly underdiagnosed in women. Dr. Towfigh explained that many doctors simply do not think of hernias when they examine women, considering hernias to be a “man’s problem”—even though certain types of hernias actually are more common among women. Also, since hernia symptoms can mimic pelvic pain and may worsen during menstrual periods, the signs often are mistakenly attributed to gynecological disorders. Misdiagnosis leads to unnecessary suffering and increased risk for complications, including tissue death. Here’s what women need to know to protect themselves…

Types of hernias. A hernia occurs when part of an internal organ or fat tissue bulges through a hole, tear or weak area of muscle, most commonly in the abdomen. A hernia is classified by location…

  • Inguinal hernia occurs in the groin area where the torso meets the thigh (called the inguinal crease).
  • Femoral hernia develops just below the inguinal crease toward the inner thigh. It is more common in women due to the wider bone structure of the female pelvis.
  • Umbilical hernia, in the belly button area, also is more common among women, especially after pregnancy.
  • Epigastric hernia occurs between the navel and breastbone.
  • Hiatal hernia develops when part of the stomach protrudes through the diaphragm.
  • Incisional hernia forms at the site of a previous abdominal surgery.

Who’s at risk? Often doctors cannot pinpoint why a particular patient has a hernia, but there are known risk factors, Dr. Towfigh said. Anything that increases pressure on the abdominal area can contribute to risk—for instance, pregnancy and vaginal childbirth… chronic cough from smoking, asthma, bronchitis, postnasal drip or gastroesophageal reflux disease… frequent constipation with straining… heavy lifting… or being overweight. Additional risk factors include genetics (hernias tend to run in families)… aging, because tissues weaken over time… smoking… and a history of abdominal surgery, such as a C-section or abdominal hysterectomy.

Warning signs. In men, a hernia usually creates a visible bulge that doctors can easily detect—but in women, hernias tend to be tiny and internal. The lack of a distinguishable bulge is another reason why hernias are underdiagnosed in women, Dr. Towfigh noted.

What to watch for: A hernia typically causes burning or sharp pain in the affected area. Pain worsens when there is an increase in abdominal pressure, such as when you bend over, and can be reproduced by pressing directly on the spot… pain improves when you lie flat on your back. The pain can be constant if a piece of fat or tissue is caught in the hernia hole, or intermittent if tissue gets pinched only occasionally (for instance, during certain activities).

If you have any such symptoms, see your primary care physician first and ask whether the problem could be a hernia. You may then be referred to a general surgeon for further evaluation. “Among general surgeons, a small number have a special interest in hernias—they are referred to as herniologists. This type of doctor is most likely to correctly suspect hernias in women and to order radiologic testing if needed to confirm the diagnosis,” Dr. Towfigh said. Referrals: American Hernia Society (www.AmericanHerniaSociety.org).

Help for hernias. Once a hernia develops, it will not go away on its own. Hernia surgery usually consists of an open or laparoscopic procedure in which mesh is used to patch the hole. Good news: After a hernia is surgically corrected, Dr. Towfigh said, the pain typically disappears quickly and completely.

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Source: Shirin Towfigh, MD, is an associate professor of surgery and a faculty surgeon in the division of general surgery and the Center for Minimally Invasive Surgery at Cedars-Sinai Medical Center in Los Angeles. She is a nationally recognized leader in hernia surgery, including advanced laparoscopic surgery and complex hernia repair, and serves on the board of directors of the American Hernia Society and the editorial board of the journal Hernia. Date: January 5, 2012 Publication: Bottom Line Health
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