Turn Your Head and Cough: The First Step in a Hernia Diagnosis

By Craig Zaretsky, MD, General Surgeon, Virtua Surgical Group—Voorhees

If you ask a man to tell you what he knows about hernias, he might tell you about the slightly embarrassing moment in the doctor’s office when he’s asked to turn his head and cough as the doctor checks for hernias. The reason why the doctor checks for them is because they’re EXTREMELY common, especially in men. In fact, hernia repair is quickly becoming the most common surgical procedure in the United States, with more than 700,000 performed every year.

The following will help you understand what causes hernia and how you can help prevent and treat it.

What is a hernia?

Normally, the abdominal muscles form a thick wall that contain and protect the intestines and other internal organs. A hernia occurs when a weak spot forms in the wall and internal (usually intestinal) tissue starts to protrude through the wall. There are four major types of hernia based on where they occur:

• Inguinal: inner groin (most common)
• Femoral: outer groin
• Umbilical: belly button
• Hiatal: upper stomach

A hernia generally appears as a noticeable bulge under the skin. It may not be painful at first, and is usually more noticeable when you cough or strain. While hernias can occur in both men and women, they’re generally more common in men.

What causes a hernia?

Hernias are caused by activities that put stress on the abdominal wall. These can include:

• Obesity: The abdominal wall undergoes additional stress from the strain of carrying extra abdominal fat.
• Smoking: A persistent smoker’s cough can cause damage to the abdominal wall over time.
• Physical activity: Those in physically demanding professions where heavy lifting is required may be susceptible due to repetitive strain on the abdominal muscles.
• Incisional: If you’ve had your abdominal muscles cut due to surgery, a hernia can develop if the abdominal wall doesn’t heal properly over time.

For some, hernias are hereditary conditions that occur naturally due to genetic and individual factors. That means that even those who live a healthy lifestyle can develop them over time. That said, avoiding the risk factors only helps prevent hernias from developing.

How is a hernia treated?

While ice and rest can help reduce the swelling in the area of a hernia, it won’t heal on its own. Instead, a hernia will only get worse over time, especially if the hernia undergoes continued stress. If you think you have a hernia, surgery is the most effective treatment. Usually a primary care doctor or gynecologist can confirm this with a simple physical examination, and refer you for surgical treatment.

How involved is hernia surgery?

Most people are hesitant to have hernia surgery because they think it’s more involved than it really is. In fact, most hernia surgeries are minimally invasive and performed on an outpatient basis. The most common method for hernia repair is laparoscopic surgery. The surgeon makes three small (1 – 2 cm) incisions in the area of the hernia, pulls back the protruding tissue, and repairs the abdominal wall with surgical mesh.

Robotic surgery is another option for hernia repair. The surgeon uses robotic technology with high definition, 3-D imaging and wristed robotic arms to precisely repair the affected area. After laparoscopic or robotic hernia surgery, most patients go home the same day and, within 2 to 4 weeks, they’re back to their regular routine without restrictions.

If you need a hernia repair, talk to your doctor. Or, call 888-847-8823 to make an appointment with a Virtua surgeon.

Updated June 17, 2020