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Hernias: What Every Service Member Should Know

Military personnel performing a bench press Senior Airman Thomas McMurray with the 387th Expeditionary Support Squadron Force Protection prepares to perform a bench press at Al Mubarak Air Base, Kuwait, on May 13, 2021. McMurray has competed in two weight-lifting competitions since deploying in Kuwait, placing first with an overall score of 1,800 pounds (Photo by: Airman 1st Class Kaitlyn Ergish, 386th Air Expeditionary Wing Public Affairs).

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This June, the Military Health System celebrates National Men's Health Month, and sheds light on a variety of medical areas that primarily impact men.

June is also Hernia Awareness Month. According to the National Institutes of Health, men are eight to 10 times more likely than women to develop inguinal hernias.

So, what is a hernia? And what do you need to know about diagnosing, treating, and preventing hernias?

Your abdomen is covered in layers of muscle and strong tissue that help you move and protect internal organs. A hernia is a weakness or defect in this muscle wall that allows internal organs or fat to protrude through the abdominal wall causing a bulge, explained Navy Cmdr. (Dr.) Jesse Bandle, vice chairman, Department of General Surgery, Naval Medical Readiness and Training Command in San Diego.

"The most common hernias occur near areas where blood vessels or other structures naturally penetrate, or have penetrated the abdominal wall," Bandle said, such as the umbilical cord in men, women, and infants, and the inguinal canal near the groin, most frequently in men.

Inguinal hernias usually show up as lumps near the groin or testicles, and most often appear on the right side.

Men commonly describe the sensation of an inguinal hernia as feeling as if something "popped" or gave way. The symptoms can also include:

  • A bulge you can see or feel
  • Aching pain in the area
  • A feeling of pressure
  • A tugging sensation of the scrotum around the testicles

Hiatal hernias occur when part of the stomach is pushed up through a hole in the diaphragm.

"Hernias also can occur at the spot where a prior incision for surgery was made," Bandle said.

"The clearest symptom of a hernia is a new bulge in your abdominal wall," Bandle continued. However, "many hernias do not produce pain symptoms, and patients often have mild or subtle discomfort or sensations of pressure, or achy, burning discomfort."

He noted that the bulge often "is only seen or felt when doing strenuous activity or actively increasing intra-abdominal pressure, such as straining to urinate or defecate, or working out."

What are some of the causes of hernias? Increased intra-abdominal pressure over time increases the chances of developing a hernia, Bandle continued. This increased pressure, he added, can come from pregnancy, heavy lifting, chronic coughing, obesity, and straining.

Hernias also may develop "later in life, when the muscles weaken or deteriorate due to aging, strenuous physical activity, after an injury or abdominal surgery, or coughing that accompanies smoking," Bandle said.

Or, they can be congenital, or due to a birth defect.

If you think you have a hernia, Navy Cmdr. (Dr.) Andrew Kung, a general surgeon with the Naval Medical Center - Camp Lejeune in North Carolina, said to make an appointment with your primary care provider for a routine evaluation. The provider also may choose to prescribe a CT scan or ultrasound, he said.

If you have symptoms of a hernia, you should be evaluated by a surgeon, Kung said. For active-duty service members, "some surgeons will recommend surgical repair of the hernia to prevent issues while deployed," even if there are no signs of difficulty.

"A more urgent evaluation would be needed if you are unable to push the bulge back in," Kung said. "This could be a sign of the hernia contents being trapped, or incarcerated. An incarcerated hernia can become strangulated," he explained, "which means that the blood supply is cut off to the tissue that is trapped. A strangulated hernia can become life threatening if it is not treated by surgery."

Kung said emergency surgery may be called for, especially if you have:

  • Sudden pain that quickly worsens
  • Nausea and/or vomiting
  • Fever
  • Difficulty having a bowel movement or passing gas
  • Bloating or distension of your abdomen
  • Red, purple, or dark skin over the bulge

The surgeon will push back the herniated tissue inside the intestinal lining and sew up the surrounding muscle. Sometimes, a mesh fabric piece will be used to reinforce the repair.

There are more than 750,000 hernias in the United States that are operated on each year, Bandle said. Worldwide, he noted, it is estimated that more than 20 million hernias are operated on each year.

How can you prevent a hernia? "You can try to reduce the strain on your abdominal muscles and tissues," Kung advised. This includes:

  • Maintaining a healthy weight
  • Eating a balanced high-fiber diet to prevent constipation and straining
  • Lifting heavy objects carefully or avoiding heavy lifting
  • Quitting or avoiding smoking, which could lead to a chronic cough

Bandle agreed. "Most hernias will slowly evolve over time. There are no clear ways to prevent a natural hernia from forming if your body has an inherent weakness at one of the sites that are prone to hernias," he said. "However, you can modify some of the risk factors for hernias, such as obesity, smoking, and chronic constipation. Stay fit, don't smoke, keep hydrated, and eat fiber."

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