When my then-70-year-old mother was diagnosed with a hernia some years back, my first thought was: Has Mum been wrestling?
It wasn’t that farfetched for my mind to jump there when Dwayne Johnson’s triple hernia surgery after wrestling John Cena made the news then. If that doesn’t sound painful enough, the actor and WWE star also tweeted that his doctor “had to push my intestines back thru the tear in my abdomen”. Ouch.
Outside the wrestling ring and in real life, hernias are not as uncommon as you think. National University Hospital’s (NUH) Hernia Centre, for instance, treats over 500 new cases each year, said Professor Davide Lomanto, the centre’s director as well as the head and senior consultant with NUH’s Minimally Invasive Surgery Centre.
Doctors in private practice, such as general surgeon Dr Lee Chin Li from Gleneagles Hospital, also see “a relatively high incidence rate”. “Hernias affect approximately 15 per cent of the population in Singapore,” he said. “In my private practice, I typically see about five or six cases per month.”
Dr Reyaz Singaporewalla, another general surgeon in private practice as well as the senior consultant in endocrine and medical director of ACE Specialist Surgery & Endoscopy, has the same observation. “Hernias are relatively common in Singapore. At our centre, we typically see 15 to 20 new hernia patients a month.”
But if you’re thinking you’re off the hook because you don’t wrestle or aren’t that old yet, you might want to brace yourself – especially when you cough.
WHY DOES A HERNIA FORM?
A hernia occurs when tissue or organ bulges through a weak area in the surrounding muscle or tissue wall. “To understand the contributory factors for hernia formation, we need to understand the two main mechanisms,” said Dr Lee. “Firstly, weakened abdominal wall muscles; and secondly, increased intra-abdominal pressure.”
Your abdominal wall is made of muscles and tissues to hold your bowels and other organs in the abdominal cavity. But this wall isn’t impenetrable; there are natural openings such as the belly button, and in men, the tubes that carry sperm from the testicles to the penis, explained a JAMA Network report. Some of these natural openings don’t lead outside the body but within, such as the blood vessels that travel from inside the abdomen to the legs.
“Hernias generally begin with an increase in abdominal pressure, causing an organ like the small intestine, to protrude through a weakened muscle or tissue,” explained Dr Lomanto. This can be caused by genetics, weakened muscles through ageing or a collagen deficiency.
If you have a certain amount of weakness in your abdominal wall, you don’t have to wrestle like a WWE star or do very heavy lifting to develop a hernia. Any activity that creates pressure in the abdomen can push an organ through the weakened area like Play Doh through an extruder.
“Chronic coughing, smoking (which affects the production of collagen, increases collagen breakdown and causes chronic coughing), heavy weightlifting and being overweight are risk factors for developing a hernia,” said Dr Lomanto.
WHO CAN BE PRONE TO HERNIAS?
In Singapore, “most hernia patients tend to be middle-aged to older males,” said Dr Singaporewalla. “However, we also see younger adults, especially those engaged in manual labour or weight training, and women with a history of pregnancy or abdominal surgery.”
Dr Lee explained that “elderly patients may have a weaker abdominal wall due to ageing”, while “pregnancy will stretch the abdominal wall and thin it, in addition to increased abdominal pressure”.
WHERE ARE HERNIAS USUALLY FOUND?
Even if you skipped Biology in school, the Black Adam star’s description ought to clue you in: The abdomen.
However, hernias can also occur between your chest and tummy area, according to Health Direct. Depending on its location, a hernia can be classified as:
- Inguinal hernia: A bulge in the groin at the top of your inner thigh.
- Femoral hernia: Also presents as a bulge in the groin at the top of the inner thigh.
- Umbilical hernia: A bulge around the belly button.
- Incisional hernia: Where your abdominal wall was cut during surgery. About a third of patients will develop a hernia after abdominal surgery, according to Johns Hopkins Medicine.
- Epigastric hernia: The area between the breastbone and belly button.
In Singapore, the more common types of hernias seen are inguinal hernia, umbilical hernia and incisional hernia, according to the doctors CNA Lifestyle spoke to. As for the typical patient profile, “it really depends on which type of hernia”, said Dr Lee.
“Inguinal hernia tends to occur in more male children or infants within six months of birth,” he said. “In adults, it is typically seen in patients older than 50 years old and more commonly in males.”
Women who have had multiple pregnancies may develop umbilical hernia, said Dr Lomanto. “Umbilical hernia occurs when part of the intestine bulges through the opening of the abdominal muscles near the belly button.”
WHAT ARE THE SIGNS THAT YOU MAY HAVE A HERNIA?
“Many patients ignore early signs like a bulge in the abdomen or groin that comes and goes, especially if it is painless,” said Dr Singaporewalla. “Some dismiss it as a muscle strain or a fat lump.” He added that in young athletes and weightlifters, the earliest symptom is often a pulling pain in the groin fold before swelling appears.
In some cases, a hernia “can be uncomfortable and may cause pain in certain situations, such as when standing for a long time, during long walks, and carrying heavy weights”, said Dr Lomanto.
WHAT IS THE TREATMENT FOR HERNIA?
It depends on the type of hernia, according to Dr Lee. “The more common inguinal hernia usually requires surgery.” Doctors may not call for urgent surgery for umbilical hernia (unless the surrounding skin is thinned out or the hernia increases in size) as well as hernias without any symptoms and instead, “opt for watchful waiting”, he said.
But don’t make the call yourself by not seeing a doctor at all. “Untreated hernias can become painful and may lead to serious complications like bowel obstruction or strangulation, which are surgical emergencies,” said Dr Singaporewalla. Signs of a bowel obstruction or strangulation can include nausea and vomiting, explained Dr Lomanto.
Minimally invasive keyhole surgery is usually performed to patch you up. “The goal is to return the protruding tissue to its original position and reinforce the weakened area, often with the use of a mesh,” said Dr Singaporewalla.