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Dr. Steven Williams in Boise, Idaho

13Dec

What Causes Hernias?

Dr. Steve Williams | Hernia Repair | | View Counts (1008) |Return|

A hernia is an abnormal protrusion through a muscular wall. As we have previously discussed, a hernia is most often caused by a hole within the fascia. The fascia is the tough wrapper around our muscles which holds our muscle fibers in place as a bundle. When we eat meat, we might encounter the fascia as ‘gristle’, the tough part which is hard to chew.

Some hernias are present at birth. Newborn babies often have inguinal, or groin, hernias, or even hiatal hernias of the diaphragm which cause the babies to suffer gastroesophageal reflux and spit up feedings. I see many young men (and some women) who have groin hernias in their teens and twenties which have likely been present since birth, but are becoming larger and with symptoms for the first time in these young adults. These hernias which are congenital (people are born with them) are always at a natural hole or weak spot in the muscular fascia.

For instance, the hiatus is the natural hole within the diaphragm that the esophagus passes through. The inguinal ring, is a similar natural hole within the fascia of the groin in which the spermatic cord in men, or the round ligament in a woman passes through. These natural gaps in the fascia create a space that when enlarged for some reason, create the most common hernias.

Other times, hernias are acquired. An acquired hernia can develop when the fascia holding the muscle together is ripped or cut. Trauma or surgery can cause a cut in the muscle which will then create a weak spot for the hernia to develop. A rip in the fascia could be caused by a quick stretching of the unprotected fascia such as a slip on the ice which can result in the leg being over extended at the groin and causing a rip at the inguinal ring resulting in a groin hernia.

Whichever the mechanism, some people are more predisposed to hernias. Doctors have long noted two factors which seemed to increase the risk of a patient developing a hernia. Both of these have now been proven by science. First, heredity plays a part. Some people have a genetic code that changes the relationship of elastic fibers and collagen fibers with the muscular fascia. Those that have a strong family history of having hernias could have this genetic predisposition to hernia formation. Secondly, cigarette smoke contains a chemical which also changes the relationship in these fibers and smoking definitely increases your chances of having a hernia. It is not yet known if vaping has the same effect. Moreover, if you do smoke and you are considering a hernia repair, the best thing you can do is to stop smoking for at least a month before the repair and six weeks after. Smoking is a known risk factor for a recurrence of hernia after surgery.

Obesity is also another known risk factor for hernia recurrence as well as recurrence after surgery. This may be only due to the excess force placed on the area of the hernia from the weight, or it could also in part be due to alterations in metabolism. Weight loss will not “fix” a hernia which has occurred but it will lessen the symptoms and weight loss will also decrease the chances of having the hernia recur after surgery.

For more information on hernias, be sure to click here and check out our Hernia FAQ page.

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Practicing General Surgery in the Boise area since 2002