Diagnosing and treating hernia

How is a diagnosis made?

At your consultation, your doctor may ask you series of questions to gain a better understanding of your symptoms, as well as to determine the best means of diagnosis and treatment.

Typical questions can include:

• How long ago did you first start experiencing symptoms or notice something unusual?
• What is the nature of your symptoms?
• Do you experience them occasionally or on a continuous basis?
• How would you describe your symptoms - mild or severe?
• Have you tried anything that has provided symptom relief?
• Has anything seemingly made your symptoms worse?

Hernias are typically diagnosed according to their type and severity, and treated accordingly.

A hernia can be diagnosed in the following ways:

• Inguinal hernia: Diagnosed through a physical exam as the bulge is generally visible. Your doctor will ask you to stand upright. A hernia is generally more prominent in this position and will be easy enough to see with the naked eye. If necessary, your doctor will ask you to cough or act as if straining the body (for instance reaching for something or attempting to lift something heavy). This will also cause the bulge to protrude. If for any reason the bulge is not clearly visible and your doctor strongly suspects a hernia or wishes to check for (or rule out) other conditions, an imaging test may be recommended. These can include an abdominal ultrasound, MRI or CT scan. All of these provide detailed images which can help to make a definite diagnosis.
• Hiatal hernia: This type is often diagnosed when a doctor performs tests to try and determine a cause of heartburn, reflux or upper abdominal pain. Tests can include an eosphagram / barium swallow, blood testing (checking blood count and for signs of anaemia), endoscopy (generally a gastroscopy), or manometry (a catheter which is passed through the nose, down the oesophagus and into the stomach, and measures pressure of movement).
• Umbilical hernia: A doctor will perform a physical exam and sometimes include an imaging test (CT scan or abdominal ultrasound).
• Incisional hernia: This type of hernia will be diagnosed in a similar way to an inguinal hernia.
• Femoral hernia: Your doctor will try and feel the bulge through a physical exam. He or she will also recommend an abdominal ultrasound in order to make a diagnosis. If necessary, an imaging test can also be used to show the weakened or torn muscle gap, and the protruding tissue.

Treatment

Treatment of a hernia may or may not be entirely necessary. Your doctor will determine the size of your hernia during the physical examination, as well as through various tests. If unnecessary to intervene, your doctor may merely monitor you, requesting follow-up appointments, to check for potential signs of enlargement and other developing complications.

General treatment for hernia involves:

• Lifestyle and dietary changes: Your doctor may suggest that you be mindful of what you eat (avoiding spicy and tomato-based foods that cause heartburn and acid reflux) and take care not to consume heavy meals. Other tips you may be given include not lying down or bending following a meal, and maintaining a healthy weight. Smoking habits should also be stopped. Often, such changes can help alleviate hernia related discomfort. If not, surgery to correct a hernia may be recommended.
• Medication: Not all types of hernia need be treated with medication. A hiatal hernia can be treated with prescription or over-the-counter medication that helps to relieve stomach acid and its associated symptoms. In this instance, antacids, proton pump inhibitors and H-2 receptor blockers are commonly recommended.
• Surgery: Pain is a strong sign that the hernia has reached a stage which can’t necessarily be managed with medications and lifestyle adjustments. A hernia can increase in size and due to the forceful nature of tissue pushing through muscles and other connective tissues, it can cause intense pain. Surgery may then become necessary to alleviate pain by repairing holes or weakened areas (closing the opening) with surgical mesh. Depending on the surgeon and the nature of your hernia, surgery may be performed as either open surgery through an incision or laparoscopically through much smaller incisions. In the case of laparoscopic surgery, a surgeon will perform the procedure with a tiny camera and miniaturised surgical tools, making a few small incisions. This is sometimes a favoured procedure as it is less damaging to surrounding tissues, but a hernia can recur and it isn’t always a suitable option for some body locations (such as near the scrotum of a male). Open surgery will result in a longer recovery period. You may be immobile for up to 6 weeks during recovery.