Hien T. Nguyen, M.D.

Dr. Hien T. Nguyen (Barbara Haddock Taylor, Baltimore Sun / April 26, 2012)

Hernias are a common ailment among Americans; more than 4 million people develop the painful condition. And although both men and women develop hernias, female patients may be harder to diagnose. Doctors and patients may not realize the abdominal pain a woman is feeling is because of a hernia. Dr. Hien Nguyen, assistant professor of surgery at the Johns Hopkins University School of Medicine, said the pain can be mistaken for other conditions with similar symptoms, such as adhesions from prior surgery, endometriosis, fibroids and ovarian cysts. Nguyen talks about treating hernias in women.

What is a hernia?

The word "hernia" comes from the Latin word meaning "rupture." It refers to a weakness in the abdominal muscle wall, which creates a separation or gap between the muscle layers. This is often caused by a sporting event or excessive physical strain. Over time, the separation widens and tissue from within the abdomen can be pushed through this defect

What kinds of hernias are commonly seen in women?

The most common type is a groin hernia, also known as an inguinal hernia. Incisional hernias are the second-most-common type, and occur after abdominal surgery when the muscle layers separate below the skin. During pregnancy, the enlarging uterus creates more pressure in the abdomen and pushes the stomach up against the diaphragm. This may cause a hiatal hernia, when the stomach herniates past the diaphragm and into the chest, affecting the lungs and heart. Umbilical hernias can also be seen in women. This occurs when the muscle wall does not completely close at the umbilicus and a small defect allows tissue to push through, creating an "outie" bellybutton.

What are some of the symptoms of women with hernias?

A hernia typically feels like a mild, painless bulge that enlarges with physical activity and can be easily reduced. Some people have subtle discomfort or burning sensation over the hernia where tissue is pushing through. Due to their mild symptoms, hernias tend to be ignored. Over time, most hernias become larger. When patients wait too long, they present at a more severe stage of the disease and may have severe pain, nausea and vomiting. In these situations, surgical options may be more limited, and the complication rate for surgery can become higher.

Are there any differences in surgical treatments or considerations for women with hernias?

Certain patients can be candidates for minimally invasive surgery. With this approach, small incisions roughly the diameter of a pen are made. In addition to improved cosmetic outcomes, studies show that minimally invasive surgery may lead to less pain and faster recovery from the operation. Whether someone is a candidate for minimally invasive surgery depends on many factors, including the size and complexity of the hernia.

What does surgical treatment entail for women with hernias?

Currently, surgery is the only definitive treatment for hernias. The goal of surgery is to close the defect and to restore function to the muscles affected. This often times can be performed with minimally invasive surgery. In other circumstances open surgery is necessary and is performed through a larger incision, usually slightly bigger than the size of the hernia defect. Mesh is commonly used to reinforce the repair and leads to a better outcome with less recurrence.

What kind of recovery period would someone expect after surgery?

Most hernia surgery is same-day surgery, which means that patients go home the evening of their operation. Those with more complex hernias will be kept in the hospital for one to two nights. Most patients will be sore for up to four days afterward, and patients are recommended to take one to two weeks off from work to recuperate. Most patients are back to normal after four weeks.

Are there ways women can prevent a hernia?

Hernias can form and enlarge from excessive and chronic straining. Not smoking can minimize the risk of hernias by preventing the chronic cough that can occur. Having a healthy diet will minimize constipation and the straining that is associated with it. Also, many studies have linked obesity to hernias. A healthy lifestyle will help prevent many ailments, including hernias.

Dr. Nguyen recently participated in a free patient information seminar on hernias. To view the seminar, go to http://bit.ly/herniatreatmentvideo.


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