Re: To Tina Re;Hernias

From: Tina Shelby (
Mon Jan 10 20:34:53 2000

Hi Susan,

You've got the right one who worked with the GI doc. There have been several members with hernias so I thought I would just give a brief overview of the types of hernias, symptoms etc. for you.

HERNIA DEFINITION The definition of a hernia is basically a defect in the normal lining of the abdominal wall so that some of the abdominal cavity organs protrude through the abdominal wall.

CAUSES Causes are multiple, many are due to a congenital defect but conditions that increase intra-abdominal pressure can cause a hernia to occur. These include obesity, lung problems such as COPD, chronic cough, fluid in the abdominal cavity, chronic constipation with straining, hard physical labor, and for most here - surgery.

TYPES Hernias can occur most anywhere along the abdominal wall, but the most common places are femoral, incisional, umbilical, hiatal/diaphragmatic, and epigastric.

SYMPTOMS Symptoms are not related to the size of the hernia but to the amount of pressure on the contents. Symptoms for a diaphragmatic/hiatal hernia can include difficulty/painful swallowing, and pain that usually occurs after eating especally when bending over or lying down, and/or chest pain, heartburn, and regurgitation. Incisional hernias are more common in vertical than in transverse scars. Incisional hernias are usually obvious and can be easily seen as a bulge through the incision. These usually need to be repaired quickly an intestinal obstruction can develop. Most of the patients with hernias that are reducible usually have no symptoms or have only mild pain. However, patients with strangulated or incarcerated hernias have colicky abdominal pain, nausea, vomiting, abdominal distention, and hyperactive bowel sounds. These need to be treated as an emergency and repaired quickly.

DIAGNOSIS Diagnosis is usually based on the exam. There is the obvious bulge in the abdominal wall, however, hiatal hernias may not be so obvious but can cause the above mentioned symptoms. Hiatal hernias can be detected with a barium swallow, direct visualzation from endoscopy.

HIATAL/DIAPHRAGMATIC HERNIAS - TREATMENT Measures that will help symptoms of this type of hernia include, elevating the head of bed on blocks, avoid lying down after eating, and prescription H2 blockers or proton pump inhibitors such as Prilosec. Foods to avoid include chocolate/ pepperment, high fat foods, alcohol, coffee, citrus juices, onions, high-fat foods, and smoking. Treatment is usually done in stages and surgery is usually a last resort because of the difficulty with going into the chest cavity. However, new laser surgical techniques can be done fairly easily without the trauma of opening the chest cavity.

Susan, as far as adhesions being above the pelvic surgery - yes, they can form that far away from the surgical site. Things such as poor surgical technique, infection in the abdominal cavity, excess bleeding during the surgery, and physical trauma are some of the reasons. The symptoms you describe are not typical of a hiatal hernia. Your GI work up would have shown a hernia if there was one. As you have probably read here that adhesions really can only be accurately diagnosed by actual visualization of the abdominal cavity by an open lap or a laproscope. No x-rays or CT scans can accurately tell if adhesions are there or not. Based on the research info I have, many patients that have had an appendectomy or TAH will have adhesions that may or may not cause problems.

If you were experiencing the pain and symptoms you describe before your very first abdominal/pelvic surgery then the odds are that it is not being caused by adhesions. However you the symptoms started after your first abdominal/pelvic surgery then adhesions could be the problem. You don't mention any other surgeries except for the one you had 5/26. Have you had other surgeries other than this one? If not then the adhesions have occured for other reasons such as physical trauma to the abdomen, infection, ect.

The most important thing to remember is to keep looking for the cause of your pain. Don't give up. Just because x-ray/labs etc can't find anything wrong doesn't mean it is all in your head.

I hope I have answered your questions. If anything is unclear or missing, please just let me know, I'm glad to be able to help!


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