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- Written by Dr. Bruce Freedman Dr. Bruce Freedman
Hernias can happen at any age, but they are most commonly diagnosed in adults over 50. In fact, a study conducted by JAMA found that an increase in emergent hernia rates was the highest in the older adult population (over 65 years).
While hernias are common and treatable, the type of mesh material a surgeon uses for the hernia repair can play a role in how well a patient recovers and their quality of life after surgery.
What Is a Hernia?
A hernia occurs when a portion of an organ (most commonly the small intestine) pushes through a weakness in the wall of a muscle or tissue that holds it in place, creating a bulge that can be seen and felt.
When a hernia is left untreated, it can result in serious health complications, including severe pain, bowel obstructions, and even infections.
According to the National Institute of Diabetes and Digestive and Kidney Diseases, 75-80% of all hernias are inguinal or femoral, which occur in the groin area. Both are due to weakened muscles, which can be associated with aging and repeated strains on the abdominal and groin areas.
These strains can result from physical exertion, obesity, frequent coughing, or straining due to constipation.
Hernia Risk Factors
While the exact causes of hernias are unknown, some of the top indicators are:
• Any activity that strains the abdominal wall (chronic coughing or sneezing, constipation)
• Heavy lifting, which can increase abdominal pressure
• Abdominal weight gain that leads to stretching of the abdominal wall
• Former surgical procedures on the abdomen can weaken the wall over time
• Aging, as older adults tend to have much weaker core muscles
Common Symptoms of a Hernia
A hernia can take place almost anywhere in the midsection, and each type of hernia produces its own unique symptoms. The most common symptom of a hernia is a small- to medium-sized lump in the affected area.
In many cases, hernias have no symptoms, and you may not know you have a hernia unless it shows up during a routine physical or a medical exam.
Some of the top indicators for the two main types of hernias — inguinal and femoral — are:
• A heavy feeling in the abdomen that sometimes comes with constipation or blood in the stool
• Discomfort in the abdomen or groin when lifting or bending over
• A burning or aching sensation at the bulge
• Weakness or pressure in your groin
• A hard time swallowing
• Pain and swelling around the testicles
• Heartburn, shooting pain, vomiting, or constipation
When to Seek Medical Attention
COVID-19 led many to delay seeing any kind of doctor, but if you suspect you have a hernia, it’s important to be seen quickly. Left untreated, hernias can grow larger, become symptomatic, and become increasingly painful.
Fortunately, the advancements in hernia repair have come a long way in the last few years, and there are innovative options available to patients.
Hernia Mesh Options
With over 1 million hernia-repair procedures performed each year in the U.S. and more than 90% requiring the use of mesh, it’s important for patients to understand the treatment options available to them.
Repairing the hernia without mesh has a higher chance of recurrence than with the use of mesh. So, once a hernia has been diagnosed, the next question should be, “What kind of material should we use to reinforce the repair?”
Each material has its benefits and limitations, so discuss them with your doctor.
Synthetic mesh. For years, the standard has been to use synthetic mesh to support a hernia repair. While strong and potentially useful for some hernia repairs, these meshes are made of plastic and have the potential to cause a foreign body response.
Biologic mesh. The most natural option is biologic mesh, sourced from animals or humans. These are most often used in more complex hernia cases due to their high cost.
While naturally derived, biologic mesh can stretch over time, potentially resulting in a bulge and even a recurrence, especially in larger hernias.
Reinforced tissue matrix (hybrid). There is a third option: reinforced tissue matrix. This option is composed of polymer fiber interwoven through layers of biologic in a proprietary “lockstitch” pattern that encourages more natural tissue growth.
No mesh. Using no mesh can be an option for some patients, depending on the complexity and size of their hernia. This approach is a preference for patients who want to minimize the amount of foreign material in their bodies, but the chance of recurrence is higher without any type of reinforcement.
As a patient, it’s critical to know you do have options for your hernia repair, and you have a say over what is being put into your body. Before surgery, express any concerns to your doctor so you have a complete understanding of the risks associated with each mesh option.
Dr. Bruce Freedman is vice president of clinical development for TELA Bio (telabio.com). After 32 years as a private practice general surgeon specializing in hernia repair and abdominal wall reconstruction, Freedman joined TELA Bio to advocate for more natural hernia repair mesh options.