Q: Good morning, Dr. Could you please advise – I have a hernia problem. My doctor told me that it might be repaired later but it’s troubling me – pains into my rib and my back. When I eat my stomach is so bloated, I look pregnant. I’m so ashamed. I noticed for the first time, very dark stools and I am worried it might be more serious then what the Dr thinks. Thank you and have a blessed day.

A: First rule of thumb for any condition you have is that where in doubt, please revert to your doctor again or seek a second opinion. If indeed you have hernia and you are now having pain, as you will see in this post, see your doctor IMMEDIATELY.

Starting from the beginning, hernia is the protrusion of an organ through a defect (like a hole or opening) in the wall of the muscle or cavity which usually holds it in place. There are different types hernias (or herniae) and they include:

Inguinal hernia: The most common type of hernia. It usually happens in situations where the pressure inside the abdomen is increased.

Other hernias include incisional hernia (where a protrusion develops from the site of a previous surgery, especially abdominal surgery), femoral hernia (which has the same risk factors as inguinal), umbilical hernia (common in black children where the umbilicus, aka navel does not form a small ‘button’ on the abdominal wall but protrudes) and hiatal hernia (where the stomach squeezes through a hole meant for the oesophagus (the pipe through which food gets to the stomach).

Typically, all hernias are caused by a weakness in the wall of muscles or containing cavities and an increase in pressure. Examples of activities that increase pressure in the abdomen are long-standing cough or frequent sneezing, carrying heavy loads regularly, straining at stool whether due to constipation or diarrhea etc. The walls of muscles are usually weakened in people who are obese, pregnant women, smokers and malnourished people. It is also more common in men and as people grow older.

What are the symptoms? People with hernia would usually notice a protrusion after a strain eg lifting something heavy or coughing. Sometimes, they are able to push it back. Other times they are not. The worry about hernia and the reason why they have to be treated quickly is that they may strangulate. Yes, just think about the word strangle and you understand what strangulate means J The protrusion may become squeezed by the opening through which it passes blocking off blood supply to the area protruding. Once a part of the body is deprived of blood, it dies. We don’t want that to happen!

The decision as to whether to go for surgery or not depends on where the hernia is located (inguinal and femoral hernias usually need surgery), the contents of the hernia sac and the symptoms. A truss (a supportive device that prevents enlargement of a hernia) may be prescribed by your doctor to help for a short period of time. Typically a doctor will schedule a surgery to repair a hernia. Complaints of pain in a hernia patient may mean strangulation, which needs to be dealt with immediately. Umbilical hernia does not usually require surgery as the protrusions usually ‘return’ on their own. If this persists beyond 5 years, then surgery may be needed.

If you do require surgery, you don’t need to fret about it…really. This is not major surgery…it’s intermediate (sort of like half way between minor and major :D). Your doctor will provide answers to all the questions you have and of course, counseling. There are options for laparoscopic surgery which is surgery done through small incisions guided by a camera.

Preventive measures include having a healthy weight, giving up smoking, treating conditions that may lead to long-standing coughs, eating healthy to prevent straining at stool etc. These are the self-help options available to you now. I am worried though, about the possibility of strangulation. I suggest that you go to a Government hospital. Consultation fee will be moderate and a doctor will give you a proper diagnosis after examining you.

Dark stools could be due to iron supplements, upper digestive tract bleeding etc. You really should go back to see your doctor or get a second opinion to tie in all these symptoms.

All the best!