Don’t ignore that bulge

A hernia occurs when part of the inner lining of the abdomen, or sometimes an organ, pushes through a weak spot in the abdominal wall. These bulges most commonly appear at the navel (umbilical hernia), the groin (inguinal hernia), or at the site of a previous operation (incisional hernia).

Hernias can cause pain, an unsightly swelling during coughing or straining, or a persistent bulge—sometimes referred to locally as a ‘Bosen’ or ‘Bosson’– a term often used when the swelling extends all the way into the scrotum in men. Groin hernias also occur in women and may require even more urgent attention.

The real danger with hernias occurs when they become complicated. Hernias are effectively tunnels through the abdominal wall, allowing other intra-abdominal organs, most commonly the intestines, to slip in and become trapped. When this happens suddenly, patients may notice:

A bulge that once “went back in” now stays out.

Severe pain at the hernia site, sometimes spreading across the abdomen.

Nausea and vomiting.

Redness and swelling of the overlying skin.

This happens because the trapped organ is tightly squeezed at the rim of the hernia opening, like a cord tied too tightly around a bag. If not treated promptly, the trapped organ can become necrotic and perforate. This is a true medical emergency and requires urgent attention.

To relieve symptoms and prevent complications, your doctor will usually refer you to a surgeon for repair. Despite widespread promotion of various hernia remedies, such as elixirs, drinks, and creams, these offer only empty promises. Hernias are a mechanical problem — a hole in the abdominal wall—and surgery is the only effective cure. Hernia repair is highly effective and widely available.

Hernia surgery is among the most commonly performed elective procedures in Jamaica and worldwide. Modern techniques are reliable, often performed as outpatient procedures, and allow a rapid return to normal activity. A small number of patients may experience chronic pain afterwards, but this usually improves over time and simple pain relief medication.

Hernia surgery can be performed as an open procedure or using minimally invasive (laparoscopic) techniques. Minimally invasive surgery often results in smaller scars and a lower risk of chronic pain, though not all hernias or patients are suitable. Repairs may use synthetic mesh to strengthen the area and reduce recurrence, but mesh is not always required. The choice of technique depends on your medical condition and type of hernia, so discussing options with a surgeon is essential.

Before repairing a hernia, your surgeon may recommend addressing conditions that contributed to its development, such as obesity, smoking, chronic cough, constipation, or difficulty urinating. Managing these and other illnesses, like diabetes, can reduce surgical complications, repair failure, and the risk of hernia recurrence.

In a few select cases, particularly in men with minimal or no symptoms, observation may be an option. However, this should only be decided after consultation with a surgeon, as not all hernias, and certainly not all patients, qualify.

If you or someone you know notices a bulge — especially one causing pain — prompt consultation with a surgeon can make all the difference. With timely treatment, hernias can be repaired before complications arise, allowing a return to normal life without the bothersome bulge.

Dr Matthew-Anthony Lyew is a consultant general surgeon at Kingston Public Hospital and Island Medical Specialists. Send your questions for consideration via DM on Instagram @drmatthewlyew or email surgicalconsult@gleanerjm.com.