CONGENITAL: Many patients are born with hernias either in the inguinal or umbilical area, where the natural openings do not close completely after birth. Some of these may require surgery in the infant or child age group. Some patients have a family history of hernias and hernia surgery. Since we are genetically derived from our parents, there may be a predisposition to developing a hernia based on similarities in anatomy to other family members.
INCREASED INTRA-ABDOMINAL PRESSURE: Many hernias are caused or made worse by increased abdominal pressure, either a single strenuous event such as a cough or sneeze, or from repeated episodes. Increasing one’s abdominal pressure can be done by flexing the abdominal muscles, holding one’s breath, and pushing, pulling, or lifting. A twisting motion or other abdominal wall muscle movement at the same time can add to the risk for developing a hernia by weakening or tearing the muscle and fascia. This increased pressure occurs commonly with normal activities such as heavy lifting, coughing and sneezing, abdominal trauma (such as a fall or an automobile accident), as well as lifting weights and other athletic activities. Some hernia will develop over time without a single event or injury – these will often present as a bulge with no pain.
Increased abdominal pressure, in addition to stretching of the abdominal wall occurs with pregnancy – it is not uncommon for an umbilical, or even a groin hernia to be identified during pregnancy. These will often get smaller or go away after delivery, but may also persist.
SMOKING AND HERNIAS: Smoking can be a causative factor for hernias in two ways. Almost all smokers cough vigorously to try to clear their airways and wind passages. This repeated sharp increase in abdominal pressure can damage or tear the abdominal wall muscles, weakening them and allowing a hernia to form. In addition, smoking actually changes the biologic structure of collagen, a substance that is needed to strengthen the fibrous tissues, ligaments and tendons, and the tough tissue (fascia) that attaches to the muscles. The collagen in smokers has been shown to be chemically different, and is weaker than collagen produced by non-smokers.
WORKPLACE HERNIAS: Hernias commonly occur in patients who are working in positions that require strenuous activities including lifting, pushing, pulling, and twisting, on a regular basis. Hernias can occur as a result of a single accident or injury, but may also be caused by repeated lifting or other activities over a period of time. Hernias in the workplace will sometimes appear as a bulge without a specific single injury or incident where a sharp pain is noted. However, pain is commonly a symptom.
PATIENT FACTORS: Some patients may have other medical illnesses or body make-up, or take medications that may weaken muscles and tissues and increase the risk for developing a hernia. Obesity causes increased abdominal pressure as well as stretching and weakening of the abdominal muscles and fascia which are factors that increase the risk for hernias. Patients who are constipated, or have enlarged prostates and have difficulty urinating, will frequently have to increase their abdominal pressure to have a bowel movement or urinate. This repeated activity can contribute to the development of a hernia. Smoking is a contributing factor in many patients.