Our Approach

The Hernia Center at Vincera Institute brings together top specialists dedicated to hernia diagnosis, treatment, rehabilitation and prevention. Experts in our comprehensive center include surgeons, physical therapists, radiologists, yoga therapists, health coaches, nutritionists, chiropractors, massage therapists, medical acupuncturists, psychologists and exercise physiologists.

Besides focusing on your particular hernia condition, we also emphasize strengthening your core muscles in order to enhance support of your hips. Your treatment plan is also tailored to your specific clinical needs. This ensures that you receive the individualized care that is essential to your recovery and return to pain-free athletic activities, optimum performance, and health. To talk with a specialist or make an appointment, contact us at 267.592.3200 or email us.

Hernias

 What is a hernia?

A hernia is a protrusion that occurs when layers of the abdominal wall become weak or torn. An organ or fatty tissue squeezes through this weak spot in the muscle or connective tissue (called fascia) and causes a bulge. This bulge may start small and it can grow large as it pushes the fatty tissue and intestines out.

Complications from having a hernia may be severe. Complications include:

Intestinal blockages

Incarceration: A hernia can become incarcerated, which means it can get “stuck.” Depending on what tissue is incarcerated, symptoms include severe pain, nausea and vomiting, and if the hernia contains intestines, a bowel obstruction can occur and require emergent surgery.

Strangulation: Strangulation occurs when blood flow is cut off to the herniated tissue and it dies. This can be life threatening and requires emergent surgery.

Symptoms include:

  • bulge or swelling in the groin, navel or near a previous scar
  • pain during physical activities like jogging, lifting
  • pain while sneezing or coughing
  • constipation
  • nausea and vomiting

Causes include:

  • lifting heavy objects without stabilizing core muscles
  • diarrhea or constipation/straining
  • persistent coughing or sneezing
  • weakness present at birth
  • previous abdominal surgery
  • pregnancy
  • lifestyle – obesity, poor nutrition and smoking

Treatment varies depending on the type of hernia. However, surgery is often recommended if no other significant, contraindicating medical conditions exist and the patient is willing to undergo surgery.

 Inguinal Hernia

Inguinal hernias occur in the groin area. About 96 percent of hernias are groin (inguinal) hernias and most occur in men because of a natural weakness in the area. With this type of hernia, fat, intestines, the bladder, or other organs protrude through the abdominal wall or into the inguinal canal in the groin. This type of hernia is usually associated with heavy lifting, an enlarged prostate or straining due to constipation or coughing.

Direct inguinal hernias occur when there is a weak spot or tear in the muscles that form the inguinal canal. Fat, part of the small intestine, the bladder, an ovary, or another organ can slide through the hole and into the inguinal canal.

Indirect inguinal hernias result from a defect present at birth in which the lining of the abdominal cavity at the inguinal canal does not close properly. This leaves an opening where fat, part of the small intestine, the bladder, an ovary, or another organ can slide into the inguinal canal.

Pantaloon hernias occur when both a direct and indirect hernia develop on the same side of the groin. Patients with pantaloons hernias are at a higher risk for recurrent hernias.

Other Types of Groin Hernias

Obturator hernias are a less common type that affect elderly women. Tissue protrudes into the inner thigh and often causes bowel blockage.

Femoral hernias are more common in women and involve tissue passing beneath the inguinal canal into the thigh. These also frequently cause bowel blockages.

 Complex Abdominal Wall Hernia

The abdominal wall is supposed to protect the inner organs and is usually durable and thick. However, a traumatic injury, recurrent hernias or a non-healing wound can weaken the abdominal wall and cause complicated hernias.

Treatment options for complex abdominal wall reconstruction include:

  • compartment separation (laparoscopic, endoscopic, or open)
  • reconstruction with permanent, bioabsorbable, or biologic mesh
  • open or laparoscopic hernia repair.

At The Hernia Center at Vincera, we handle extremely complex abdominal wall hernias and abdominal wall reconstruction.

Other Types of Hernias

Ventral Hernia
Ventral hernias occur in the midline of the abdomen at a site other than the belly button.

Umbilical Hernia
Umbilical hernias occur due to a natural weakness in the abdominal wall at the belly button. The hernia sac contains fatty tissue, intestines or fluid that pushes out through that weakness. This sometimes causes an “outie” belly button.

Spigelian Hernia
Spigelian hernias occur at a natural weakness of the abdominal wall along the edges of the “6-pack” muscles. Because the herniating tissue passes between the layers of the abdominal wall, a bulge is usually not present. Such hernias can cause pain and bowel blockages.

Incisional Hernia
An incisional hernia occurs at the site of a healing surgical scar, so people who have had previous abdominal surgery are at risk. Incisions are most susceptible for the first three to six months after the procedure, but such hernias may not become noticeable until later.

Parastomal Hernia
A parastomal hernia occurs after a stoma is created. A stoma procedure involves bringing a portion of the bowel through the abdominal wall so it can be accessed at skin level and allow for the elimination of stool or urine. This causes weakness in the abdominal wall. Examples of stomas include gastrostomies, ileostomies and colostomies.

 Related Conditions

Sports Hernia
The term “sports hernia” is a misnomer, as it is not a true hernia but rather a core muscle injury.

Diastasis Recti
Diastasis recti is a separation of the left and right sides of the “6-pack” abdominal muscles (rectus abdominis). It is common in pregnant women and the risk increases higher with multiple pregnancies. Your physician can see a ridge which runs down the middle of the belly area and this ridge increases with muscle straining. While usually cosmetic, this condition can be repaired surgically.

Abdominal and Pelvic Pain
Chronic abdominal and pelvic pain can occur anywhere from the abdomen to between the hipbones. It is often frustrating because the causes are difficult to pinpoint, patients are often misdiagnosed and dissatisfied with their treatments; their quality of life diminishes while their healthcare costs rise.

Some common diagnoses for abdominal and pelvic pain include:

  • hernias
  • nerve entrapment
  • gynecologic causes such as menstrual cramps, ovulation, endometriosis, ovarian cysts, fibroids and cervical cancer
  • digestive tract disorders such as irritable bowel syndrome, gastroenteritis, inflammatory bowel disease (Crohn’s disease, ulcerative colitis), appendicitis, diverticulitis, constipation, a blockage or perforation in the intestine, colon cancer, gastroesophageal reflux disease (GERD), gallbladder inflammation, pancreatitis, peptic ulcers and intestinal obstruction
  • urologic disorders such as cystitis, kidney stones, interstitial cystitis, prostatitis and bladder infection
  • core muscle injuries
  • other musculoskeletal disorders.

At the Vincera Institute, our team of trained professionals work with you to ensure: accurate diagnosis; cohesive and comprehensive treatment; and prevention of your abdominal and pelvic pain. We also collaborate with your medical team to ensure that your care is tailored to your medical needs.

Nerve Entrapment Syndromes
Nerve entrapment syndromes occur when nerves are chronically compressed or inflamed and there results a pain or loss of function. Symptoms include:

  • burning
  • pain
  • tingling
  • numbness
  • aching sensation
  • difficulty walking

Causes include:

  • prior surgery, often with mesh placement
  • pregnancy
  • appendectomy
  • inguinal hernia
  • inguinal lymph node dissection
  • femoral catheter placement
  • hysterectomy
  • trauma, including from sporting events, motor vehicle accidents and knife wounds
  • obesity
  • repetitive stress

Diagnosis may be made by:

  • using anesthetic nerve blocks to determine diagnosis and to prevent unnecessary surgical exploration of an uninjured nerve
  • physical exam (looking for weak hip flexion, weak knee extension, etc.)
  • MRI

Treatments for nerve entrapment syndromes vary, depending upon the anatomy, etiology, presentation and prognosis. Treatments include:

  • local injection of anesthetic (with or without corticosteroid)
  • physical therapy
  • use of thermal therapies and TENS (Transcutaneous Electrical Nerve Stimulation)
  • massage
  • yoga
  • oral medications (analgesics, anxiolytics, antidepressants, anti-inflammatories, and antispasmotics have helped some people)
  • surgery

Diagnosis

The experts at The Hernia Center at Vincera Institute will personally guide you through every step of this process. A visit will likely include:

  • MRI, ultrasound or other imaging
  • functional assessment
  • history and physical
  • other diagnostic procedures
  • meeting with physicians
  • consultations with experts in such areas as physical therapy, acupuncture, yoga therapy, nutrition, behavioral counsel, anesthesiology/pain management, massage therapy, radiology, neurosurgery and chiropractic.

What to Bring to Your Appointment
When you come for your appointment, bring a list of all prescription and over-the-counter medications you take, any imaging studies you may have, any charts from other physicians or therapists and a list of all of your questions. Our team will meet with you and determine the best course of treatment for you.

Treatment & Procedures

In consultation with you and your medical professionals, The Hernia Center team will recommend appropriate treatment and procedures to you so you can get back to pain-free activities. Each treatment protocol is personalized to your diagnosis, history and prognosis. Here are some examples of treatments your team may suggest:

  • Open repair without mesh: Can be done when mesh is not needed; stitches in the abdominal wall can close the hole.
  • Open repair with mesh: Often done with a single open incision near the site of the hernia.
  • Laparoscopic repair or minimally invasive surgery
  • Percutaneous Interventions
  • Component Separation: Can be done open or laparoscopically, and may be used to avoid the need for mesh or in addition to mesh.
  • Non-Surgical Repair
  • Planning for Pre- and Post-Surgery

Rehabilitation, Pre-habilitation & Prevention Programs

At The Hernia Center, our clinicians ensure you are provided with a comprehensive and tailored treatment plan to enable a speedy recovery. Examples of treatment plans that may be ordered are:

Pre-habilitation Programs: Being healthy before surgery enables you to recover more quickly after surgery. Depending on your history and diagnosis, your team may recommend “pre-hab,” which may consist of physical therapy, exercise physiology, yoga, nutrition, acupuncture, behavioral medicine or chiropractic visits.

Day of Surgery Physical Therapy: Your medical team is focused on the most appropriate plan to quicken your recovery. When you are discharged from the ambulatory surgery facility, you may begin physical therapy immediately, which may consist of cold laser therapy, therapeutic activities, education and ice compression.

Physical Therapy and other Post-operative Plans: Your physical therapy and other treatment plans will begin as soon as your physician clears you. Your comprehensive plan may include physical therapy, massage therapy, yoga therapy, nutrition, exercise physiology and behavioral medicine.

Prevention Program: While we like working with you, we do not want you to have a recurrence. We work with patients closely on lifestyle and other prevention programs to educate you so you can lead a healthy and hernia-free life.