Dr. Donohue: The Ins and Outs of Hernias

Dear Drs. Donohue And Roach: Recently, during a visit with my primary-care doctor, I was told that I have an abdominal hernia, but I never asked him for an explanation of what this means. Could you explain it, and also the pros and cons of treatment? Thank you. — J.R.

Answer: A hernia is a weakness in the muscles of the abdominal wall, which has the potential to allow part of the intestines or other abdominal structures to come through it. There actually are several types of hernias, but the most common are inguinal hernias, which occur in the groin; ventral or incisional hernias, which occur at the site of a former surgery; and umbilical, which is right around the belly button.

Most hernias are abdominal-wall weaknesses a person was born with, which may have gotten bigger during development or aging. While a bout of heavy lifting certainly can make the diagnosis obvious, lifting doesn’t cause the weakness in the first place; that’s a myth. However, people who are known to have hernias probably should NOT do excessive weightlifting.

Although some hernias need surgery, most do not. A hernia needs repair if it is causing symptoms (usually pain), if it is getting bigger, or if the abdominal contents that come through the hernia get stuck outside the abdominal wall. In most cases, when the abdominal contents come through the hernia, they can be gently pushed back in. This is referred to as “reducing” the hernia. A hernia that can’t be reduced (referred to as an “incarcerated” hernia) needs immediate attention. Hernias that are too small for abdominal contents to come through — or too large to become incarcerated —usually don’t need surgical treatment unless you are having symptoms.

A general surgeon is the expert in treating hernias, and this is done both by traditional open surgery and by laparoscopic surgery — surgery done with tiny instruments passed through a small incision. You should see a general surgeon if you have symptoms, or if your primary-care doctor is concerned that your hernia is at risk of becoming incarcerated.

Dear Drs. Donohue And Roach: My son had bariatric surgery three years ago, and lost almost 200 pounds. He diligently follows the recommended exercises and a healthy diet, and has not regained any of the weight he lost. However, the problem he has now is the excessive skin that cannot contract any further and hangs in large, uncomfortable pouches on his inner thighs, arms, neck, etc.

What can he do? My son’s health care plan will not cover “cosmetic surgery,” and he cannot afford it on his own. With the serious problem of obesity in the U.S. and so many doctors speaking out for weight-control surgery, surely someone has addressed this problem. — M.Z.

Answer: Thank you for raising this important point. Unfortunately, I don’t have an answer for you. The surgery to remove this excess skin is not easy, and the surgeons who do these procedures certainly have a right to be paid. In the United States’ dysfunctional (a polite term for it) health care system, the surgery is almost never covered by insurance.

However, people should be made aware of this complication before having the surgery. Your son should take comfort in the extraordinary benefits he’s gained from losing 200 pounds.

Drs. Donohue and Roach regret that they are unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may write the doctors at P.O. Box 536475, Orlando, FL 32853-6475.

Dear Drs. Donohue And Roach: I am a 75-year-old woman with thinning hair. It began about four years ago. I am on several medications. I have tried rosemary oil, with no success. Do you have any suggestions? — J.L.C.

Answer: Much is made of hair loss in men, but it happens in women as well. It’s usually hereditary, and it might affect up to 50 percent of women. In most cases, it’s simply common female-pattern hair loss. However, hair loss can be caused by medical conditions such as thyroid disorder or autoimmune disease, so see your doctor to rule those out.

Rosemary oil will not hurt your scalp, but it’s unlikely to regrow hair.
