One of the most common ailments affecting men and women in the United States are hernias, and over 4 million individuals experience them each year. There are different types of hernias, some that will heal and go away on their own, and some that require surgical intervention to repair.
What Is a Hernia?
Physical strain or stress exerted on the muscular abdominal wall can cause it to separate causing a gap. This gap is called a “hernia” and is derived from the Latin word for “rupture”. This gap can progressively become wider until tissue (often intrabdominal fat, but can involve a loop/loops of bowel) from inside the abdomen is pushed through the abdominal wall to lie just under the skin.
Often hernias will cause a prominent protrusion that can be seen from the outside when looking at the abdomen. Umbilical hernias are often seen in infants located at the belly button (causing an “outie”) but adults can experience them as well. Usually, a child’s umbilical hernia will close on its own by age 2, but adults often require surgery to repair it.
Causes and Types Of Hernias Often Seen In Women
Women can experience several different types of hernias with the most common being a groin hernia or “inguinal hernia”. The second most common hernias found in women are incisional hernias which can form after abdominal surgery when the incision weakens the abdominal muscles in that location.
Hiatal hernias are also seen in women during pregnancy and can be caused by a very large uterus pushing the stomach into the diaphragm area. Women can also experience umbilical hernias as a result of pregnancy. Although rather rare, another source of hernia formation can come from the presence of a large uterine fibroid.
Can a Fibroid Cause a Hernia?
There was a case report of a 40-year-old woman who had undergone tubal ligation (16 years prior) and presented with a swollen uterus (similar to a 4-month pregnant size) and an incisional hernia. The woman had a BMI of 32 and had been experiencing heavy prolonged bleeding during menstruation and anemia for about a year.
Upon examination, a large anterior wall fibroid was discovered that had enlarged her uterus and created a hernia through the weakened incision site. Once an incision has been created in the abdominal wall, even though healing takes place, it will never be as strong as it was pre-surgery.
On a similar note, this is why women who undergo a surgical myomectomy will need to deliver through a c-section if they become pregnant and not by vaginal delivery. The weakness in the uterine wall caused by the surgical incision will obviate the need for this c-section delivery, as the gynecologist does not want to risk a complete rupture of the uterine wall during an attempted vaginal delivery.
A Case of Mistaken Identity: Can a Fibroid Be Mistaken For a Hernia?
A 47-year-old woman complained of pain and pressure on the left side of her pelvic region. She did not seem to have any other symptoms and doctors initially thought it was an inguinal hernia. Surprisingly an MRI revealed a mass of soft tissue measuring 19 X 6 x 2.5cm which was surgically removed and examined.
The histopathological examination of the mass revealed it was not a hernia but a round ligament fibroid. The round ligament is a rope-like structure that starts at the top of the uterus and extends along the lateral sidewall to provide support for the uterus. Occasionally, fibroids can involve the round ligament and in this case, a fibroid was mistaken for a hernia.
Can Fibroids and Hernias Combine?
In very rare cases doctors have discovered fibroids incarcerated within a hernia meaning the hernia had the fibroid trapped inside of it. There was a case of a 66-year-old woman who had a mass near her belly button for about 6 months. She had never had abdominal surgery nor was she showing any symptoms of intestinal blockage (vomiting or nausea or distended abdomen).
A physical exam found a mass the size of a goose egg that was firm but movable, and not tender to the touch contained in an umbilical lesion with no inflammation present. Surgical removal found it was a pedunculated uterine fibroid that was inside of a hernia.
Historically incarceration of uterine fibroids in umbilical hernias has manifested only in pregnant women. Despite the enlargement of the uterus up to the umbilicus (belly button), which can be seen with fibroids, there is usually not enough abdominal pressure to cause a hernia.
However, in the third trimester of pregnancy, these things can occur. In the case of the 66-year-old woman, the six-pound fibroid had caused her uterus to expand enough to cause a herniation through her aged abdominal wall and the natural “weakness” present at the umbilicus.
Diagnosing Hernias in Women
A doctor from Johns Hopkins University reported that women are often harder to diagnose, and are often misdiagnosed because the pain they experience from a hernia is mistaken for another condition. Endometriosis, ovarian cysts, uterine fibroids, and adhesions from prior surgeries can create similar pain and symptoms as a hernia in a woman. An MRI can reveal fibroids and hernias in great detail and is often the best way to evaluate the female pelvis.
Hernia Symptoms in Women
In women, hernias do not usually present themselves as the ones experienced by men. Hernias in women are more often located deeper in the body so they are less visible, may not create an obvious protrusion, or be seen from the outside.
Hernia symptoms in women can include:
- Deep achy pelvic pain;
- Sudden but acute stabbing pains;
- Burning feeling;
- A bulge at the hernia site (most often noticeable in umbilical hernia);
- Pain and discomfort increase with activity.
Other women’s health issues present with some of these same symptoms so diagnosing a hernia in a woman is often tricky and are often misdiagnosed as endometriosis, cysts, or fibroids.
When a Hernia Becomes an Emergency
The most significant type of hernias are caused by a portion of the intestinal tract protruding through a weak spot in the abdominal muscle wall. In rare cases, a piece of the intestine can become pinched or twisted and can cut off the blood supply or pathway needed to keep the bowels from becoming obstructed. This is called a strangulated hernia and can cause severe pain, nausea, or vomiting and is a medical emergency that requires immediate attention.
How Can I Lower My Risk of Getting a Hernia?
To minimize the risk of hernias, it is important to know what is causing or further aggravating your hernia(s). Maintaining a healthy lifestyle with a diet high in natural grains and leafy vegetables and fruits will help keep your bowels healthy and avoid chronic constipation. Hernias often form or get bigger from excessive straining which can happen from constipation, weightlifting out of your class, or attempting to lift objects that are too heavy for you.
Studies have also linked obesity to the occurrence of hernias so as stated previously a healthy lifestyle is key. For those who have had abdominal surgery or are diagnosed with uterine fibroids, aside from eating healthy and maintaining a healthy weight, you may have to undergo some type of procedure or surgery to address the root cause of the hernia.
Treatment of Hernias
Surgery is currently the only option to repair hernias. The type of surgery would depend on the severity of the hernia and its location. Surgeons will most often opt for the least invasive method possible to correct the defect and restore function to the affected muscle area. Surgeons often use a mesh-type substance to repair and reinforce the gaps to prevent reoccurrence.
Treatment for Hernias Caused by Fibroids
Hernias that develop due to fibroid pressure can reoccur if the root cause is not corrected. Future hernias can be best prevented by eliminating the fibroids. Depending on the severity of the fibroids, there are surgical and non-surgical procedures to get rid of myomas. Hysterectomy (the entire uterus is removed) and myomectomy (fibroids are cut out individually) are both surgical options that can bring with them long recovery times and hospital stays among other complications.
Uterine fibroid embolization is a non-surgical procedure that targets all fibroids, does not require a hospital stay, and preserves the uterus. The recovery time is normally only 5-7 days and almost every woman with symptomatic fibroids is a candidate. Once the fibroids are treated successfully, hernias that are caused by fibroids can be, too.
How Do I Learn More About Uterine Fibroid Embolization?
If you are experiencing symptoms of uterine fibroids and are seeking relief, please contact the Atlanta Fibroid Center® for a consultation. We would love to speak with you about how UFE can help you be free of fibroids and their symptoms. Dr. John Lipman and Dr. Ermentrout, experienced Interventional Radiologists and UFE experts, have over 25 years of experience in treating fibroids. With over 10,000 UFE procedures to their credit, our doctors are ready to help you leave behind those painful fibroid symptoms.