Can a hernia cause pain?

Can Hernias Cause Pain?

Yes, hernias can definitely cause pain, which is one of their most common symptoms across various hernia types, including incisional, inguinal, parastomal, and diaphragmatic hernias. 1, 2

Types of Hernia Pain

Incisional Hernias

• Incisional hernias can cause pain and discomfort to patients 1
• May lead to serious clinical sequelae including bowel obstruction, incarceration, and strangulation requiring reoperation
• Pain severity can range from mild to severe depending on the size and location

Parastomal Hernias

• Can cause significant pain, especially when incarcerated 1
• Small, reducible parastomal hernias can be managed with a hernia belt
• Elective repair is generally reserved for patients with significant pain or recurrent bowel obstruction

Diaphragmatic Hernias

• Present with nonspecific respiratory and gastrointestinal symptoms, including pain 1
• Left-sided diaphragmatic hernias commonly present with gastrointestinal symptoms including intestinal obstruction
• Undetected diaphragmatic hernias may cause strangulation of the bowel and subsequent perforation, causing severe peritonitis

Inguinal and Ventral Hernias

• Research shows 75% of patients with inguinal or ventral hernias report pain on the Brief Pain Inventory (BPI) 2
• Ventral hernia patients experience more pain (p=0.037) and greater interference with mood, sleep, relationships, and enjoyment of life compared to inguinal hernia patients 2
• Pain is the most common symptom associated with hernias 3

Pain Characteristics and Mechanisms

Pain Patterns

• Acute onset, persistent crampy/colicky abdominal pain, mostly in the epigastrium is common with internal hernias after laparoscopic Roux-en-Y gastric bypass 1
• Pain may be constant or intermittent depending on whether the hernia is reducible or incarcerated
• Diaphragmatic hernias can cause referred pain to different areas of the chest and abdomen 1

Warning Signs of Serious Complications

• Tachycardia ≥ 110 beats per minute, fever ≥ 38°C, hypotension, respiratory distress with tachypnea and hypoxia are alarming clinical signs in patients with acute abdominal pain and previous bariatric surgery 1
• The triad of persistent epigastric pain, pregnancy, and history of laparoscopic Roux-en-Y gastric bypass should raise suspicion for internal hernia 1
• Any clinical signs of intestinal bleeding such as hematemesis, melena, and hematochezia after bariatric surgery are predictors of intra-abdominal complications 1

Impact on Quality of Life

• Hernia-related pain significantly impacts quality of life, affecting daily activities and social relationships 4
• Chronic pain is a common long-term outcome after ventral hernia repair 4
• The Brief Pain Inventory (BPI) is an effective way to assess pain and its impact on physical activity and quality of life in patients with hernias 2

Diagnostic Considerations

• When a patient presents with pain possibly related to a hernia, imaging studies are often necessary
• Ultrasonography is helpful when a recurrent hernia, surgical complication after repair, or other cause of groin pain is suspected 3
• MRI has higher sensitivity and specificity than ultrasonography for diagnosing occult hernias 3
• Double-contrast upper GI series (barium esophagram) is the most effective diagnostic test for hiatal hernia 5

Treatment Implications

• Watchful waiting is reasonable for men with asymptomatic or minimally symptomatic inguinal hernias but not recommended for symptomatic hernias 3
• Surgical intervention is often necessary for painful hernias, with laparoscopic repair associated with less pain and faster recovery than open repair 3
• For hiatal hernias, initial management should focus on lifestyle modifications and PPI therapy, with surgery reserved for refractory cases 5

Special Considerations

• Pain after hernia repair is also common, affecting recovery and requiring appropriate management
• Surgical site pain can persist and become chronic in some patients
• Proper patient education about expected pain levels and management options is essential for improving outcomes

In summary, pain is a significant and common symptom of various types of hernias that can substantially impact quality of life and may indicate serious complications requiring urgent medical attention.