FAMILY MEDICINE® COLUMN

By John C. Wolf, D.O.Associate Professor of Family Medicine Ohio University College of Osteopathic Medicine

READER'S "STOMACH" PAIN MAY BE HERNIA, SURGERY MAY BE THE CURE

Question: For the last five months I've been having a muscle cramp type of pain in the lower right side of my stomach when I cough or sneeze hard. When it started, it occurred once or twice a month and lasted for a few seconds. Lately it has been happening at least once every day, and the pain lasts longer -- about 20 seconds or so. I haven't found anything that stops the pain. I just wait it out. What could be causing this?

Answer: Pain is a signal that something is wrong. Unfortunately, it usually only indicates the body region that is in trouble rather than telling us the reason for the pain. Trying to accurately make a diagnosis about the cause of your pain without being able to examine you and to ask additional questions provides a significant challenge to my diagnostic skills. That said, the top choice on my list of educated guesses is that you have a small hernia, because the symptoms of that disorder fit the description of your pain quite well.

Hernia is accurately defined in my American Heritage Dictionary as follows: "The protrusion of an organ or other bodily structure through the wall that normally contains it; a rupture." Though there are many types of hernias, the one occurring in the area around the groin, or inguinal region in doctor lingo, is the most common. This is often referred to as an inguinal hernia. In this disorder the muscle fibers that make up the abdominal wall tear in two or separate. This makes a weakness in the abdominal wall much as a broken cord or belt in a tire weakens it. Bending over, straining to lift an object, having a bowel movement or coughing increases the pressure inside the abdomen. This increased pressure causes the weakened area to bulge -- just as the tire bulges at the area of broken cord. The bulge stretches the injured muscles and may even enlarge the tear. Obviously, this stretching and tearing is uncomfortable. I think this is what has been causing your daily pain.

Hernias stem from an inherited weakness in the basic muscle structure, what we doctors call a congenital defect, or because of injury to the muscles. Twenty-five percent of men will ultimately develop one, as will 2 percent of women.

Hernias never get better on their own. They may remain as an occasional nuisance, become a persistent problem, or on rare occasions develop into a surgical emergency. The proper treatment depends upon the degree of problem the hernia is causing. It may be sufficient to just understand the disorder and continue watching hernias that are only occasionally a problem or ones that are very large but painless. Ones that cause frequent discomfort, like yours, should be surgically repaired -- the sooner the better. Fortunately, surgical repair gives lasting relief from the symptoms.

About 700,000 people have hernia surgery every year. There are several different surgical techniques used depending upon the particular type of hernia and the skill and experience of the surgeon. None seem to have a decided advantage in terms of long-term success rates, all of which are very high.

I'd suggest that you see your doctor soon to determine if your symptoms are due to an inguinal hernia or to another condition. If you do have a hernia, your surgeon can talk with you about the potential benefits as well as the risks of having hernia surgery.

"Family Medicine" is a weekly column.

To submit questions, write to John C. Wolf, D.O., at Post Office Box 110, Athens, Ohio 45701.

Past columns are available online at http://www.FamilyMedicineNews.org.