It is possible to have multiple hernias at the same time. The number of hernias a person can have depends on various factors like age, genetics, lifestyle, occupation etc. While some people may have just one hernia, others may end up with several over time.
What is a hernia?
A hernia occurs when an organ or fatty tissue squeezes through a weak spot in a surrounding muscle or connective tissue called fascia. The most common types of hernias are:
- Inguinal hernia – occurs in the inner groin
- Femoral hernia – occurs in the upper thigh/groin
- Incisional hernia – occurs through an incision or scar in the abdomen
- Umbilical hernia – occurs around the belly button
- Hiatal hernia – occurs inside the abdomen, along the upper stomach
Hernias often occur at natural weak spots in the abdominal wall or groin area. Factors like heavy lifting, coughing, straining, pregnancy, obesity, aging etc. can further weaken the abdominal muscles and cause part of an organ or tissue to push through.
What causes multiple hernias?
There are several reasons why a person may develop multiple hernias at the same time:
- Genetics – Some people are just born with weaker abdominal muscles or connective tissue that makes them prone to developing hernias.
- Chronic coughing – Long-term coughing due to smoking, asthma, bronchitis etc. can increase pressure on the abdomen and cause multiple hernias.
- Obesity – Being overweight or obese puts a lot of pressure on the abdominal muscles, often leading to hernias.
- Pregnancy – The baby bump strains the abdomen and increases risk of hernias like umbilical and inguinal.
- Fluid buildup in abdomen – Accumulation of fluid in the abdominal cavity, known as ascites, can cause increased pressure leading to multiple hernias.
- Heavy lifting or strenuous activity – Lifting heavy objects, strenuous exercise and occupational hazards like heavy physical labor can contribute to hernias.
- Prior surgery – Incisional hernias can occur through the scar tissue of a prior surgery.
- Aging – Abdominal muscles weaken over time, making seniors more susceptible to developing multiple hernias.
So in people who have one or more risk factors like obesity, chronic cough, genetics, multiple pregnancies etc., their abdominal wall becomes weakened over time and they may end up with more than one hernia simultaneously.
Common locations for multiple hernias
Some of the most common places where people tend to develop multiple hernias include:
- Groin – The inguinal region is a common site for multiple hernias, often bilateral hernias on both sides of the groin.
- Umbilicus – Repeated pregnancies can lead to multiple umbilical hernias around the belly button.
- Abdominal scars – People with multiple prior abdominal surgeries may get incisional hernias through several scar sites.
- Hiatal – It is possible to have two or more hiatal hernias along the esophageal openings in the diaphragm.
Less commonly, femoral and epigastric hernias may also occur bilaterally or at multiple sites in some individuals.
Symptoms and complications
The symptoms of having multiple hernias can include:
- Noticeable bulge(s) under the skin at the hernia sites
- A heavy or dragging sensation in the abdomen
- Pain or discomfort, especially when bending over, coughing or lifting objects
- Weakness, pressure or a feeling of heaviness in the abdomen
- Reducible hernia – disappears when pushed back in
- Irreducible hernia – cannot be pushed back into place and remains visible
Complications may arise if the hernias become irreducible or strangulated, cutting off blood supply. This can cause:
- Increased pain
- Nausea, vomiting
- Fever
- Rapid heart rate
- Inflammation
- Tissue death
Prompt medical care is necessary if the hernias become stuck in place or twisted to avoid potentially serious complications.
Diagnosis
To diagnose multiple hernias, the doctor will begin with a physical exam, inspecting the abdomen, groin and other common hernia sites. They may ask you to stand up or cough in order to see and feel a hernia protrusion.
Other diagnostic tests may include:
- Abdominal CT scan
- Abdominal MRI
- Abdominal ultrasound
- Herniography – imaging with radiopaque dye
This helps confirm the location, size and type of each hernia present. Let your doctor know if you have a prior hernia repair, as recurrent hernias are possible at the same site.
Treatment options
Treatment options for multiple hernias may include:
- Watchful waiting – For minimally symptomatic hernias, your doctor may just monitor them closely at first.
- Lifestyle changes – Losing weight, quitting smoking, preventing constipation etc. may help relieve symptoms.
- Trusses – Wearing an external hernia truss provides compression and support.
- Medication – Constipation medications can reduce abdominal straining.
- Surgery – Hernia repair surgery is required in moderate to severe cases. This can be open surgery or laparoscopic depending on the case.
The surgical options include:
- Herniorrhaphy – Suturing together the edges of the abdominal wall defect.
- Hernioplasty – Reinforcing the abdominal wall with surgical mesh.
- Herniotomy – Removing the trapped hernia sac.
For people with multiple hernias, the surgeon may opt to repair the most symptomatic or highest risk hernia first. Laparoscopic repair allows the surgeon to view and operate on some hernias from inside the abdomen using small incisions.
Recovery and prevention
Recovering after hernia repair surgery may take 2-4 weeks for soreness and swelling to resolve. Your activity will be restricted during this time. Full recovery can take up to 8 weeks.
To help prevent further hernias, your doctor may advise you to:
- Lose weight if overweight
- Avoid heavy lifting or strenuous activity
- Use proper lifting techniques like bending knees when lifting
- Avoid straining during bowel movements
- Quit smoking
- Do Kegel exercises to strengthen abdominal muscles
- Wear a hernia belt or truss for added support
Eat a high fiber diet and stay hydrated to avoid constipation. Report any worsening symptoms, unusual pain or difficulties to your doctor promptly. Lifelong monitoring may be required as recurrence is possible even after surgical repair.
How many hernias can you have at one time?
There is no specific limit to the number of hernias a person can have simultaneously. Some contributing factors include:
- Age – Hernias tend to increase with age as muscles weaken.
- Genetics – Connective tissue disorders can predispose people to multiple hernias.
- Chronic illnesses – Diseases like COPD increase risk.
- Obesity – Higher BMI adds strain and intra-abdominal pressure.
- Occupational hazards – Jobs requiring heavy manual labor.
- Recurring causes – Ongoing heavy lifting, smoking, constipation etc.
- Prior hernia repairs – Scar tissue may lead to additional hernias.
- Number of pregnancies – Multiple pregnancies weaken the abdomen.
Some case reports have documented people with 5-10 hernias at one time, though this is relatively rare. More commonly, people have 2-3 concurrent hernias, for instance bilateral inguinal hernias.
The most hernias documented in one person is 37. This was a case report of a man in his 60s who had:
- Bilateral inguinal hernias – 2
- Umbilical hernia – 1
- Epigastric hernia – 1
- Incisional hernias – 33 along prior surgical scar sites
However, most people will only have 1-3 hernias at one time. Key factors are ongoing strain, multiple pregnancies, obesity, older age, strenuous labor, prior hernias, and genetic connective tissue disorders that predispose individuals to developing multiple abdominal wall hernias simultaneously.
Risk factors
Some of the key risk factors for developing multiple hernias include:
- Obesity – Excess weight puts pressure on the abdominal muscles.
- Prior hernia – Already weakened areas are prone to further herniation.
- Chronic cough – From smoking, COPD, asthma etc.
- Family history – Genetic factors that affect connective tissue.
- Male gender – Men have a much higher rate of inguinal hernias.
- Constipation/straining – Leads to high abdominal pressure.
- Age – Above 60 years old due to muscle weakness.
- Pregnancies – Associated with umbilical and other hernias.
- Heavy lifting – Weight training or physically strenuous jobs.
- Ascites – Fluid buildup in the abdomen.
- Collagen disorders – E.g. Marfan or Ehlers-Danlos syndromes.
- Smoking – Contributes to chronic cough and abdominal pressure.
The more risk factors present, the higher someone’s chance of developing multiple concurrent hernias. Genetic collagen disorders in particular make people prone to numerous hernias throughout their lifetime.
Hernia prevalence by age
Here is an overview of hernia prevalence across different age groups:
- Infants/children – Umbilical hernias most common, followed by inguinal hernias.
- 20-40 years – Inguinal hernias most common in men, incisional hernias in women.
- 41-60 years – Inguinal hernias still common, along with umbilical hernias.
- Over 60 years – All types become more prevalent, especially incisional and femoral.
Inguinal hernias have a peak prevalence in men between ages 40-59. After 60 years old, the percentage of people with multiple hernias at once increases noticeably.
Factors like obesity, pregnancy, prior hernias, collagen disorders and cumulative abdominal strain contribute to hernia development across a person’s lifespan. Weakened areas are prone to future herniation as well.
When to see a doctor
You should make an appointment with your doctor if you notice any signs or symptoms of a hernia, such as:
- A noticeable bulge under the skin, especially when standing
- Pain, pressure or discomfort at the bulge site
- A feeling of heaviness or dragging in the abdomen
- Difficulty with urination
- Fecal matter coming through a hernia in the groin
Prompt medical evaluation is key to prevent complications like strangulation, where the hernia becomes stuck in place. This can obstruct blood flow and damage the trapped tissue or organ segment.
Let your doctor know if you have a history of prior hernias, frequent heavy lifting, abdominal surgery, collagen disorders, chronic cough or other underlying medical conditions. A physical exam and imaging tests will help determine the presence, location and severity of any hernias present.
Prevention
While heredity plays a role in hernia development, some lifestyle measures may help prevent or minimize your risk:
- Maintain a healthy weight
- Strengthen abdominal muscles with regular exercise
- Practice proper lifting techniques – bend knees, avoid twisting, use legs to lift
- Avoid straining during bowel movements
- Treat coughs, constipation and urinary difficulties promptly
- Stop smoking
- Wear a supportive truss or brace
- Avoid heavy lifting and strenuous activity after a prior hernia
Making dietary changes like increasing fiber, staying hydrated, and avoiding foods that worsen constipation can help prevent abdominal straining. After a hernia repair surgery, strictly follow all postoperative care instructions provided by your surgeon.
Conclusion
The number of hernias a person can develop depends on individual risk factors. Someone with a genetic collagen disorder or ongoing heavy lifting may end up with more hernias over their lifetime compared to the average person. Concurrent hernias most often involve the groin, umbilicus and prior surgical scars. Seeking prompt treatment and making lifestyle changes can help manage symptoms and prevent complications arising from multiple hernias.