A hernia occurs when an internal organ or tissue pushes through a weak spot in the surrounding muscle wall. While typically causing a visible bulge and localized discomfort, this protrusion can sometimes interfere with structures in the lower abdomen, including the urinary system. When a hernia forms, the resulting displacement or pressure can affect the function of the bladder and the flow of urine. Understanding this connection is important for anyone experiencing both a hernia and changes in their urinary patterns.
How Hernias Cause Urinary Changes
Hernias influence the urinary system primarily through mechanical interference. The physical mass of the herniated tissue presses against the adjacent bladder or the urethra, the tube that carries urine out of the body. This external compression can distort the shape of the bladder or narrow the urethra’s passageway, creating an obstruction that hinders normal urine flow.
Displacement of the bladder, especially in larger hernias, also contributes to functional changes. When the bladder is pulled or pushed out of its normal anatomical position, its ability to contract efficiently and empty fully is compromised.
Beyond physical blockage, a hernia can cause reflexive irritation of the urinary tract nerves. This irritation creates a false signal of bladder fullness, leading to symptoms like increased frequency or an urgent need to urinate, even when the bladder is not full. These combined mechanical and neurological effects disrupt the coordinated process of storing and releasing urine.
Anatomical Relationship: Which Hernias Affect the Bladder
Hernias located in the groin area are most likely to cause urinary symptoms due to their proximity to the bladder and its outflow tract. Inguinal hernias are the most common type to interact with the urinary system, especially large ones that develop over time.
In some cases, the bladder wall itself can become part of the herniated tissue, a condition sometimes called a bladder hernia or cystocele. When bladder tissue is directly involved, it is highly likely to cause noticeable urinary symptoms. Femoral hernias, which occur slightly lower in the groin and are more common in women, can also impinge upon the bladder.
The risk of urinary symptoms increases with the size and duration of the hernia, as a larger protrusion creates more extensive pressure or displacement on nearby structures.
Identifying Signs of Urinary Obstruction
Symptoms of a hernia affecting urine flow often manifest as lower urinary tract symptoms (LUTS) resulting from a partial obstruction. These signs include:
- Difficulty initiating the flow of urine (hesitancy).
- A weakened or intermittent urine stream.
- A feeling that the bladder has not completely emptied after urination.
- Increased urinary frequency during the day.
- Nocturia, or the need to wake up at night to urinate.
A specific sign suggesting bladder involvement is a two-phase voiding pattern. This occurs when a person voids urine, and then a second voiding happens spontaneously or after manual compression of the hernia sac, allowing the herniated portion of the bladder to empty.
Acute urinary retention is a medical emergency requiring immediate attention. This condition involves the sudden, complete inability to urinate despite a strong urge and a full bladder. Acute retention is often accompanied by severe pain and discomfort in the lower abdomen. Any sudden inability to pass urine, or the onset of worsening symptoms like fever, warrants an urgent visit to a healthcare provider.
Treating Hernia-Related Urinary Issues
Diagnosis of a hernia-related urinary issue begins with a physical examination and a review of symptoms. Imaging studies, such as a computed tomography (CT) scan or a cystography, are used to confirm the diagnosis. These techniques show if a portion of the bladder has herniated or if the bladder is under external pressure.
The definitive treatment for urinary issues caused by a hernia is surgical repair. Repairing the weakness in the abdominal wall and returning the displaced tissue to its proper position immediately relieves pressure on the bladder and urethra. The goal is to eliminate the anatomical cause of the obstruction, resulting in the resolution or improvement of urinary symptoms.
If a patient experiences acute urinary retention, temporary measures are necessary before definitive repair. This involves catheterization, where a tube is inserted to drain urine from the bladder, relieving immediate pressure and pain. Once acute retention is managed, the patient proceeds with surgical repair to address the underlying hernia and prevent recurrence.