A hernia is a condition where an internal organ or tissue pushes through a weakness in the surrounding muscle or tissue wall, most often occurring in the abdomen. This protrusion creates a noticeable bulge. Incontinence is the involuntary loss of bladder or bowel control. While hernias are common, the direct link between a hernia and incontinence depends entirely on the location and size of the protrusion, requiring an examination of how the hernia physically interferes with the body’s continence system.
The Direct Relationship Between Hernias and Incontinence
A hernia can directly cause or intensify incontinence symptoms, but this is specific to hernias near the pelvic floor organs. When the hernia sac contains part of the bladder or bowel, it creates a mechanical problem that disrupts normal function. Urinary incontinence is far more likely because the bladder is located in the lower abdomen and pelvis, in close proximity to common hernia sites.
Fecal incontinence is less common, typically associated with hernias involving the rectum or large bowel. For most hernias (e.g., simple umbilical or small inguinal hernias), incontinence is not a symptom. Symptoms arise when the protruding tissue places sustained pressure on or physically distorts the organs of elimination. Urinary symptoms often manifest as frequency, urgency, or difficulty emptying the bladder completely. If the hernia sac contains a portion of the bladder wall, this can cause chronic irritation or obstruction, leading to leakage or retention.
Anatomical Pressure and Functional Interference
The physiological mechanism linking a hernia to incontinence involves external pressure and anatomical distortion. The hernia sac, containing fat, bowel, or a portion of the bladder, protrudes into a confined space, pressing on adjacent structures. This external pressure can directly compress the bladder, leading to a sensation of fullness and urinary urgency.
A large hernia can mechanically obstruct the bladder neck or the urethra, the tube through which urine exits the body. This obstruction prevents the bladder from fully emptying, causing urinary retention. Retention can paradoxically lead to overflow incontinence, where the bladder leaks due to chronic overfilling.
The hernia can also indirectly affect continence by altering intra-abdominal pressure (IAP). A hernia represents a weakness in the abdominal wall, and the protruding sac may divert internal pressure away from the pelvic floor. While increased IAP from coughing or straining can cause stress incontinence if the pelvic floor is weak, the hernia may sometimes mask existing stress incontinence by absorbing some pressure.
Specific Hernia Locations That Affect Continence
The location of the hernia determines the likelihood of continence issues due to the proximity of the bladder and rectum. Large inguinal hernias, particularly in men, can descend into the groin or scrotum and sometimes contain a portion of the bladder. The presence of the bladder wall within the hernia sac, known as a sliding hernia, causes direct mechanical distortion and irritation, often leading to frequency and urgency.
Femoral hernias, which occur lower in the groin and are more common in women, can similarly involve the bladder and cause urinary symptoms. Pelvic hernias are more accurately described as pelvic organ prolapse and are highly relevant to continence. These include a cystocele, where the bladder wall prolapses into the vagina, and a rectocele, where the rectum bulges into the vagina.
A cystocele is strongly associated with stress urinary incontinence because the displacement of the bladder and urethra compromises the support needed for the sphincter mechanism to close during physical exertion. A rectocele is primarily linked to symptoms of incomplete bowel evacuation, but its presence can also correlate with urge incontinence. These pelvic floor issues occur in the immediate vicinity of the urinary and bowel outlets, making them the most common structural causes of hernia-related incontinence.
Addressing the Cause: Treatment and Resolution
When incontinence results from a hernia, the underlying cause is structural, and the definitive treatment is typically surgical repair. The goal is to return the protruding tissue or organ to its proper anatomical position and repair the weakness in the tissue wall. For hernias involving the bladder, such as an inguinoscrotal hernia, the surgeon reduces the bladder back into the abdomen before repairing the defect.
Diagnostic steps, including imaging studies like CT scans and a physical examination, are performed first to confirm the exact contents and size of the hernia sac. Once structural pressure is removed through successful hernia repair, patients often experience improvement or complete resolution of their continence symptoms. For pelvic organ prolapse like a cystocele, surgical repair aims to restore the supportive anatomy of the pelvic floor, resolving the mechanical issue causing leakage.
While repair often resolves the issue, some patients with pre-existing, masked incontinence may experience new or intensified symptoms immediately following abdominal wall stabilization. In these instances, the surgical correction has simply exposed an underlying weakness in the pelvic floor. Consulting a physician is necessary to receive an accurate diagnosis and develop a treatment plan, which may include physical therapy or further procedures if symptoms do not resolve.