A pergunta “Doutor, será que isso é uma hérnia?” é uma das mais frequentes no consultório.
Muitas vezes, o problema começa de forma silenciosa, no entanto, saber identificar os sinais iniciais é fundamental para permitir um diagnóstico precoce e um tratamento planejado, evitando complicações e cirurgias de emergência.
Abaixo, consolidamos os principais sinais de alerta baseados nos protocolos do American College of Surgeons e das Sociedades Europeia e Americana de Hérnia.
Sinal clássico: o abaulamento que aparece e desaparece
O sintoma mais conhecido de uma hérnia é o surgimento de um abaulamento ou “caroço” na região do abdome ou da virilha. Uma característica típica é que essa protuberância costuma ser dinâmica, ou seja, muda conforme o esforço e a posição do corpo. Ele costuma:
- Aparecer ou aumentar quando o paciente tosse, levanta peso, faz força abdominal ou fica muito tempo em pé;
- Diminuir ou desaparecer quando se deita e a musculatura relaxa.
Quando o conteúdo da hérnia retorna para dentro do abdome nessas situações, chamamos essa condição de hérnia redutível.
Sinais mais sutis (quando não há volume visível)
Nem toda hérnia apresenta um volume visível logo no início. Em muitos casos os primeiros sinais são discretos. Entre os principais sintomas de uma hérnia, estão:
- Sensação de peso na virilha ou abdome: pode surgir um desconforto ou sensação de pressão constante, geralmente mais perceptível ao final do dia ou após esforço físico
- Dor em pontada ou sensação de “choque”: alguns pacientes descrevem dores rápidas e agudas que aparecem em momentos de esforço súbito, como espirrar, tossir ou levantar objetos pesados.
- Ardência e aumento da sensibilidade da pele: isso pode ocorrer devido a compressão de nervos da região inguinal pelo conteúdo da hérnia. A sensação de queimação pode irradiar da virilha para parte interna da coxa ou para o escroto, piorando com os esforços e melhorando com o repouso.
- Sensação de “rasgar” ou “puxar”: esta sensação ocorre porque a abertura (defeito) na fáscia (tecido que reveste o músculo) sofre microtraumas repetidos, à medida que o conteúdo abdominal tenta se projetar através da abertura.
Atenção aos “falsos positivos”
Duas condições nem sempre estão relacionadas com hérnias e necessitam de tratamento diferenciado, muitas vezes não cirúrgico.
Diástase dos músculos reto abdominais:
É um afastamento dos músculos centrais do abdome, comum após a gravidez ou ganho de peso. Um sinal típico é o surgimento de uma elevação longa e vertical no meio da barriga ao contrair o abdome (uma “lomba”), especialmente ao fazer um movimento semelhante a um abdominal. Apesar de causar alteração estética, não se trata de uma hérnia verdadeira, mas muitas vezes exige tratamento médico.
Pubalgia ou “hérnia do esporte”:
Muito comum em atletas, causa dor crônica na virilha, especialmente durante atividades físicas. Nessa condição, não existe um defeito real na musculatura abdominal, mas sim lesões nos tendões e estruturas musculares da região inguinal.
Quando a hérnia pode se tornar uma urgência?
Se você já percebeu um abaulamento, é importante ficar atento aos sinais de encarceramento e estrangulamento da hérnia. Procure atendimento médico imediato se:
- A “bolinha” ficou presa e não diminui ou retorna para dentro do abdome, mesmo quando você se deita;
- A dor se tornou intensa e constante;
- O abaulamento que antes era macio se tornou duro, doloroso ou com mudança de cor da pele no local;
- Surgir náuseas, vômitos ou dificuldade para eliminar gases e fezes.
O que fazer se tiver suspeita de hérnia?
O diagnóstico da maioria das hérnias abdominais e inguinais é clínico.
Isso significa que um cirurgião experiente e dedicado ao tratamento de hérnias consegue identificar o problema por meio da história clínica e do exame físico no consultório.
Quando existe dúvida diagnóstica ou quando a hérnia é muito pequena, exames de imagem podem ajudar na avaliação da parede abdominal, como:
- ultrassonografia
- tomografia computadorizada.
O próximo passo: quando procurar avaliação médica
Se você se identificou com algum desses sintomas, o passo mais importante é buscar avaliação com um cirurgião com foco no tratamento das hérnias.
Uma consulta permite determinar se:
- o quadro pode apenas ser acompanhado
- ou se a correção cirúrgica é a opção mais segura.
Identificar a hérnia precocemente permite planejar o tratamento de forma tranquila e segura, evitando complicações futuras.
Referências:
Este conteúdo foi desenvolvido com base em informações respaldadas por evidências científicas e em materiais educacionais revisados, assegurando precisão, confiabilidade e alinhamento com padrões clínicos atualizados.
Cleveland Clinic. Hernia Repair Surgery: Types & What to Expect.
American College of Surgeons (ACS). Adult Umbilical Hernia Patient Education.
Cleveland Clinic. Sports Hernia (Athletic Pubalgia). Disponível em: https://my.clevelandclinic.org/health/diseases/21873-sports-hernia
European Hernia Society guidelines on management of rectus diastasis. British Journal of Surgery (BJS), 108(10), 1189-1191.
American College of Surgeons. Adult Inguinal and Femoral Groin Hernia Repair.
Este texto tem finalidade educacional e não substitui a avaliação individualizada por um profissional de saúde.
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