A. What is a hernia?
An inguinal (in the groin) hernia is a painful groin bulge. The lifetime risk of this condition is twenty-seven percent in men and three percent in women. It is one of the most common surgical procedures in the U.S.
It occurs when tissue, such as a portion of the intestine, protrudes through a weak spot in the lower abdominal muscles, causing a bulge, “hernia sac.” Symptoms include pain and bulging on the right or left groin at the pubic bone. Coughing, standing, and passing a bowel movement are painful.
Bulging is more prominent at the pubic bone. Symptoms are more prevalent with standing, coughing, passing a bowel movement and straining. Pain may radiate to the scrotum. A burning or aching sensation occurs at the bulge. Application of an ice pack could ease pain and swelling. This reduces swelling enough so that the hernia slides inward with direct pressure. Watchful waiting is reasonable if symptoms don’t progress.
B. Cause
Hernias can be the result of a pre-existing weak spot in the groin, known as the “superficial inguinal ring.” Low abdominal wall weakness at the inguinal canal can be present at early childhood. Hernias can develop as the result of straining during bowel movements, strenuous physical activity, chronic coughing, or sneezing. In men, the weak spot is the inguinal (groin) canal, where the spermatic cord enters the scrotum. In women, the canal carries a ligament that helps hold the uterus in place. Hernias may be inheritable. Some hernias have no apparent cause.
C. Surgery is recommended to repair the hernia if is painful or enlarging. Incarcerated hernia is when the patient can’t nudge the hernia bulge back in place. This would suggest a “strangulated hernia.” A strangulated hernia cuts off the blood flow to tissue that is trapped. It could progress to bowel obstruction, which is life-threatening and surgery is necessary.
There are two types of hernia surgery; open and laparoscopic repair. Open repair is done under local anesthesia and sedation. The incision is closed with stitches, staples or surgical glue.
Laparoscopy this minimally invasive procedure, which requires general anesthesia, the surgeon operates through several small incisions in the abdomen. Gas is used to inflate the abdomen to make the internal organs more visible. A small tube equipped with a tiny camera (laparoscope) is inserted into one incision. Guided by the camera, the surgeon inserts tiny instruments through other incisions to repair the hernia using synthetic mesh.
People who have laparoscopic repair might have less discomfort and scarring after surgery and a quicker return to normal activities. Laparoscopy allows the surgeon to avoid scar tissue from an earlier hernia repair, so it might be a good choice for people whose hernias recur after traditional hernia surgery. It also might be a good choice for people with hernias on both sides of the body (bilateral).
D. Prevention
· Maintain a healthy weight. Talk to your doctor about the best exercise and diet plan for you.
· Emphasize high-fiber foods. Fruits, vegetables and whole grains contain fiber that can help prevent constipation and straining.
· Lift heavy objects carefully or avoid heavy lifting. If you must lift something heavy, always bend from your knees — not your waist.
· Stop smoking. Besides its role in many serious diseases, smoking often causes a chronic cough that can lead to or aggravate an inguinal hernia.
· Don't rely on a truss. Wearing a supportive garment designed to keep hernias in place (hernia truss) doesn't correct the problem or help prevent complications. Your doctor might recommend a hernia truss for a short time before surgery to help you feel more comfortable, but the truss isn't a replacement for surgery.
