In layman’s term, Hernia is a defect or weakness in the abdominal wall, through which the intra-abdominal organs push through and protrude outside. The meaning of the word ‘Hernia’ is ‘something coming through’.
When we speak about the abdominal wall, they are a sheet of strong muscles and tendons that run down from the ribs to the upper leg or groin area. One of the functions of the abdominal wall is to hold the organs inside, mainly the intestines. Now, if a form of weakness occurs in this abdominal wall, then it may rupture and the organs will start pushing out. This generally appears as a bulge in the abdominal wall and is what we call a hernia.
Acc. to a 2006 report by the Faculty of Medicine, University of British Columbia Department of Surgery (https://bit.ly/3kThuvM), Inguinal hernia repair began with the Greeks and Egyptians who used tightly fitting bandages and trusses. The first surgeries employed by the Greeks involved incision of the scrotum and dissection of the hernial sac. Galen developed the concept of hernia formation by “rupture” in the 2nd century. Sushruta, known as the ‘Father of Surgery’ in Ayurveda, wrote the extensive text Sushruta Samhita in the 2nd century BC and discussed many surgical interventions including hernia.
Most of the hernias occur in the abdominal or the groin area. These are therefore named in different ways or in simple terms there are different types of hernias. Acc. to a report by Council For Medical Schemes (CMS) (https://bit.ly/3kZHRjF):
US researchers Dr. David B. Earle & Dr. Jennifer McLellan, in a 2013 study in the journal Surgical Clinics of North America (https://bit.ly/2EM00lN), suggested that Umbilical hernias, or “ruptures” as they were referred to in the past, were described in some of the earliest surgical literature, dating as far back as 1500BC. Umbilical hernias are quite common in infancy, and represent the only time hernias can be cured without an operation; most defects are small and more than 80% will close spontaneously by the age of 5. Because of this, umbilical hernia repair is generally recommended only if the defect persists past the age of 5, or before the age of 5 if the defect is larger than 1 to 2cm.
Acc. to a 2014 study in the Journal of International Medical Science Academy, by an Indian research team, led by Dr. S. Singh, Consultant Surgeon, Department of Surgery and Anaesthesiology, GMSH, Sector-16, Chandigarh, Punjab (https://bit.ly/3kYGr93); Inguinal hernia most probably has been a disease ever since mankind existed. It occurs in different kinds of animals, particularly primates; even prehistoric human beings were affected by the disease. The surgical history of inguinal hernias dates back to ancient Egypt. Accounting for 75% of all abdominal wall hernias, and with a lifetime risk of 27% in men and 3% in women, inguinal hernia repair is one of the most commonly performed surgeries in the world.
There would be a range of symptoms from the hernia. The protruding lump can be painless or it can be extremely painful with swelling. You will have severe pain while doing certain movements like bending over, lifting heavy objects, coughing or sneezing, etc. There are other symptoms like nausea and vomiting, pain in passing stool and constipation, etc.
Acc. to the report by CMS (https://bit.ly/3kZHRjF), these symptoms may indicate that either the blood supply to a section of an organ or tissue trapped in the hernia has become cut off (strangulation), or a piece of bowel has entered the hernia and blocked the blood flow (obstruction). Strangulated hernia and obstructed bowel are medical emergencies and need to be treated as soon as possible.
Acc. to a US research team, led by Dr. Kim Edward LeBlanc, from the Louisiana State University School of Medicine, in a 2013 study in the journal American Family Physician (https://bit.ly/2GfglzX), Inguinal hernias may be asymptomatic and found incidentally on routine physical examination. Symptomatic patients often present with groin pain, which can be severe. Stretching or tearing of the tissue at and around the hernia defect can lead to a burning, gurgling, or aching sensation in the groin. This usually causes localized pain directly at the site of the hernia. Pain may worsen with Valsalva manoeuvres. Patients may experience a heavy or dragging sensation in the groin, especially toward the end of the day and after prolonged activity.
Activities that increase intra-abdominal pressure, such as coughing, lifting, or straining, cause more abdominal contents to be pushed through the hernia defect. As this occurs, the bulge of the hernia gradually increases in size. If the patient indicates that this bulge disappears while he or she is in the supine position, clinical suspicion of a hernia should be increased.
Just like other aspects of Hernia, there is a lot of confusion pertaining to the causes of hernia and many self-made theories are floating around. But certain hernias may not have an exact cause, some can be sudden or some can be gradual. Some of the common causes of hernia are:
The doctor will do a physical examination to diagnose the extent and type of hernia. Acc. to Dr. LeBlanc & team (https://bit.ly/2GfglzX), hernias may be easily diagnosed with an adequate physical examination. The physical examination should begin by carefully inspecting the femoral and inguinal areas for bulges while the patient is standing. Then, the patient should be asked to strain down (i.e., Valsalva manoeuvre) while the physician observes for bulges.
If no bulge is detected with a Valsalva manoeuvre, a hernia is unlikely. However, athletic pubalgia (sports hernia) may be considered in athletes with groin pain and no bulge. A sports hernia is not a true hernia, but rather a tearing of tissue fibres. This typically occurs in patients with a history of high-intensity athletic activity. Although these patients have typical hernia symptoms, there is no evidence on physical examination. Further follow-up and re-examination are needed to diagnose a sports hernia.
In some cases, the physical examination may be difficult as the person may be obese or may have some form of scarring on the abdominal. In such cases, other forms of diagnosis methods are used like Ultrasound scan (USS) of the abdomen, Computed tomography (CT) scan of the abdomen, or X-ray of the abdomen. The doctor may also recommend some other tests to assess the functions of other organs like the kidney and liver, and other blood parameters.
When it comes to the treatment, it will depend on the size and symptoms of a hernia. In cases, where the symptoms are extreme pain and growth in the protrusion, the doctor may immediately suggest surgery.
Once you detect hernia, you cannot push back the protrusion, the very first thing you do is go to your doctor. Yes, there are no stupid home remedies and treatments for this issue. Your YouTuber or social media experts can’t do anything to hernia. It requires 100% medical intervention. And in most cases there are only two options:
The types of surgeries recommended are:
Acc. to a 2012 meta-analysis report by Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services (https://bit.ly/2Go4FuE), a common question in terms of hernia surgery is whether to repair a pain-free hernia or “wait and see,” and whether to repair a painful hernia using an open or laparoscopic approach. Researchers found that, for painless hernia, evidence was mostly insufficient to permit conclusions, but the quality of life at 1 year was better after surgery than watchful waiting. It was seen that Laparoscopic surgery for hernia is associated with longer operation times but less severe post-operative pain, fewer complications, and a more rapid return to normal activities.
You may go home within 24 hours for small hernia procedures but may need to stay in the hospital longer for more complex repairs. The average length of stay for patients with complex repair is 1-2 days.
Complications post hernia surgery can be a reoccurrence of the hernia, infection, injury to the bladder, blood vessels, or intestines; and continued pain at the hernia site.
Acc. to a report by the American College of Surgeons (https://bit.ly/2SaqujQ), following are the steps to be taken care of post a hernia repair surgery:
RETURN TO WORK
Contact your surgeon if you have:
One of the most common myths about hernia in sports is that lifting heavy weights causes hernia. Lifting heavy can definitely lead to a hernia, but the heavy lifting is not a cause of it, as we saw that hernia can even be caused by coughing and sneezing.
Heavy lifting and strenuous activities may aggravate a hernia that is already there, i.e. if there is a pre-existing weakness in the abdominal muscles. In fact, regular exercise, and progressive resistance training is a great way to strengthen the abdominal muscles and prevent hernia, unless the person has genetically weak abdominal muscles, or there is a birth defect in the abdominal wall.
Another myth, which I have already cleared in my earlier video and ebook, is that wearing an exercise supporter during weight training will prevent hernia.
(source for reference: https://youtu.be/nEr4e08wZYA
A supporter does nothing in sports and is absolutely useless for preventing hernia or any medical condition. The only place a supporter is needed is either contact support, where it holds the testes and penis firm, and prevents injury to these areas, due to aggressive violent movements in sports; or in a sport like cricket, hockey, ice hockey, etc. where you need a supporter with a hard cup in the front to prevent any direct shot of the ball on the testes or penis.
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