WHAT IS HERNIA?

hernia

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.

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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.

 

TYPES OF 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):

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  • Ventral/Incisional hernia – This type of hernia may occur after abdominal surgery due to which the tissues remain weakened and the intestines push through the incision scar or the surroundings. A hernia forming after surgery through the site of an incision is known as an “incisional” hernia.
  • Umbilical hernias – The umbilical area (navel or belly button) is an area of natural weakness that is prone to hernia. Umbilical hernias occur when fatty tissue or a part of the bowel pokes through the abdomen near the belly button. This type of hernia can occur in babies if the opening in the abdomen, through which the umbilical cord passes, does not seal properly after birth. Adults can also be affected, possibly as a result of repeated strain on the abdomen.

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.

  • Groin hernias – these are divided into Inguinal and Femoral, both of which are often associated with ageing and repeated strain on the abdomen. They occur when fatty tissue or a part of the bowel pokes through into the groin at the top of the inner thigh. In terms of the likelihood of developing these hernias, an inguinal hernia is the most common type and affects mainly men. Femoral hernias are less common than inguinal hernias and tend to affect women more than men.

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.

  • Then there are other types of hernia, which are uncommon, like Epigastric hernia (fatty tissue protrudes through the abdominal area between the navel and lower part of the breastbone); Spigelian hernias (the intestines push through the abdomen at the side of the abdominal muscle, below the navel); Diaphragmatic hernias (organs in the abdomen move into the chest through an opening in the diaphragm) and Muscle hernias (part of a muscle pokes through the abdomen; they also occur in leg muscles as the result of a sports injury).

 

SIGNS & SYMPTOMS

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.

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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.

 

CAUSES

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:

  • Weakness in the abdominal muscles which can be due to age, injury or surgery, living a sedentary lifestyle due to which the muscles get atrophied and lack strength, during pregnancy, etc.
  • The sudden strain which can be due to hard sneezing, chronic coughing, any sudden heavy lifting be in exercise or lifting of any heavy object, constipation due to which the person strains hard while passing stool, etc.

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DETECTION & TREATMENT

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:

  • Non-Surgical Option – watchful waiting is an option for adults with hernias that are reducible and not uncomfortable. In such cases, a type of belt is advised to be wrapped around the abdominal area to support the wall. The key reasons to repair a hernia in an adult are that they do not heal or repair themselves, they tend to get larger with time, they often become painful or develop other problems. The most serious risk of non-surgical management is that intestine or other organs can become stuck in the hernia. Usually, the hernia contents can be pushed back into the abdomen (“reducing” the hernia). When this cannot be done, the hernia is called “incarcerated”. Incarceration can lead to obstruction or blockage of the intestine in the hernia. This can result in nausea, vomiting, and abdominal pain. Incarceration can also cut off the blood supply to the intestines; this is caused by “strangulation”. Strangulation can lead to the death of the affected section of the intestines and is a surgical emergency. If this is not treated quickly, it can lead to serious complications for the patient or death.
  • Surgical Option – ideally, surgery is the only way to repair a hernia. Post-surgery the complications are generally minimal and a person returns to his normal life without further complications.

The types of surgeries recommended are:

  • Open Hernia Surgery – The surgeon makes an incision near the hernia site. The bulging tissue is generally pushed back into the abdomen. Sutures, mesh or a tissue flap are generally used to close the muscle.
  • Open Mesh Repair – The hernia sac is removed. Mesh is placed over the hernia site. The mesh is attached using sutures sewn into the stronger tissue surrounding the hernia site. Mesh is often used for large hernia repairs and may reduce the risk that the hernia will come back. The site is closed using sutures, staples, or surgical glue.
  • Laparoscopic Hernia Repair – Acc. to Dr. Sarabjeet Singh & team (https://bit.ly/3kYGr93), hernias are typically repaired through a surgical procedure called herniorrhaphy, in which the surgeon repairs the hole in the abdominal wall by sewing surrounding muscle together or by placing a patch called “mesh” over the defect. Most surgeons make an incision at the site of the hernia in order to gain access to the defect, although some surgeons prefer to do these procedures laparoscopically. During a laparoscopic hernia repair, the surgeon makes very small incisions to pass through specialized instruments and an endoscope, a device that allows the surgeon to see the abdominal area without opening the patient up. Laparoscopic hernia repair generally results in less postoperative pain and recovery time than open surgery.

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.

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POST-SURGERY RECOVERY RECOMMENDATIONS

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:

WOUND CARE

  • Do not soak in a bathtub until your stitches, staples are removed. You may take a shower after the second postoperative day unless you are told not to.
  • Follow your surgeon’s instructions on when to change your bandages.
  • A small amount of drainage from the incision is normal. If the dressing is soaked with blood, call your surgeon.
  • If you have a glue-like covering over the incision, let the glue to flake off on its own.
  • Avoid wearing tight or rough clothing. It may rub your incisions and make
    it harder for them to heal.
  • Protect the new skin, especially from the sun. The sun can burn and cause darker scarring.
  • Your scar will heal in about 4 to 6 weeks and will become softer and continue to fade over the next year.

ACTIVITY

  • Slowly increase your activity. Be sure to get up and walk every hour or so to prevent blood clot formation.
  • You may go home the same day for a simple repair. If you have other health conditions or complications such as nausea, vomiting, bleeding, or infection after surgery, you may stay longer.
  • Do not lift items heavier than 10 pounds or participate in strenuous activity for at least 6 weeks.

RETURN TO WORK

  • After recovery, you can usually return to work or school within 2 to 3 days.
  • You will not be able to lift anything over 10 pounds, climb, or do strenuous activity for 4 to 6 weeks following surgical repair of a ventral hernia.
  • Lifting limitation may last for 6 months for complex or recurrent repairs

BOWEL MOVEMENTS

  • Avoid straining with bowel movements by increasing the fibre in your diet with high-fibre foods or over-the-counter fibre medicines or supplements. Be sure you are drinking 8 to 10 glasses of water each day.

Contact your surgeon if you have:

  • Pain that will not go away
  • Pain that gets worse
  • A fever of more than 101deg F
  • Repeated vomiting
  • Swelling, redness, bleeding, or foul-smelling drainage from your wound site
  • Strong or continuous abdominal pain or swelling of your abdomen
  • No bowel movement by 3 days after the operation

 

HERNIA IN SPORTS

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

https://youtu.be/OCI7Qk6KUuE)

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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