When a hernia occurs a part of the bowel or abdominal fat, normally within the abdomen, protrudes out through a weakened part. An inguinal hernia is the commonest type and occurs in the groin. There is a small gap deep in the wall of muscle in the abdomen, just above the ligament in the groin, through which the veins and arteries course to reach the testicle. If the gap or the tissues around it stretch or weaken then part of the peritoneum (lining of the abdomen) can protrude through. This protrusion can occur, with fat or bowel bulging out, on vigorous activity, coughing or standing.
Aching and discomfort can be caused by the bulge of the hernia but the protrusion generally returns back into the abdominal area when the person lies down, with the necessity to manually press it back into place at times. Aching can occur without any visible bulging and then a doctor's examination is needed to find the hernia. A very longstanding hernia may develop into a very large protrusion, even going so far as to fill up a man's scrotum. A very large hernia like this will likely remain protruded most of the time and be very difficult to relocate.
Women suffer inguinal hernias less commonly than men but a different kind of hernia, a femoral hernia, occurs more often in women than men and a doctor can diagnose this by examination. Femoral hernias are more typically repaired as a matter of course.
Most hernias are just a nuisance due to causing a bulge and the tendency to ache, symptoms which are annoying but not medically important. Strangulation is the most serious complication where the bowel fills the hernia sac and becomes trapped there, potentially cutting of its blood supply. It needs to be operated on immediately, with a likely removal of a damaged area of bowel. It is not common for bowel to become strangulated and hernias can exist for years without this happening. Bowel obstruction can develop as the bowel becomes trapped and this needs operating on even if the blood supply is still working.
The one permanent cure for a hernia is operation as a hernia will not go away and may get larger. It can cause inconvenient symptoms with a small danger of strangulation. If a hernia is causing no problems then an operation is not essential and patients can discuss this with their surgeon. A truss can be used to hold a troublesome hernia and should be put on before the person gets up and while the hernia is not bulging out. In general an operation is a much better treatment for a hernia which is causing symptoms. Since a local anaesthetic can be used and general anaesthetics are very safe nowadays, advanced age or medical problems should not usually prevent any hernia repair.
A groin incision about 12 centimetres in length is used for the repair of a hernia, with an opening of a layer of muscle and then the careful separation of the bulging hernia sac from the veins, arteries and tube to the testicle. The protruding fat or bowel from the abdomen is compressed back in and the sac is then stitched back into the abdominal cavity or tied off at its narrow neck area.
The weakened area is then repaired and strengthened and the hole for the veins and arteries to the testicle is recreated back to its usual size. The hernia will be likely to return if it is not repaired, with surgeons typically using a plastic mesh which they stitch over the herniated area. Stitches can also be used without employing the mesh and this is more likely in femoral hernias. Good long term results have been shown with both techniques and the typical chance of hernia reoccurrence is 2%.
A hernia can be performed as an open operation or by using a laparoscope, using a general anaesthetic. The surgeon inserts the scope into the abdomen just under the tummy button and then pumps gas into the abdomen to separate the muscle layers in the lower groin and abdomen. The surgeon makes two very small (5mm) incisions in the low abdomen so that instruments can be inserted, by which the mesh of plastic is introduced and the hernia repaired.
Aching and discomfort can be caused by the bulge of the hernia but the protrusion generally returns back into the abdominal area when the person lies down, with the necessity to manually press it back into place at times. Aching can occur without any visible bulging and then a doctor's examination is needed to find the hernia. A very longstanding hernia may develop into a very large protrusion, even going so far as to fill up a man's scrotum. A very large hernia like this will likely remain protruded most of the time and be very difficult to relocate.
Women suffer inguinal hernias less commonly than men but a different kind of hernia, a femoral hernia, occurs more often in women than men and a doctor can diagnose this by examination. Femoral hernias are more typically repaired as a matter of course.
Most hernias are just a nuisance due to causing a bulge and the tendency to ache, symptoms which are annoying but not medically important. Strangulation is the most serious complication where the bowel fills the hernia sac and becomes trapped there, potentially cutting of its blood supply. It needs to be operated on immediately, with a likely removal of a damaged area of bowel. It is not common for bowel to become strangulated and hernias can exist for years without this happening. Bowel obstruction can develop as the bowel becomes trapped and this needs operating on even if the blood supply is still working.
The one permanent cure for a hernia is operation as a hernia will not go away and may get larger. It can cause inconvenient symptoms with a small danger of strangulation. If a hernia is causing no problems then an operation is not essential and patients can discuss this with their surgeon. A truss can be used to hold a troublesome hernia and should be put on before the person gets up and while the hernia is not bulging out. In general an operation is a much better treatment for a hernia which is causing symptoms. Since a local anaesthetic can be used and general anaesthetics are very safe nowadays, advanced age or medical problems should not usually prevent any hernia repair.
A groin incision about 12 centimetres in length is used for the repair of a hernia, with an opening of a layer of muscle and then the careful separation of the bulging hernia sac from the veins, arteries and tube to the testicle. The protruding fat or bowel from the abdomen is compressed back in and the sac is then stitched back into the abdominal cavity or tied off at its narrow neck area.
The weakened area is then repaired and strengthened and the hole for the veins and arteries to the testicle is recreated back to its usual size. The hernia will be likely to return if it is not repaired, with surgeons typically using a plastic mesh which they stitch over the herniated area. Stitches can also be used without employing the mesh and this is more likely in femoral hernias. Good long term results have been shown with both techniques and the typical chance of hernia reoccurrence is 2%.
A hernia can be performed as an open operation or by using a laparoscope, using a general anaesthetic. The surgeon inserts the scope into the abdomen just under the tummy button and then pumps gas into the abdomen to separate the muscle layers in the lower groin and abdomen. The surgeon makes two very small (5mm) incisions in the low abdomen so that instruments can be inserted, by which the mesh of plastic is introduced and the hernia repaired.
About the Author:
Jonathan Blood Smyth is the Superintendent of Physiotherapists at an NHS hospital in the South-West of the UK. He writes articles about back pain, neck pain, and injury management. If you are looking for Physiotherapists in Kensington visit his website.
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