Hernia

There are two types of hernia; internally and externally. Usually, the external hernia is more common which is clinically detected through physical examination. External Hernia is the protrusion of abdominal contents through a weakness in the anterior abdominal wall. The external hernia could be located at the inguinal area (common in males) or femoral area (common in females). The inguinal hernia could be indirect due to congenital or acquired due to continuous straining or an increase in intra-abdominal pressure; or direct hernia which usually occurs in older men. It is caused by the same underlying factors as indirect inguinal hernia.

The most common symptom would be that the patient discovers a lump over the inguinal area. The lump will appear when coughing, straining or carrying heavy objects; and can be reduced by lying down or sitting down happens to patient. Initially, there is no pain, but the lump will increase in size. Gradually, there will be slight discomfort or even pain. Occasionally, due to the dragging sensation of the contents of the hernia, the patient may feel some abdominal discomfort and pain.

The usual complications are due to the relatively big size of the contents which is trapped in the hernia sac. As it will be deprived of blood supply due to congestion at the entry and the contents will undergo vascular changes, causing them to die. Hence, symptoms like abdominal discomfort and vomiting and abdominal distension or fever and other signs of infection, may trigger to visit a doctor. However, the hernia may reach such a large size that the contents will still remain viable, but the patient will be walking with a large mass at the inguinal area.

Prevention

If it is congenital, the hernia will appear at an earlier age and there is no way to prevent this. But in indirect or direct hernia, the prevention ways could be:​

  • Avoiding strain

  • Carrying heavy items using the correct posture

  • Controlling constipation

  • Reducing the symptoms of passing urine

  • Controlling asthmatic attacks and chronic cough

  • Strengthening abdominal walls by gentle exercises

Treatment

The only treatment for hernia is surgery. One can wear truss to prevent the lump from appearing when straining, but this will not eliminate the cause. The objective of the surgical operation is to correct the weakness by using the mesh and cutting off the sac that communicates with the abdominal cavity. It can be done by laparoscopic means and by open method and this only requires day surgery admission.

The complications of surgery are the following:​

  • Injury to the surrounding organs like the underlying femoral vessels, to the spermatic cord and the underlying bladder and colon

  • Haematoma formation especially to the scrotal area

  • Infection to the wound

  • Wound firmness due to the insertion of the praline mesh

  • Recurrent hernia – if the hernia is not repaired properly, then recurrent will happen especially if the precipitating

 

 

Disclaimer: This is not a guide to self-diagnose. We encourage to seek urologist advice further.

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