Inguinal hernia, what to do?

Inguinal hernia requires surgical treatment in most cases to avoid, or resolve, serious complications.

The leakage of a bowel from the cavity that normally contains it is indicated by the term “hernia”.

Inguinal hernia, in particular, occurs when, due to a sagging, weakness or a small congenital malformation of the abdominal wall, an abnormal opening is formed, called the hernial gate.

This opening facilitates the leakage of a bowel at the inguinal canal, a duct located between the thigh and the abdominal wall. The bowel may consist of abdominal fat or an intestinal loop.

Inguinal hernia is a frequent pathology, which can affect both children and the elderly. In adulthood it occurs more often around the age of 50 and, due to the anatomical conformation of the male inguinal canal, richer in blood vessels and nerves, it is more frequent among men.

Classification of hernias

Typically, hernias form at points in the body where fairly voluminous structures, such as tracts of the intestine or blood vessels, enter or exit a cavity.

Inguinal hernia belongs to the largest category of abdominal hernias, of which it makes up 75% of the series.

To this category also belongs the umbilical hernia, localized in the ring surrounding the navel, more frequent in newborns and pregnant women. In addition to a birth defect, it can arise over time favored by conditions such as obesity, ascites or chronic peritoneal dialysis.

Other types of herniations of the abdominal wall are the epigastric hernia, which, due to a congenital weakness, comes out at the area located between the sternum and navel, and the incisional one, deriving from scars for pre-existing surgical interventions, which can occur even after years. And, again, the hernia called lateral ventral or Spigelio, a rare disease due to defects of the transverse abdominal muscle and generally localized below the level of the navel.

The most frequent type of hernia, after the inguinal one, is the crural hernia, also known as femoral: it represents 2-5% of abdominal hernias and affects the female sex more easily. It manifests itself in the crural region, at the root of the thigh under the inguinal ligament, with the leakage of an intestinal loop into the pubic area due to the weakening of the muscle fascia covering this part.

Causes of inguinal hernia

Inguinal hernia can have different origins. It can in fact be of a congenital nature, that is, be present from birth due to anomalies or incorrect morphogenesis; or it can result from an anomaly in the development of the abdominal wall or depend on a weakening of the muscle groups, normally associated with the aging process or heavy lifting, in particular if performed inappropriately or repetitively as in the case of some strenuous work activities.

The appearance of acquired hernias is favored by some conditions such as overweight and obesity, violent and repeated cough, trauma and injuries to the abdomen, pregnancy, sedentary lifestyle. Constipation, forcing an effort to evacuate, is also a potential factor favoring the development of hernia.

Direct or indirect?

Inguinal hernias can be direct or indirect. Indirect hernias are the most common and attributable to a congenital origin, common in premature births. They form above the inguinal ligament and pass through the inguinal ring inside the canal.

They are more common in males; During gestation, in fact, the spermatic cord, together with the testicles, descends into the scrotum through the inguinal canal. If the entrance to the canal does not close properly, the corresponding tissue of the abdominal wall will remain weak.

The inguinal hernia, which can be unilateral or bilateral, is located more frequently on the right: the right testicle, in fact, descends into the scrotum later than the left one and therefore the right inguinal canal closes after the left one.

Direct hernias are less frequent. Here the intestinal loops exit directly from the abdomen through an opening in the abdominal wall itself, without passing into the inguinal canal. They are caused by a weakening of muscle tissue typically related to repeated strain on the abdominal muscle. They are predisposing factors chronic cough, constipation, overweight, efforts for lifting heavy objects.

Symptoms of inguinal hernia

The typical manifestation of inguinal hernia is a bulge, localized in one or both sides of the groin area. The texture to the touch is usually soft, but may vary depending on the content. The dimensions are also variable and can increase considerably with the passage of time, until they reach the size of a pineapple.

In some cases the bulge is visible only when the person is in an upright position; Stretching, in fact, the leaked bowel returns to its anatomical site and the disorder is completely asymptomatic.

More often, however, in the affected area the person feels discomfort, feeling of weight and pressure, pain and sometimes burning. These are symptoms that decrease with rest and that increase as a result of exercise, fatigue, long walks, intense abdominal efforts such as sneezing and coughing.

Insome cases the pain may radiate to the leg and affect the scrotum, with swelling and increased size. Other possible symptoms are also stomach pain and digestive difficulties. In some cases the disorder caused by the hernia can become disabling and prevent standing or walking.

Most hernias can be “reduced” by the patient himself or by the doctor, that is, pushed inward into the abdominal cavity by a manual maneuver.

An unreducible hernia is defined as incarcerated: the leaked intestinal bowel remains “stuck” in the hernial door. It is a dangerous situation that usually preludes to choking: the bowel is tightened by ligaments and muscles, or by the narrowing of the canal in which it has entered, and can no longer go back to its original location.

The risk is that the hernia obstructs the passage of feces, causing an intestinal blockage or, even worse, that the blood supply to the small intestine is interrupted, with the consequent necrosis of the tissues. Strangulated hernia is a very serious complication that, if not resolved with timely surgical intervention, can lead to the death of the patient.

The symptomatology in this situation is more intense and involves fever, fixed and intense pain that worsens in a short time, nausea and vomiting, low blood pressure. The skin above the affected area may also be reddened and erythematous.

Diagnosing inguinal hernia

The diagnosis of inguinal hernia is made by the surgeon and is based on the patient’s medical history and clinical visit.

Since the hernia can only be evident when abdominal pressure is increased, the patient should be examined in an upright position. The patient may also be asked to cough in order to make even hernias otherwise not very evident appreciable.

In women, detecting the presence of inguinal hernia can be difficult; Unlike what happens in men, in fact, in women the hernia is internal and almost always much smaller, but no less painful. In addition, it happens that pelvic pains are attributed to gynecological problems such as ovarian cysts or fibroids, resulting in a delay in diagnosis.

Treatment of inguinal hernia

The inguinal hernia is not a danger in itself, but it can give rise to very serious complications that require emergency intervention.

For this reason, the therapy of choice is surgery, in order to prevent the risks of incarceration; however, surgery must be personalized on the basis of the characteristics of the patient.

Only rarely and in children, the problem can resolve spontaneously. In general, in fact, with time the inguinal canal is destined to widen more and more and the hernia to become more and more evident, making the risk of a recurrence more likely.

Open surgery is usually performed with local or spinal anesthesia; The hernia is returned to its original location, and to strengthen the weakened abdominal wall, a mesh of synthetic material is placed. Laparoscopic surgery requires general anesthesia. In children the prosthesis of reinforcement of the abdominal wall is not inserted and we proceed with the simple suture of the hernial port.

In most cases the intervention takes place in a day hospital. The post-operative course is variable depending on the size of the hernia, the technique used, the age and state of health of the patient.

However, operated patients are advised to avoid any kind of effort for three to four weeks after the operation. For the resumption of normal activities there is no rule and the duration of convalescence will depend on individual characteristics. In children, recovery is usually faster.

The complications of surgery may concern infection and bleeding of the wound, situations to which, in the clinical control after surgery, the surgeon must pay particular attention: it may happen that the infection of the wound actually hides an internal infection linked to the prosthesis, which the body may not tolerate.

In some patients, neuralgic pain may occur, due to intestinal fibrosis induced by the implantation of the prosthesis. In the first instance, these disorders can be treated with anti-inflammatory drugs, but if they persist, a pharmacological approach that acts centrally is necessary.

There are no prevention strategies for inguinal hernia. Certainly, however, it is advisable to keep a weight within the norm, avoid excessive efforts or lifting. In general, it can help to maintain the muscle tone of the abdomen with targeted exercises. As far as nutrition is concerned, a diet rich in fiber and liquids can counteract the tendency to constipation and the consequent efforts related to difficult evacuation.

Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.

The blog covers a wide range of topics related to health and wellness, with articles organized into several categories.

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