Urology And Urosurgery
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What is inguinal hernia?
An inguinal hernia is a condition in which intra-abdominal fat or part of the small intestine, also called the small bowel, bulges through a weak area in the lower abdominal muscles. An inguinal hernia occurs in the groin—the area between the abdomen and thigh. This type of hernia is called inguinal because fat or part of the intestine slides through a weak area at the inguinal ring, the opening to the inguinal canal. An inguinal hernia appears as a bulge on one or both sides of the groin. An inguinal hernia can occur any time from infancy to adulthood and is much more common in males than females. Inguinal hernias tend to become larger with time.
Figure : An inguinal hernia showing the small intestine descending through the inguinal canal.
What are the types and causes of inguinal hernia?
The two types of inguinal hernia have different causes.
1] Indirect inguinal hernia
Indirect inguinal hernias are congenital hernias and are much more common in males than females because of the way males develop in the womb. In a male fetus, the spermatic cord and both testicles—starting from an intra-abdominal location—normally descend through the inguinal canal into the scrotum, the sac that holds the testicles. Sometimes the entrance of the inguinal canal at the inguinal ring does not close as it should just after birth, leaving a weakness in the abdominal wall. Fat or part of the small intestine slides through the weakness into the inguinal canal, causing a hernia. In females, an indirect inguinal hernia is caused by the female organs or the small intestine sliding into the groin through a weakness in the abdominal wall.
Indirect hernias are the most common type of inguinal hernia. Premature infants are especially at risk for indirect inguinal hernias because there is less time for the inguinal canal to close.
2] Direct inguinal hernia
Direct inguinal hernias are caused by connective tissue degeneration of the abdominal muscles, which causes weakening of the muscles during the adult years. Direct inguinal hernias occur only in males. The hernia involves fat or the small intestine sliding through the weak muscles into the groin. A direct hernia develops gradually because of continuous stress on the muscles.
One or more of the following factors can cause pressure on the abdominal muscles and may worsen the hernia:
Indirect and direct inguinal hernias usually slide back and forth spontaneously through the inguinal canal and can often be moved back into the abdomen with gentle massage.
- Sudden twists, pulls, or muscle strains
- Lifting heavy objects
- Straining on the toilet because of constipation
- Weight gain
- Chronic coughing
What are the symptoms of inguinal hernia?
Symptoms of inguinal hernia include:
- A small bulge in one or both sides of the groin that may increase in size and disappear when lying down; in males, it can present as a swollen or enlarged scrotum
- Discomfort or sharp pain—especially when straining, lifting, or exercising—that improves when resting
- A feeling of weakness or pressure in the groin
- A burning, gurgling, or aching feeling at the bulge
What are “incarcerated” and “strangulated” inguinal hernias?
An incarcerated inguinal hernia is a hernia that becomes stuck in the groin or scrotum and cannot be massaged back into the abdomen. An incarcerated hernia is caused by swelling and can lead to a strangulated hernia, in which the blood supply to the incarcerated small intestine is jeopardized. A strangulated hernia is a serious condition and requires immediate medical attention. Symptoms of a strangulated hernia include:
- Extreme tenderness and redness in the area of the bulge
- Sudden pain that worsens in a short period of time
- Rapid heart rate
- Left untreated, nausea, vomiting, and severe infection can occur. If surgery is not performed right away, the condition can become life threatening, and the affected intestine may die. Then that portion of the intestine must be removed.
How is inguinal hernia diagnosed?
To diagnose inguinal hernia, the doctor takes a thorough medical history and conducts a physical examination. The person may be asked to stand and cough so the doctor can feel the hernia as it moves into the groin or scrotum. The doctor checks to see if the hernia can be gently massaged back into its proper position in the abdomen.
How is inguinal hernia treated?
Figure : Illustration of an inguinal hernia
In adults, inguinal hernias that enlarge, cause symptoms, or become incarcerated are treated surgically. In infants and children, inguinal hernias are always operated on to prevent incarceration from occurring. Surgery is usually done on an outpatient basis. Recovery time varies depending on the size of the hernia, the technique used, and the age and health of the patient. The two main types of surgery for hernias are as follows:
1] “Open” hernia repair
In open hernia repair, also called herniorrhaphy, a person is given local anesthesia in the abdomen or spine to numb the area, general anesthesia to sedate or help the person sleep, or a combination of the two. Then the surgeon makes an incision in the groin, moves the hernia back into the abdomen, and reinforces the muscle wall with stitches. Usually the area of muscle weakness is reinforced with a synthetic mesh or screen to provide additional support—an operation called hernioplasty.
Laparoscopic surgery is performed using general anesthesia. The surgeon makes several small incisions in the lower abdomen and inserts a laparoscope—a thin tube with a tiny video camera attached to one end. The camera sends a magnified image from inside the body to a monitor, giving the surgeon a close-up view of the hernia and surrounding tissue. While viewing the monitor, the surgeon uses instruments to carefully repair the hernia using synthetic mesh.
People who undergo laparoscopic surgery generally experience a somewhat shorter recovery time. However, the doctor may determine laparoscopic surgery is not the best option if the hernia is very large or the person has had pelvic surgery.
Most adults experience discomfort after surgery and require pain medication. Vigorous activity and heavy lifting are restricted for several weeks. The doctor will discuss when a person may safely return to work. Infants and children also experience some discomfort but usually resume normal activities after several days.
Who is at risk for an inguinal hernia?
Some people, especially men, are born with a weakness in their groin muscles. Ninety percent of the newborns who have inguinal hernias are boys. With or without this weakness, an inguinal hernia can be caused by increasing pressure in the abdomen. Risk factors include:
- Being moderately to severely overweight
- Lifting heavy objects
- Persistent coughing, such as smoker's cough
- Sneezing a lot, which may be common in a person with allergies
- Straining during bowel movement, which may be caused by constipation or diarrhea
- For men, trying to urinate when there is a blockage caused by an enlarged prostate
How can I prevent an inguinal hernia?
If you are overweight, follow your physician's advice for losing weight.
Avoid lifting, pulling, and pushing heavy objects. Use proper lifting, pulling, and pushing techniques when needed. Bend at your knees and lift using your legs rather than your back.
Stop smoking and try to avoid coughing.
Use deep breathing techniques to help control your coughing. Obtain a medical prescription to treat the condition causing your cough.
Take medication to reduce allergies and sneezing.
Avoid constipation by eating foods that are high in fiber, using stool softeners, or drinking a natural stimulant beverage such as prune juice. Use laxatives or enemas only if recommended by your physician.
For males, wear a jock strap or similar groin support.
Adjust your occupational duties, if necessary.
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