A hernia (inguinal hernia) is a physical condition affecting the inner wall of the abdomen. The custom wall breaks in the groin area, so that the abdominal organs are no longer held in the abdominal cavity. The most noticeable signs of an inguinal hernia are strong abdominal bulges and abdominal tumors, as well as swelling in the groin area. In addition, those affected complain of pulling and stabbing pain in this area. A hernia should be treated by a doctor as soon as possible, otherwise serious complications can set in.
What is a hernia?
With a weakened form, with normal movements, it pulls in the groin area. As soon as the affected person rests again, this pulling feeling disappears. See AbbreviationFinder for abbreviations related to Hernia.
The hernia (medical hernia) is a break in the soft tissues in the area of the inguinal canal. A distinction is made between direct (usually internal) and indirect (usually erupting externally and pulling inwards) inguinal hernias.
The difference is that indirect fractures are usually congenital and usually run through the entire inguinal canal. The direct ones, on the other hand, break through the middle of the weak point and are mostly acquired breaks.
However, this classification is more important for understanding than for therapy. Hernia occurs in young and old. Due to their anatomy, males are affected much more frequently.
Causes
The hernia usually occurs at the bottom of a pre-existing weak point in the connective tissue. A sudden increase in pressure in the abdomen (coughing, going to the toilet, heavy lifting, crying in the infant) can create a gap through which parts of the intestine or even a large mesh (this is fat between the intestinal loops) can pass.
The indirect, congenital hernias show up as a painless swelling in the central inguinal canal in the infant. If the pressure in the abdomen increases, bowel loops are pushed through a canal that has remained open (processus vaginalis testis). The bowels are usually easy to push back with this type of hernia.
Acquired inguinal hernias also rarely show pronounced symptoms. Here, too, only swelling and possibly a slight pain or feeling of pressure are indicative. Severe pain – especially if it occurs suddenly – is suspicious of an incarcerated hernia. Parts of the intestine pass through the hernia, swell up due to the squeezed out blood flow and can no longer be pushed back into the abdominal cavity.
A trapped inguinal hernia is an absolute surgical emergency situation, since the intestine is no longer supplied with blood and would die without therapy. The parts of the intestine that are not supplied with blood can also easily become infected, which can lead to life-threatening peritonitis.
Symptoms, Ailments & Signs
Depending on whether the hernia is larger or smaller, the symptoms will be more severe or weaker. With a weakened form, with normal movements, it pulls in the groin area. As soon as the person rests again, this tugging feeling disappears.
If the fracture is larger (hernia), a bulge that is pressed outwards can be seen. In many cases, this curvature can be pushed back. The person concerned also suffers from pain. These symptoms also subside when the patient rests or lies down. If there is a fracture down to the testicles, a swollen scrotum is a typical sign of this disease.
Severe pain can be observed in patients where tissues or organs have been pinched due to the fracture that has occurred. Fever, nausea and [[vomiting9] can be observed in connection with this. In such a case, medical help must be provided, as the intestines can become stuck or the affected tissue can die due to undersupply. Surgery is vital.
The disease can also occur in children. Parents recognize signs in the form of a swollen scrotum or swollen outer labia. The child may also complain of pain. Here, too, a doctor should be consulted immediately, since internal organs can also be affected.
Complications
Complications from an inguinal hernia are rare. In principle, however, consequences are possible that can have serious effects on the health of those affected.
One of the most common and serious complications of an inguinal hernia is the hernia contents being trapped within the hernia gap. This causes the blood supply to the visceral area in the hernial sac to be cut off, which occurs through strangulation. In the further course, therefore, there is a risk of the visceral part dying off.
Another serious consequence is the development of peritonitis (peritonitis), which can become life-threatening. However, if an operation is carried out in good time, this danger can be prevented. In emergency surgery, the mortality rate is five to ten percent.
However, complications can also be caused by an operation on the hernia. It is possible that damage to the vas deferens can occur. A narrowing of the inguinal canal vessels is also conceivable. As a result, the testicles regress in men. If a leg vein is constricted, there is a risk of thrombosis.
Other possible consequences of inguinal hernia surgery are damage to the nerves, chronic pain, injuries to the urinary bladder or intestines, inflammation and wound infections. Due to modern surgical methods, however, these after-effects are only rarely seen.
After an inguinal hernia operation, there is a risk of recurrence, which depends on the surgical procedure and the condition of the connective tissue. About five to ten percent of all patients are affected by a recurrence of the hernia.
When should you go to the doctor?
If a hernia is suspected, a doctor should be consulted immediately. If typical symptoms such as nausea and vomiting or pain in the groin area occur, this must be clarified by the family doctor or a gastroenterologist. When the characteristic bump appears, it is best to see a doctor right away. Parents who notice a bulge in their child’s groin area should consult their pediatrician. Emergency services should be called if there are warning signs such as sharp pains or blood in the stool that indicate a trapped intestine.
The affected person must then be treated in intensive care to avoid serious complications. Early treatment can usually rule out damage to tissue and organs. Obese people, pregnant women and boys with undescended testicles are particularly susceptible to a hernia. Athletes and people with a congenital weakness of the connective tissue are also among the risk groups and should consult a specialist if they have the symptoms mentioned. Patients who have already suffered an inguinal hernia inform the doctor responsible if symptoms recur.
Treatment & Therapy
In order to prevent an incarceration, an asymptomatic inguinal hernia is also operated on (electively) at a freely selectable time. The much-touted alternative therapy with a hernia ligament only makes sense if an operation cannot be carried out for a variety of reasons. The problem is that the hernia ligaments relieve the muscles of additional holding work, thereby weakening them. As a result, the opposing force holding the intestines in the abdominal cavity decreases.
Depending on the demands on the resilience, different surgical techniques are possible. If the person concerned wants a minimally invasive procedure (by means of a laparoscopy), a synthetic mesh is always inserted in adult patients. The operation can be performed in two ways. Either the peritoneum is not opened (TEPP) or the operation is performed through the abdominal cavity (TAPP). The greatest advantage of these so-called “tension-free techniques” is above all their early resilience.
Cutting operations can be carried out with or without inserting foreign material. Classic procedures are the Lichtenstein operation (a plastic mesh is also inserted) and the Shouldice operation (hernia closure with a direct suture. For more stability, the muscle fascia is also doubled with this technique). The biggest advantage here is that these procedures can be performed under local anesthesia. Older people in particular can benefit from reduced surgical risks.
Outlook & Forecast
The prognosis mainly depends on whether surgery is done in time or not. If the symptoms are ignored or not treated, the hernia will enlarge. Self-healing is impossible. Life-threatening complications can occur. Surgeons have accumulated a lot of knowledge about the operation of a hernia. There are three best practices to choose from. An operation is usually uncomplicated, so that there are no symptoms afterwards. This favorable prognosis can worsen in old patients and a difficult situation.
Possible complications mainly relate to trapped intestines. This can result in the disease spreading to the entire abdomen or damage to the reproductive organs. However, such circumstances are very rare. In five to ten percent of all successful surgeries, the fracture recurs, which doctors call recurrence. However, there is also a favorable prospect after a repeated intervention.
Patients prevent hernia recurrence by not lifting heavy and eating an easily digestible diet for up to six months after surgery. Medical treatment according to European standards promises freedom from symptoms for life.
Prevention
Since the congenital weakness of the connective tissue cannot be changed, direct prevention is difficult. The muscle coat can only be strengthened through physical activity. Contrast showers are able to tighten the connective tissue. Prevention focuses on avoiding increased pressure in the abdomen. This can be achieved, for example, by reducing weight, taking bowel movements, or lifting heavy loads properly.
Aftercare
Since an inguinal hernia is treated with surgery, careful aftercare is necessary. Even after a successful operation, the patient has to undergo numerous check-ups that serve as follow-up care. The condition of the groin and abdomen is usually examined. Scar care is also part of these examinations.
However, a one-time and successfully treated hernia is no guarantee that a hernia will not occur again. Therefore, aftercare for this disease also includes actively preventing another hernia. These follow-up measures include the minimization of risk factors, whereby medical supervision is sometimes appropriate.
For example, if those affected are severely overweight, a doctor can oversee the weight reduction and monitor the patient’s state of health. A general element of aftercare for a hernia is to discuss sporting activities with the doctor. Certain types of sport, movement sequences and stress increase the pressure in the abdomen and thus promote a hernia.
These factors must be reduced as part of the aftercare so that no new hernia occurs. After surgical treatment of the first hernia, it is also advisable to give up smoking or at least severely limit nicotine consumption. Medical supervision is also recommended. Quitting smoking also reduces the likelihood of another hernia.
You can do that yourself
A weakly pronounced inguinal hernia does not necessarily have to be operated on. In most cases, it is possible to prevent the break from expanding by adapting the behavior.
Those affected should not lift heavy loads and avoid high-impact sports such as soccer or strength training. In addition, you should not push too hard when you have a bowel movement. If you also pay attention to a normal weight, the hernia can be kept at the original level. Still, pain can occur, which is best relieved by bed rest and relaxation . Cramps and pinching can be reduced by walking upright and stretching regularly. In addition, cold helps in the form of cool packs, ice packs or frozen vegetable packs from the freezer. Hot water bottles and cherry pit pillows help with tension.
In the case of a severe hernia, it is important to see a doctor and make an appointment for the operation. Rest is indicated after the operation. Children should spend at least a few days in bed, for adults a break of two to three days is recommended. After that, major efforts should initially be avoided. Both classic painkillers and natural remedies such as valerian or passion flower help against pain . Accompanying the symptomatic treatment, the causes of the hernia must be determined and specifically addressed in order to avoid another hernia.
