A hernia is a bulge due to bowel or fat from inside the abdomen protruding out through a weak area. The most common kind is an inguinal hernia in the groin. Above the ligament of the groin is a small hole, deep in the muscle wall of the abdomen, through which arteries and veins pass to the testicle. If this hole, or the area near to it becomes weak and stretched then a pocket (or sac) of the membrane lining the abdomen (the peritoneum) can bulge through. On standing, coughing or vigorous activity, the sac becomes filled with bowel or fat from within the abdomen.
The bulging hernia area can cause discomfort, with the contents of the hernia sac usually going back into the abdomen on lying down, although sometimes they need to be pushed back gently. Sometimes a small hernia can cause aching without an obvious bulge and the hernia is then only found during examination by a doctor. If a hernia has been present for a long time then it can become very large, and in a man it can even fill the scrotum. When this happens, it may stay out most of the time, and prove very difficult to push back.
Inguinal hernias occur less frequently in females than males but femoral hernias, a different type, occur more frequently in females and can mostly be found on examination by a specialist. Femoral hernias are more likely to need to be repaired.
Hernias are usually troublesome only because they cause a bulge and aching whilst the most serious risk of a hernia is strangulation which means the bowel which becomes completely trapped and its blood supply may become cut off. The produces sudden severe pain and requires an urgent operation when the affected piece of bowel may need to be removed. Strangulation is not very common and many people have hernias for years without them ever becoming strangulated. Obstruction of the bowel can also occur it the bowel becomes trapped and this demands an operation even if the blood supply has not been cut off.
Hernias can only be permanently cured by operation, as leaving them may allow them to increase in size or at least remain as troublesome, although there is a small risk of strangulation and continued discomfort. A hernia does not have to be operated on if it is not causing undue symptoms and surgeons can discuss the pros and cons with their patients. To hold a troublesome hernia within the abdomen a truss can be used but it needs to be applied before a person gets up and the abdominal pressure increases on activity. Operation is a superior treatment for a hernia which is giving symptoms and being of advanced age or having medical complications should not prevent repair being performed due to safer general and local anaesthetics.
The surgeon performs the operative repair through an incision in the groin of approximately 12cm in length. The surgeon opens a muscle layer and turns their attention to the hernia sac, dividing off the sac from the tube to the testicle, arteries and veins. Bulging bowel or fat is pressed back into the abdomen and the surgeon either ties off the neck of the sac or stitches it back in.
A repair is then done to strengthen the weak area and to restore the hole for the arteries and veins of the testicle to its normal small size. The repair is necessary to prevent the hernia from coming back. This is usually done by stitching a plastic mesh over the whole area. Occasionally stitches are used without a mesh, for example in femoral hernias. Both these methods have been shown to give good long term results, and the chance of the hernia coming back is about 2% (1 in 50) for most people.
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. - 14130
The bulging hernia area can cause discomfort, with the contents of the hernia sac usually going back into the abdomen on lying down, although sometimes they need to be pushed back gently. Sometimes a small hernia can cause aching without an obvious bulge and the hernia is then only found during examination by a doctor. If a hernia has been present for a long time then it can become very large, and in a man it can even fill the scrotum. When this happens, it may stay out most of the time, and prove very difficult to push back.
Inguinal hernias occur less frequently in females than males but femoral hernias, a different type, occur more frequently in females and can mostly be found on examination by a specialist. Femoral hernias are more likely to need to be repaired.
Hernias are usually troublesome only because they cause a bulge and aching whilst the most serious risk of a hernia is strangulation which means the bowel which becomes completely trapped and its blood supply may become cut off. The produces sudden severe pain and requires an urgent operation when the affected piece of bowel may need to be removed. Strangulation is not very common and many people have hernias for years without them ever becoming strangulated. Obstruction of the bowel can also occur it the bowel becomes trapped and this demands an operation even if the blood supply has not been cut off.
Hernias can only be permanently cured by operation, as leaving them may allow them to increase in size or at least remain as troublesome, although there is a small risk of strangulation and continued discomfort. A hernia does not have to be operated on if it is not causing undue symptoms and surgeons can discuss the pros and cons with their patients. To hold a troublesome hernia within the abdomen a truss can be used but it needs to be applied before a person gets up and the abdominal pressure increases on activity. Operation is a superior treatment for a hernia which is giving symptoms and being of advanced age or having medical complications should not prevent repair being performed due to safer general and local anaesthetics.
The surgeon performs the operative repair through an incision in the groin of approximately 12cm in length. The surgeon opens a muscle layer and turns their attention to the hernia sac, dividing off the sac from the tube to the testicle, arteries and veins. Bulging bowel or fat is pressed back into the abdomen and the surgeon either ties off the neck of the sac or stitches it back in.
A repair is then done to strengthen the weak area and to restore the hole for the arteries and veins of the testicle to its normal small size. The repair is necessary to prevent the hernia from coming back. This is usually done by stitching a plastic mesh over the whole area. Occasionally stitches are used without a mesh, for example in femoral hernias. Both these methods have been shown to give good long term results, and the chance of the hernia coming back is about 2% (1 in 50) for most people.
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. - 14130
About the Author:
Jonathan Blood Smyth is the Superintendent of Physiotherapy 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.
No comments:
Post a Comment