HERNIA: A BATTLE WITH A DANGEROUS BULGE

A hernia can occur at any age, including in newborns and infants, but in general affects mature adults and the elderly with a higher prevalence among males. It is a condition that should be recognised early because its main complication is life threatening.

A hernia is the passage of an organ, mainly the small intestine, through a weakness of some abdominal muscles, which may be of congenital origin. 

There are two main types of hernia depending on its location: the inguinal hernia, which predominantly affects males, corresponds to the protrusion of the small intestine or fat abdominal tissue through the inguinal canal where blood vessels pass to the testicles in males or some ligaments in females. 

The femoral hernia, which mainly affects older females, is a protuberance of the small intestine into the femoral canal that contains blood vessels to the leg. Due to the weak spot on the abdominal muscles, a bulging of the small intestine or some fatty tissue of the abdomen occurs and becomes visible around the groin area at the top of the inner thigh or sometimes in the scrotum. 

The initial symptom is a progressive and painless swelling on one side of the groin that looks like a round lump, which can be pushed back into the tummy. Often, the person can see or feel the hernia especially when standing upright or coughing. Pain may occur anytime later and is exacerbated when lifting heavy objects, straining or bending over. In young children, a hernia is often noticed when crying or during difficult bowel movements. 

 Any condition, which increases pressure inside the abdomen, may favour a hernia. Chronic constipation (frequent among the elderly), chronic cough due to smoking, difficulties in urinating due to prostate swelling (benign prostatic hyperplasia or BPH), weight lifting as well as obesity are all considered risk factors.

A hernia may remain stable for a long time and may not require treatment if its remains small and painless. However, it usually gets bigger with time and exposes the patient to potentially serious and unpredictable complications. 

The main issue is the possibility of a portion of the bowel becoming trapped in the hernia and strangulated. The blood flow at the hernia site is then compromised and may trigger a necrosis (destruction) of the affected intestine loop. Sometimes, the obstructed bowel trapped in the hernia leads to intestinal occlusion.

In such cases, pain will be acute and severe, and there will also usually be nausea, vomiting, interruption of passing stool or gas and the impossibility of returning the hernia into the belly. The hernia may show signs of marked tissue suffering with an unhealthy reddish appearance. 

Strangulated hernia is a life threatening condition and a surgical emergency. A general surgeon should see the patient as promptly as possible. 

Due to the potential risk of strangulation, most hernias need to be treated as soon as they become larger, bothersome or slightly painful, even if this is no more than a minor ache. The only treatment is surgical repair, usually under general anaesthesia, either through traditional “open” surgery with incision at the groin or through “keyhole surgery” (or laparoscopic surgery), which is less invasive. Both approaches have pros and cons and depend on the hernia condition. Besides repositioning the intestine to its right abdominal location, the weak abdominal tissue is repaired and reinforced with the placement of a synthetic mesh. In the case of a complicated hernia, the emergency surgery aims to promptly restore the blood supply to the trapped intestine. 

Although many hernias may not be prevented, healthy habits limiting the pressure on the belly muscles may be useful: they start with avoiding smoking, preventing constipation with high-fibre foods and maintaining healthy body weight.

 

 

Dr Gerard Lalande is managing director of CEO-Health, which provides medical referrals for expatriates and customised executive medical check-ups in Thailand. He can be contacted at gerard.lalande@ ceo-health.com.