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(Friday, 19th Dec, 2014)
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Hernia

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Inguinal Hernia

What is an inguinal hernia?

When people use the term hernia they are usually referring to an inguinal hernia.

An inguinal hernia is commonly referred to as a rupture. It occurs in the groin at the level of the groin crease.

The term hernia means that a portion of gut has bulged out through a gap in the abdominal muscles giving rise to a small swelling in the groin. Hernias occur in both sexes and can affect all age groups from infancy to old age.

There is a related condition known as a femoral hernia. It is similar in many respects to an inguinal hernia except that it arises just below the groin crease.

What causes an inguinal hernia?

Inguinal hernias are very common in infants under the age of one year. They occur as a result of a congenital weakness in the abdominal wall and are easily repaired.

The following is a list of causes of hernia in older people:

  • excessive coughing,
  • straining while lifting heavy objects,
  • obesity,
  • loss of abdominal muscle tone due to old age,
  • severe constipation resulting in straining at stool.

What are the symptoms?

Many people with a hernia will have diagnosed the condition themselves because they will have noticed a bulge or swelling in the groin. The swelling increases in size throughout the day depending on the level of physical activity. Usually the hernia reduces in size after a night's sleep and may not be visible the next morning on first waking up.

Some people may complain of pain or discomfort in the area of the swelling. Others may complain of a bloated feeling. If the level of discomfort is becoming more severe over the course of the day or if there is any difficulty in passing stools, medical advice should be sought.

What does it look like?

An inguinal hernia is usually easily identifiable as a swelling in the groin. The examining doctor will usually request that the patient give a cough, which increases the size of the bulge. This is known as a cough impulse. Hernias can range in size from a small barely visible swelling to a bulge the size of a small football.

How is it treated?

Hernias are best repaired through elective surgery. The traditional operation involves making an incision parallel to the groin crease. The portion of gut or intestine that has created the bulge is pushed back into the abdominal cavity. The defect in the abdominal muscles, through which the gut has bulged outwards, is then repaired. A piece of plastic mesh is stitched in place as part of the repair. Hernia surgery is a repair procedure and does not involve removal of the swelling. It simply reduces the swelling and repairs the defect in the lower abdominal wall.

Traditional hernia repair requires a hospital stay of several days' duration. Increasing numbers of people now undergo a keyhole procedure, which results in a shorter hospital stay and quicker convalescence.

Infants requiring hernia repair are usually sent home a few hours after undergoing surgery. This is perfectly safe and is standard practice in most paediatric units.

In the past many people were treated with a surgical truss. A truss is a support device that prevents the hernia from bulging out. They are rarely used nowadays and surgical treatment remains the treatment of choice.

Can a hernia be dangerous?

The principal risk with a hernia is that it can strangulate. This means that the bulge into the groin gets stuck and is unable to reduce back into the abdomen. As a result of this process the bowel obstructs leading to swelling of the abdomen and increasing pain. A strangulated hernia is a surgical emergency and requires speedy attention.

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