What you need to know about inguinal hernia
Congenital inguinal hernia occurs in young boys and girls, acquired - in adult women and men. Despite the variety of causes, this disease manifests itself in a number of specific symptoms, which can immediately indicate the presence of a problem. It is impossible to get rid of an inguinal hernia without surgery, its removal has been carried out since 6 months, more often laparoscopic technique is used for this.
It is safe to say that a disease such as an inguinal hernia can become a threat to the health of every patient, so treatment must be carried out.
The defect is eliminated by a surgeon, the patient is treated by a urologist or gynecologist. The protrusion does not go away on its own when there is an irreducible inguinal hernia, then treatment should be started immediately.
A hernia in the groin is the exit of the contents of the abdominal cavity into the inguinal canal, in men - into the scrotum, in women - under the skin in the area of the labia. The main predisposing factor is the non-closure of the vaginal process, through which part of the intestine and some other organs pass.
Risk factors and mechanism of development
Congenital pathology begins its development at the 5th month of fetal development. During this period, the testicles descend from the abdominal cavity into the groin. Normally, up to 9 months, the organs already take their anatomically correct position, but the communication of the groin with the peritoneum remains.
When the process is disrupted, the vaginal process, which forms as the testicles descend, remains stretched and does not grow together. In this case, the child may be born with a hernia, or it appears in the first days, weeks, months after childbirth at the time of increased intra-abdominal pressure, which can provoke a strong cry, straining or crying of the child.
In girls, the pathology is formed in a similar way. In the embryo, the uterus is higher, as it forms, it descends, forming the same vaginal process, which becomes the main cause of a birth defect.
The causes of acquired inguinal hernia are somewhat different, but the predisposing factor in the form of non-closure of the vaginal process remains. Prerequisites appear from birth, but the disease manifests itself at an older age. But it also happens that the disease is not associated with anomalies of intrauterine development, and the pathology occurs against the background of acquired factors. The causes of an inguinal hernia will differ between women and men, but there are common risk factors.
Psychosomatics considers the main cause of this defect a feeling of disappointment and oppression.
Why does a hernia occur in the groin in adults:
- genetic predisposition - doctors recommend doing prevention, strengthening the muscles of the abdominal wall to prevent protrusion, when there were cases of the disease among close relatives;
- pregnancy, excess weight - increased intra-abdominal pressure contributes to the "pushing" of organs through a weakened inguinal canal;
- trauma - this can cause a weakening of the ligamentous apparatus, which will lead to the exit of part of the intestine into the scrotum;
- exhaustion of the body, sudden weight loss - an insufficient amount of body fat leads to the appearance of "empty" gaps, into which a layer of the peritoneum can fall;
- lack of adequate physical activity - this factor applies to all hernias without exception, physical inactivity will be considered as an indirect cause of protrusion of internal organs, whether it be the abdominal cavity, chest or spine;
- increased physical activity - it is dangerous with a sharp increase in intra-abdominal pressure against the background of weakness of the ligamentous apparatus, this can be provoked by sneezing, chronic coughing, constant hard work or a sharp rise in weight without preparation;
- frequent constipation - this violation is accompanied by a regular increase in intra-abdominal pressure.
Types of disease
Classification of inguinal hernias is carried out on the basis of the location of the defect, the period of occurrence, the number of hernial sacs and other factors. According to mobility, not restrained and restrained defects are distinguished.
The restrained elastic protrusion can be fecal, retrograde, Richter's. An uninjured defect moves freely, the organs in a relaxed state return to their place. Sliding inguinal hernia is one of the most dangerous type of disease, it is most often infringed, which requires immediate surgical treatment.
- right-sided inguinal hernia;
- left-sided inguinal hernia;
- bilateral inguinal hernia.
Other types of inguinal hernias:
- cord - the contents of the bag descend to the spermatic cord;
- inguinal-scrotal - in men and boys, the sac descends to the testicles;
- oblique - the contents in the form of a spermatic cord and duct pass through the entire groin canal;
- direct - the contents of the bag passes into the inguinal canal through the abdominal wall;
- combined - rare, consists of 2 bags on the left or right side;
- interstitial or subcutaneous - the exit of the contents of the bag into the layer of the oblique muscle;
- according to the degree of irreducibility - reducible and complicated (infringed).
How does it manifest
The clinic of uncomplicated hernias manifests itself in the same way for everyone, but when the disease becomes complicated, other specific signs appear, depending on the organ or system involved in the pathological process. Each type of disease has its own characteristics.
Congenital disease is difficult to consider in terms of subjective sensations, but it is known that a hernia in a child causes discomfort and pain, which manifests itself in the form of crying, restless behavior, poor sleep and appetite.
All hernias have one similarity - there is an external defect, swelling in the groin area, in men one or two testicles are enlarged, in women the shape of the labia majora is changed.
The symptoms that appear over time increase, pain increases, discomfort during walking, the function of the genitourinary system and intestines is disturbed.
What other symptoms are observed with an inguinal hernia:
- pain of varying intensity - aggravated during physical work, during sexual intercourse, while walking and with constipation;
- swelling in the groin area periodically disappears - a symptom of reducible protrusion, the contents of the bag either reduce itself in the supine position, or it can be returned to its place by light pressure;
- pain radiates to the lower back;
- pain during menstruation - observed when the ovary or fallopian tubes prolapse;
- dyspeptic manifestations, bloating, constipation - when a part of the caecum exits;
- unilateral or bilateral enlargement of the scrotum - occurs with inguinal-scrotal hernia in boys and men.
A hernia can be infringed or “burst”, from which no one is immune. With a complication, there is a rupture of the internal organs that have penetrated the inguinal canal. This is accompanied by tissue death, ischemia, or internal bleeding. This condition requires immediate treatment.
How to identify infringement in time:
- sudden onset of all symptoms;
- strong pain;
- it is impossible to correct the defect;
- constipation, gas retention;
- general serious condition;
- enlargement and tension of the swelling.
In pregnant women
During pregnancy, important factors in the development of pathology appear - an increase in load and an increase in intra-abdominal pressure. Given all the risks of this disease, it is important to know what symptoms will appear, and what to do in this case.
Features of the defect in pregnant women:
- even during the planning period, doctors recommend undergoing an examination to eliminate the risk of developing the disease already during gestation;
- there is a risk in case of overweight, which was before pregnancy;
- weak muscles of the abdominal wall increase the likelihood of the disease, and during pregnancy, muscle tone also decreases;
- multiple pregnancies, second births, large child weight increase the risk of the disease;
- with the growth of the fetus, the protrusion also increases, which can lead to complications before the birth itself;
- as the defect increases, symptoms increase, the condition worsens, the function of internal organs may be impaired, which already threatens the woman's health.
The main diagnostic method is ultrasound. This study is carried out by everyone without exception, therefore there are no difficulties with the definition of the disease. In addition, a doctor can make a diagnosis without additional instrumental methods, but they are needed to visualize the surrounding tissues, identify complications and choose treatment tactics.
It is impossible to cure a hernia without surgery. Conservative therapy is carried out before and after excision of the hernial sac during the early rehabilitation period in order to prevent complications. There is a group of patients for whom surgery is contraindicated, then only supportive treatment is performed. It includes wearing a bandage, maintaining a proper diet, avoiding stress, and conducting physiotherapy.
Nutrition for inguinal hernia should exclude constipation and bloating in order to prevent an increase in intra-abdominal pressure.
Treatment without surgery is carried out according to the following indications:
- old age;
- a weakened body, when the risks of surgery outweigh the potential benefits;
- severe systemic diseases, bleeding disorders;
- period of pregnancy;
- cachexia, severe exhaustion of the body.
The bandage performs a supporting function, prevents the exit of the abdominal organs into the inguinal canal. It is prescribed before and after surgery for young children and adult patients. It helps in restoring muscle tone in the late period of rehabilitation, when it is already possible to include physical activity and exercise therapy.
Can an inguinal hernia go away on its own with constant wearing of a bandage:
- the supporting bandage does not heal, it only prevents infringement;
- prolonged wearing only aggravates the condition, the abdominal muscles weaken;
- the bandage is selected individually, if it does not fit, there will be no benefit;
- it is contraindicated in case of infringement and dermatological diseases.
What to do with a hernia in a child
Currently, the only effective treatment option for a hernia in a child is hernioplasty, surgical excision and inguinal canal plasty. Treatment is planned, prescribed from 6 months.
With a complicated defect in girls, an emergency operation is indicated, otherwise there is a risk of death of the fallopian tube and ovary, which leads to infertility. With a strangulated hernia in a boy, attempts are first made at conservative treatment, reduction. If there is no result, an operation is performed.
After surgical treatment, the child is shown a bandage, diet, regular wound treatment, for which an antibacterial ointment is used. The treatment prognosis is favorable, recurrence occurs in 1 child out of 100, which is associated with a violation of the operation technique. After hernia repair, there is a risk of complications such as lymphocele, high position of the testicle, lymphostasis.
Acquired hernias in the groin are removed by hernioplasty in 4 stages:
- Creation of access to the inguinal canal.
- Isolation of the hernial sac and its removal.
- Sewing up the inguinal ring to normal size.
- Canal plastic.
Tension hernioplasty according to Lichtenstein is the gold standard of treatment. It is performed under anesthesia, an anesthetic is injected into the spinal cord. Then an incision is made about 5 cm parallel to the inguinal ligament, the tissue and the area where the muscles pass into the tendons are dissected. The next step will be the separation of the aponeurosis from the spermatic cord and its fixation with a special holder. The contents of the bag are returned to their place, and then a mesh is applied, which will further prevent the exit of the peritoneal organs into the inguinal canal. The last stage is the suturing of the aponeurosis and suturing.
Complications and relapse
After hernia repair, there is a risk of relapse, re-entry of organs into the inguinal canal. This phenomenon occurs in about 5% of adults and 1% of children. The reasons may be the mistakes of the surgeon, non-compliance with recommendations after surgery and anatomical features. Repeated protrusion can also provoke a chronic cough, a quick return to physical work after removal, constipation and purulent processes in the area of the surgical suture.
Complications after surgery:
- infection and purulent inflammation of the wound - a dangerous consequence, occurs when the rules of asepsis and antisepsis are not followed, in case of improper care of the sutures;
- hematoma is the result of tissue trauma, it can be prevented if a cold compress is applied to the wound immediately after surgery;
- dropsy - an increase in the scrotum can be unilateral or bilateral;
- thrombosis of the veins of the lower leg - more often occurs in older people, it does not pose a danger, if only anticoagulant treatment is started on time;
- damage to the intestine - a consequence of improper processing of the contents of the bag, occurs after the removal of a sliding hernia, the surgeon can also touch the bladder.
Rehabilitation after surgery
To prevent recurrence and complications after surgery, it is recommended:
- abandon the heavy load on the abdominal muscles;
- balance the diet, exclude foods that contribute to constipation;
- wear a bandage while performing various physical work;
- undergo a scheduled examination by a surgeon;
- treat the surgical wound and change the bandage regularly;
- after recovery, work on strengthening the muscles of the abdominal wall.
After the operation, a supporting bandage should be used in children, in the future the child can be enrolled in the pool for moderate exercise and maintaining the general tone of the body. After childbirth, prophylaxis is standard, women are advised to be examined by a gynecologist to exclude complications in the pelvic organs. And in case of a predisposition, it is important to regularly wear a bandage during the entire period of pregnancy and for some time after the birth of a child.