Inguinal hernia

A Inguinal hernia (inguinal hernia) is a physical disease affecting the inner abdominal wall. The custom wall breaks in the area of ​​the groin, so that the abdominal organs are no longer held in the interior of the abdomen. The most noticeable signs of an inguinal hernia are strong abdominal bulges and abdominal swelling, 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 an inguinal hernia?

Of the Inguinal hernia (medical inguinal hernia) is a rupture of the soft tissue in the area of ​​the inguinal canal. A distinction is made between direct (mostly internal) and indirect (mostly external and internal) inguinal hernias.

The difference is that the indirect fractures are mostly 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 and less for therapy. The inguinal hernia occurs in young and old. The male sex is affected significantly more often due to the anatomy.

causes

Of the Inguinal hernia usually arises on the floor 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, screaming in the infant) can create a gap through which mostly parts of the intestine or even only a large network (this is fat between the intestinal loops) can pass.

The indirect, congenital inguinal hernias show up as a painless swelling in the central inguinal canal in the infant. If the pressure in the abdominal cavity rises, loops of the intestine are pushed through an open channel (processus vaginalis testis). In this type of hernia, the viscera are usually easy to push back.

The acquired inguinal hernias also rarely show pronounced symptoms. Here, too, only a swelling and possibly a slight pain or feeling of pressure point the way. Severe pain - especially if it occurs suddenly - is suspect that the inguinal hernia is trapped. Intestinal parts pass through the hernia, swell due to the squeezed out blood flow and can therefore no longer be pushed back into the abdomen.

A pinched inguinal hernia is an absolute surgical emergency, as the intestine is no longer supplied with blood and would die without treatment. The intestinal parts that are not supplied with blood can easily become infected, which can lead to life-threatening peritonitis.

Symptoms, ailments & signs

Depending on whether the hernia is larger or smaller, the symptoms are more severe or weakened. In the case of a weakened form, it pulls in the groin area with normal movements. As soon as the person is resting, this pulling feeling disappears.

If it is a larger break (hernia), an outwardly pressed bulge can be seen. In many cases, this bulge can be pushed back again. The person also suffers from pain. These symptoms also subside as soon as the patient rests or lies down. If there is a break up to the testicles, a swollen scrotum is a typical sign of this disease.

Severe pain can be observed in patients where tissue or organs have become trapped as a result of the resulting break. 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 jammed or affected tissue can die due to insufficient supply. 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 can also complain of pain. A doctor should also be consulted immediately here, as internal organs can also be affected.

Complications

Complications are rare with an inguinal hernia. In principle, however, sequelae 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 trapping of the contents of the hernial sac within the hernial gap. This results in the blood supply to the intestinal area in the hernial sac being interrupted, which occurs through strangulation. In the further course there is a risk of the intestinal part dying off.

Another serious consequence is the development of peritonitis (inflammation of the peritoneum), which can become life-threatening. However, if a surgical procedure takes place in good time, this risk can be prevented. In an emergency operation, the mortality rate is five to ten percent.

However, complications can also be caused by an operation on the inguinal hernia. It is possible that the vas deferens may be damaged. A narrowing of the inguinal canal vessels is also conceivable. As a result, the testicles recede in men. If a leg vein is narrowed, 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 the intestine, inflammation and wound infections. However, due to modern surgical methods, these after-effects are rarely seen.

After an inguinal hernia operation, there is a risk of relapse, which depends on the particular surgical procedure and the condition of the connective tissue. Around five to ten percent of all patients are affected by a recurrence of the inguinal hernia.

When should you go to the doctor?

A doctor should be consulted immediately if an inguinal hernia is suspected. If typical symptoms such as nausea and vomiting or pain in the groin area occur, this must be clarified by your family doctor or a gastroenterologist. If the characteristic bump appears, it is best to see a doctor immediately. Parents who notice a bulge in their child's groin should consult their pediatrician. Emergency medical services should be called in the event of warning signs such as stabbing pain or blood in the stool that indicate an entrapment of the bowel.

The affected person must then receive intensive medical care to avoid serious complications. With early treatment, tissue and organ damage can usually be ruled out. Overweight, pregnant women and boys with undescended testicles are particularly prone to an inguinal hernia. Athletes and people with congenital connective tissue weakness also belong to the risk groups and should confer with a specialist in the event of the complaints mentioned. Patients who have already suffered an inguinal hernia inform the doctor responsible if symptoms recur.

Treatment & Therapy

In order to prevent an entrapment, an asymptomatic one is also less Inguinal hernia operated at a freely selectable time (elective). The much-advertised alternative therapy with a truss ligament only makes sense if an operation cannot be performed for various reasons. The problem is that the trusses take on additional work to hold the muscles and weaken them. As a result, the opposing force holding the intestines in the abdomen decreases.

Different surgical techniques are possible depending on the demands on the load capacity. If the person concerned wishes a minimally invasive procedure (using a laparoscopy), a plastic mesh is always inserted in adult patients. The operation can be performed in two ways. Either the peritoneum is not opened (TEPP) or an 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 the insertion of foreign material. Classic procedures are the Lichtenstein operation (a plastic mesh is also inserted) and the Shouldice operation (closure of the hernia 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 this thanks to the reduced surgical risks.

Outlook & forecast

The prognosis mainly depends on whether or not the operation is carried out on time. If the symptoms are ignored or not treated, the inguinal hernia enlarges. Self-healing is impossible. Life-threatening complications can occur. Surgeons have now amassed a great deal of knowledge about the operation of an inguinal 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 elderly patients and in a difficult situation.

Potential complications relate primarily to entrapment of the viscera. This can cause the disease to spread to the entire abdominal cavity or damage the reproductive organs. However, such situations are very rare. The fracture occurs again in five to ten percent of all successful operations, which doctors call recurrent. However, there is also a favorable outlook after repeated surgery.

Patients prevent a recurrence of the inguinal hernia by not lifting heavily and eating easily digestible food for up to six months after surgery. Medical treatment according to European standards promises lifelong freedom from symptoms.

prevention

Since the congenital weakness of the connective tissue cannot be changed, direct prevention is difficult. The muscular jacket can only be strengthened through exercise. Alternating showers are able to tighten the connective tissue somewhat. The focus in prevention is on avoiding increased pressure in the abdomen. This can e.g. can be achieved through weight reduction, measures to regulate defecation or correct lifting of heavy loads.

Aftercare

Since an inguinal hernia is treated with a surgical procedure, careful follow-up care is necessary. Even after a successful operation, the patient has to go through numerous check-ups that serve as follow-up care. The condition of the groin and the abdomen is usually examined. Scar care is also part of these examinations.

However, a one-time and successfully treated inguinal hernia is no guarantee that a hernia will not recur. Therefore, aftercare for this disease also includes actively preventing another hernia. These follow-up measures include minimizing risk factors, although medical supervision is sometimes appropriate.

For example, if those affected are severely overweight, a doctor can supervise the weight reduction and monitor the patient's state of health. A general element of follow-up care for an inguinal hernia is to discuss sports activities with the doctor. Certain types of sport, movement sequences and loads increase the pressure that prevails in the abdominal cavity and thus promote an inguinal hernia.

These factors need to be reduced as part of the aftercare so that there is no new hernia. After surgical treatment of the first inguinal hernia, it is also advisable to quit smoking or at least severely limit nicotine consumption. Medical supervision is also recommended here. Refraining from smoking also reduces the likelihood of another hernia.

You can do that yourself

A weak hernia does not necessarily have to be operated on. Most of the time, it is possible to prevent the break from spreading through an adapted behavior.

Those affected should not lift heavy loads and avoid strenuous sports such as football or weight training. In addition, you must not press too hard when defecating. If a normal weight is also observed, the hernia can be kept at the original level. However, pain can still occur and is best relieved by bed rest and relaxation. Cramping and entrapment can be reduced by walking upright and stretching regularly. In addition, cold helps in the form of cooling batteries, ice packs or frozen vegetable packs from the freezer. Hot water bottles and cherry stone pillows help with tension.

If you have a severe hernia, you should see a doctor and make an appointment for the operation. After the procedure, rest is indicated. Children should spend at least a few days in bed; adults should take a break of two to three days. After that, greater efforts should initially be avoided. Both classic painkillers and natural remedies such as valerian or passion flower help against pain. In addition to symptomatic treatment, the causes of the inguinal hernia must be determined and specifically addressed in order to avoid a new hernia.