Hernias are associated with men lifting something of excess weight. This strain causes a painful bulging in the groin or pubic area, which can be temporarily disabling. This picture is certainly most common but not exclusive. Males have two small windows in the lower abdominal wall known as the inguinal canals, which do not exist in females. This natural weak spot in males is vulnerable to straining which can push some of the abdominal wall or even internal contents such as loop of intestine through the canal area. The classic situation at onset is acute straining to push, pull or lift something that is beyond an individual's ability. However, other medical conditions such as chronic cough, obesity, generally poor conditioning, and family history of hernias predispose one to this problem. The large majority of people who have this problem are males and located in the pubic area. Men or women can develop a similar weak spot and bulging of the abdominal wall centered on the navel or umbilicus. Less common are infants with a hernia or a hernia that actually is in the groin area as it tracks into the thigh following the femoral blood vessels.
The concern is with the pain that is usually associated with most hernias. With time and rest, the discomfort subsides but the defect with abdominal wall weakness persists. As regular or strenuous activities resume, the discomfort returns. Few hernias can be without severe discomfort or go unnoticed. Most are obvious in appearance and associated with some symptoms. If the protrusion of internal tissue through the abdominal wall is sufficient, pain is more severe, strangulating the blood supply to that bundle of tissue. This becomes a medical emergency to relieve the pressure or "reduce" the hernia. Lying flat on your back with gentle steady pressure applied to the area with a flat hand may relieve the acute pressure and discomfort. If not, emergency surgery is needed. In general, hernias are problems that need surgery to repair the defect in the abdominal wall on an elective basis in order to prevent complications that are more serious. No medication exists that can fix the problem. Use of a belt-like device known as a truss to apply supportive pressure over the area is antiquated and ineffective.
Diagnosis by a health care provider is usually straightforward. The history of the onset is both compelling and characteristic. Brief physical exam can usually confirm the obvious. If a hernia is small on exam, an imaging study such as an ultrasound or CT scan of the abdomen may be necessary to detect the problem. Once the diagnosis is established, elective surgical consultation is in order.
Hernia repair is one of the most commonly performed surgeries. The technique has become quite good. If of average size, small incisions are used to place a piece of synthetic mesh over the defect to reinforce the abdominal wall. A fiber-optic operating scope and small surgical instruments enable access the problem. This has become an outpatient day-surgery event with a recovery period of two to four weeks.
How do I avoid a hernia? The same fundamentals are important. Maintain a reasonable weight, high-fiber diet, don't smoke and exercise regularly. Know your limits at work or home. Get help with lifting or moving heavy objects while using good body mechanics to lift. Work smart and safely.
