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“I THINK I HAVE A HERNIA - BUT WHAT IS IT
AND WHAT CAN BE DONE?”
BY CONOR MAGEE MD FRCS, CONSULTANT SURGEON
As a surgeon, I am reminded every day of the marvel that
is the human body. I can perform complex surgery and
the body will heal itself - often to the point where the scars
have faded to near-invisibility. But the body is by no means
perfect, the evolution of our anatomy over millions of years
has left its mark with a variety of “odd bits” and also some
weak points.
The most visible shortcoming of the body I see are hernias.
These are weaknesses in the abdominal wall which give rise to
lumps that can be uncomfortable or less frequently can be life-
threatening. Rupture is a term that seems to have disappeared
from common medical usage - but I doubt there is a better
descriptive term for what a patient feels when they present with
what we now call a “hernia”.
The abdomen is the favoured site for hernia’s to develop - and
men are much more prone to them than women. The most
likely site for a hernia is in the groin - a condition known as an
“inguinal hernia”. Men develop inguinal hernias because the
groin is the site of an evolutionary and anatomical curiosity
caused by their testicles. As a foetus the testicles don’t live in the
scrotum but are found near the kidneys. Over time the foetus
develops and the testicles move through the abdomen and the
muscles of the groin into the scrotum, dragging their blood
supply with them. The path they take (the “inguinal canal”)
remains a potential weak area and can become so weak that
the abdominal contents can protrude through it - causing an
inguinal hernia. Usually patients can describe when the hernia
presented - often following unexpected exertion or lifting a
heavy weight. Inguinal hernias can be small but if left untreated
can become much larger and difficult to conceal. Many of my
patients have been too embarrassed to wear shorts or swim with
their children and in extreme cases the hernia can interfere
with intercourse or urination. It is always a privilege to fix these
hernia’s and see patients get their lives back afterwards.
Fortunately, women (not having testicles) don’t suffer as
much with inguinal hernias. However, this is not a reason to
be complacent because the wider female pelvis (to help with
childbirth) increases the chances of a rarer type of groin hernia
called a “femoral hernia.” This type of hernia is rather sneaky
and can rapidly present as an emergency needing surgery
and it is crucial that any groin lump in a lady needs review
by a surgeon. In fact, a surgeon is the best person to assess all
unusual lumps and can recommend treatment if needed.
There are other places that hernias can develop - notably around
the belly button (umbilical hernia) and sometimes inside the
abdomen (hiatal hernia).
Hernia’s can be uncomfortable and interfere with daily activities
- golf can be an especial problem with inguinal hernias and they
can limit your ability to do your job. What I do worry about is
a strangulated hernia. This is a surgical emergency - simply put
the hernia pops out but doesn’t go back in. It becomes more
painful and the contents of the hernia can become gangrenous-
a life threatening situation requiring emergency surgery.
Although most hernias are unlikely to strangulate it is much
better to fix them before they become problematic. Despite the
enormous healing properties of the human body hernia’s will
not fix themselves and the only effective treatment is surgery.
Many readers may remember hernia surgery from the past
where patients had huge cuts, followed by 2 weeks in hospital
on strict bed rest and then the hernia coming back! This is not
the case today. Today the operation takes around 30 minutes
and patients are expected to go home that day and be driving
within a week. The technique we use involves placing a very
expensive specialized mesh to reinforce the weakness in the
abdominal wall- we can even do the operation using keyhole
surgery! Follow Mr Magee on Twitter @mageefrcs
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