A hernia occurs when an internal organ or other body part protrudes through the wall of muscle or tissue that usually contains it. When a defect or weakness occurs in the abdominal wall, the contents of the abdomen jut out through the defect. It affects both the genders at any age, but it is more common among men. It can be felt under the skin as a lump. Most often a hernia presents as a gradually increasing swelling, which is usually painless. Often the swelling disappears on lying down and appears or increases on standing. The swelling is usually noted in the groin as it is the most common site of a hernia. A hernia can occur in any part of the abdomen. It can also occur through the scar of previous abdominal surgery or around the umbilicus. A reducible hernia is usually painless and can be pushed back in but comes out on standing or coughing.
Sometimes, the swelling becomes painful when it increases in size or when it does not disappear. In certain patients, this could even be the first presentation. This needs urgent attention and is known as an incarcerated hernia. In certain situations, it may get aggravated and the blood flow to the hernial contents is affected leading to a strangulated hernia. This is a surgical emergency and delay in seeking surgical guidance may have serious implications for the patient.
Diagnosis
Typically, a surgeon would listen to your problem and then examine you and feel your swelling. The patient may be examined in a lying down and in standing position as well and may even be asked to cough. At the end of the examination, the surgeon would be able to diagnose your hernia. In certain situations (obesity, multiple previous surgeries), it may be difficult to diagnose a hernia by clinical method; sometimes a hernia may not present with a swelling. In such situations CT or MRI scans, ultrasound scans or further invasive methods might be necessary to diagnose a hernia.
Each investigation has its own limitation and a hernia surgeon would be able to select and utilise the test to diagnose a hernia. When it comes to surgery, there is no ‘one size fits all’ concept. Every surgery is tailor-made based on the condition of the individual undergoing it. Hence in some cases scans may be ordered to plan the surgery.
Immediately after the lockdown was announced, there were frantic visits by patients operated earlier. While they were being sorted, there were a lot of inquiries and visits by patients whose surgeries were scheduled but postponed because of the pandemic. Routine planned surgeries have been suspended as it may not be appropriate for the patients and we may end up stretching the existing resources.
Tips for patients awaiting hernia surgery
* Relax, majority of hernias are uncomplicated
* Do not lift heavyweights
* Avoid constipation by including fresh fruits and vegetables in your diet and stay hydrated
* If you have constipation or difficulty passing urine (in elderly males with the prostate problem), ask your surgeon for appropriate medications
* If you have discomfort, then lie down on your back
* On lying down, the hernia will decrease and you should feel better
* Contact your surgeon in case of any warning symptoms or discomfort
Warning
* A hernia causing pain or discomfort
* Hernial swelling not decreasing on lying down
* Increase in hernial swelling along with pain or discomfort
* Increase in the swelling with constipation or inability to pass flatus
If you experience any of the above symptoms then contact your surgeon at the earliest.
Momin is a general and laparoscopic surgeon, Apollo Spectra Hospital, Mumbai.
