A. The most common location for hernias is the groin. Inguinal and femoral hernias occur in this region and are defined by the location of the opening of the hernia from the abdomen to the groin. A sports hernia (also known as Gilmore's groin) occurs when there is a weakening of the muscles of the lower abdominal wall, the same region where an inguinal hernia occurs.
Other types of hernia include umbilical, epigastric, lumbar, internal, and spigelian hernias, all occur at different sites over the abdomen in areas that are prone to anatomical or structural weakness. With the exception of internal hernias (within the abdomen), these hernias are commonly recognized as a lump or swelling and are often associated with pain or discomfort at the site. A hiatus hernia occurs when part of the stomach pushes through the diaphragm separating the chest and the abdomen. In other instances, a hernia can form under the scar of an operation, in which case it is called an incisional hernia.
A. Inguinal hernias are more likely to develop on both sides. This is probably because the structural elements develop symmetrically and the stresses that occur over time are similar. When a patient becomes aware of a groin swelling on one side, examination by a doctor will often identify a small hernia on the opposite side.
A. Not all lumps or swellings on the abdominal wall or in the groin are hernias. A doctor should evaluate any such swelling. Other possible causes include growths or enlarged lymph nodes. These problems require entirely different types of evaluation and treatment.
A. A recommendation for hernia repair surgery should only be given after a comprehensive assessment to ensure the most successful outcome. New advances have led to the development of techniques, which allow for rapid recovery in addition to a very low risk of recurrence. Surgeons who have interest in this type of surgery will be able to discuss the full range of surgical options.
A. Some types of hernia do not require surgery such as an uncomplicated hiatus hernia. Hernias that are at risk of complications developing, cause pain, or limit activity, should be repaired. If a hernia is not repaired, there is a risk that an emergency procedure may be required at a later date. If you are fit enough for surgery, surgery is generally recommended especially for femoral, inguinal and umbilical hernias. Most incisional hernias should also be repaired.
Sometimes, a hernia can be temporarily controlled by wearing a belt-like device called a truss. The truss applies external compression, pushing the tissues back into the abdomen and holding them there. The truss must be carefully applied on a daily basis and should only be used for selected situations following careful evaluation by your doctor.
Without surgery, you simply tolerate the hernia. Wearing a truss or binder may temporarily control the bulge from increasing in size, but it will not permanently cure the hernia. Only surgery can permanently correct the hernia defect.
If you decide not to undergo surgery, the hernia is likely to gradually increase in size over time. You also run the risk that it may not go back in on lying down (become stuck or incarcerated). This can lead to impaired blood supply in the bowel or fatty tissue within the hernia, leading to gangrene. When the blood supply is cut off, the hernia is termed strangulated. This would require emergency surgery to fix it. Repairing a hernia before it becomes incarcerated or strangulated is much safer than waiting until complications develop.
A. Fortunately, most hernia repairs (except in children) can be done with a variety of anaesthetic methods. With modern general anaesthetic techniques and monitoring, general anaesthesia (inducing "sleep") can be very safe. However the surgery can also be performed under local anaesthesia or regional anaesthetics often at the same time using sedation medications to help relax the patient. The specific type of anaesthetic for an individual patient is selected after careful evaluation of the patient's general health and individual concerns.
A. Most groin hernias can be performed as a day case while other hernia repairs require an overnight stay. The need to stay in hospital will be determined according to the extent of the operative procedure and your general health.
A. Modern surgical techniques which include laparoscopic repair and open 'tension free repair' enable rapid recovery. For most patients, this means there is very little discomfort post-operatively but it is best to avoid anything strenuous for four to six weeks after surgery.
Most patients can drive within a few days of surgery. However it is important that you take someone with you the first time you go out in case you are not up to completing the journey. You should also ensure that you are able to perform an emergency stop without experiencing any discomfort.
A. In experienced hands using modern surgical techniques including mesh to support the hernia repair, the risk of the hernia coming back (getting a recurrence) is less than 1%.
A. Some doctors have questioned whether using a plastic mesh to perform a tension-free inguinal hernia repair might affect sexual function. Although the healing process can lead to some hardening and shrinkage of the mesh, there is no evidence that hernia surgery affects sexual function.
A. Unfortunately, exercising to improve a hernia may in fact aggravate the condition. The hernia exists because of a localised tear or absence of muscle and supporting structures. Exercise can strengthen the surrounding muscles, thereby worsening the localized weakness and increasing the pressures inside the abdomen. The result is that more tissue can be forced through the defect and enlarge the hernia.
A. Most of the factors that lead to the development of hernias are beyond the control of the individual. Some of those factors are inherited and develop as the individual grows. The arrangement of the local tissues and their thickness and strength may greatly affect the relative risk of hernia over a lifetime. However, that risk can be increased by:
failure to use good body mechanics when lifting
poor abdominal support posture
being overweight
smoking
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