Inguinal Hernia | Cause, Symptoms, Diagnosis, Privention & Homeopathy
The abdomen is surrounded by
numerous muscles to keep the stomach, small intestine, and colon where they
belong, but if one of these organs starts to slip though a weakness or a hole
in the muscles, it's called a hernia.
Hernias by themselves may
be asymptomatic (produce no symptoms), but nearly all have a potential risk of
having their blood supply cut off (becoming strangulated). If the blood supply
is cut off at the hernia opening in the abdominal wall, it becomes a medical
and surgical emergency as the tissue needs oxygen which is transported by the
blood supply.
What cause hernia?
Mainly 2 factors play in causing
an inguinal hernia:-
1. Weakness of the abdominal
muscles and
2. Increased abdominal pressure
which forces the content out the normal abdominal musculature.
Weakness of the abdominal musculature
may be
a. CONGENITAL WEAKNESS
i.
Persistence of processus vaginalis.
ii.
Patent canal of Nuck in female.
b. ACQUIRED WEAKNESS
i.
Excessive fat in the abdomen causes weakness of
the abdominal musculature. Fat separates muscle fibers and thus causes
weakness.
ii.
Muscle weakness may follow repeated pregnancy.
iii.
Surgical incisions may lead to division of nerve
fibres and thus causes muscle weakness.
iv.
Incisional hernia develops through weakened
abdominal muscle following a previous operation.
Increased abdominal pressure e.g.
i.
Whooping cough in children.
ii.
Chronic cough in bronchitis,tuberculosis etc.
iii.
Bladder neck obstruction or urethral stricture.
iv.
Enlarged prostate causing dysuria.
v.
Powerful muscular effort or straining during
lifting heavy weight.
vi.
Vomiting.
vii.
Repeated pregnancy.
viii.
Constipation
Important
Local examinations
The patient is asked to turn his face away from the clinician and to
cough. This is done to avoid the salivary shower from the patient. Look
carefully at the superficial inguinal ring. If a swelling already exists, it
will expand during coughing as more abdominal contents will be driven out into
the hernia sac due to increased abdominal tension (expansile cough impulse). If
a swelling was not present a momentary bulge may be seen synchronously with the
act of coughing. Presence of expansile cough impulse is almost diagnostic of a
hernia, but absence of this sign does not exclude a diagnosis of hernia. If the
neck of the sac is blocked by adhesions additional viscera will not get access
into the sac during coughing.
Position of the penis
This is only important in case of inguinal hernia. A large hernia in the
scrotum will push the penis to the other side.
TYPES OF INGUINAL HERNIA
ANATOMICAL TYPES
Three types of classification can
be made under this heading.
According to the extent of the
hernia it can be
1. Bubonocele: - When the
hernia does not come out of the superficial inguinal ring.
2. An incomplete hernia: -
When it comes out through the superficial inguinal ring but fails to reach the
bottom of the scrotum.
3. A complete hernia: - When it reaches the bottom of the scrotum.
According to its site of
exit it can be either
1. An oblique (indirect)
hernia: - When hernia comes out
through the deep inguinal ring i.e. lateral to the inferior epigastric artery.
2. A direct hernia: - When it comes out through the Hesselbach’s
triangle which is bounded medilly by the lateral border of the rectus abdominis
, laterally by the the inferior epigastric artery and below by the inguinal
ligament.That means the neck of the sac lies medial to the inferior epigastric
artery.
According to the contents of
the hernia, a hernia may be either
1. An enterocele: - When it contains the intestine(enteron).
2. An epiplocele or omentocele: - When it contains omentum
3. A cystocele
Signs and symptoms of inguinal hernia
At first, an inguinal hernia
either may not cause any symptoms or may cause only a feeling of heaviness or
pressure in the groin. Symptoms are most likely to appear after standing for
long Periods, or when you engage in activities that increase pressure inside
the abdomen, such as heavy lifting, persistent coughing or straining while
urinating or moving the bowels.
As the hernia grows, it eventually causes an abnormal bulge under the
skin near the groin. This bulge may become increasingly more uncomfortable or
tender to the touch. As the hernia increases in size, a portion of herniated
intestine may become trapped and unable to slide back into the abdomen. If this
happens, there is a danger that the trapped intestine may twist and die because
its blood supply is cut off. This causes severe pain and requires immediate
treatment. If the hernia is obstructing the lumen of the bowel, cardinal
symptoms of intestinal obstruction will appear. These are colicky pain in
abdomen, vomiting, abdominal distension and absolute constipation.
The causes of hernia must be enquired into. Persistent coughing of whooping
cough or chronic bronchitis,constipation,dysuria due to benign enlargement of
prostate or stricture urethra may show may show other symptoms which the
patient deliberately do not mention considering them irrelevant. Ask about the
past history also. Whether the patient had any operation or not? Many patients
give a previous history of hernia repair on the same side(recurrent hernia) or
on the opposite side(right sided hernia generally precedes that of the left
side).
How Inguinal hernia is diagnosed?
Hernias
are usually easy to diagnose on physical examination. Typically, a hernia sac
with its contents enlarges and transmits a palpable impulse when the patient
strains or coughs. Hernias, undetectable by physical examination, can sometimes
be demonstrated using ultrasound, CT scan (computerized tomography), or MRI
(nuclear magnetic resonance imaging). None of these tests are as sensitive as
physical examination. The most sensitive method of diagnosing a hernia is a
diagnostic laparoscopy. This procedure, done under general anesthesia, utilizes
a scope placed into the abdominal cavity to directly view the abdominal wall.
TREATMENT OF INGUINAL HERNIA
Operation is undoubtedly the
treatment of choice in a case of inguinal hernia. A hernia is a mechanical
defect that the body cannot repair. Since the defect in the abdominal wall is a
defect in the connective tissue of the abdomen (called fascia), strengthening
the abdominal wall musculature with exercise does not repair the hernia. In
patients who are at high risk for surgery sometimes a trus or support is used
to minimize the symptoms of the hernia. These devices are not curative but only
attempt to control symptoms in patients that cannot have their hernias fixed.
OPERATIVE TREATMENT
Three types of operation are
usually performed for inguinal hernia-
1. Herniotomy
In
this operation the neck of the sac is transfixed and legated and then the
hernia sac is excised. No repair of the inguinal canal is performed. It is
indicated –
(a) In infants and children in
whom there is a preformed sac.
(b) In case of young adults with
very good inguinal musculature.
2. Herniorrhaphy
It consists of herniotomy+repair
of the posterior wall of the inguinal canal by apposing the conjoined tendon to
the inguinal ligament. The suture material which is used for such repair is usually
non absorbable material e.g.proline or silk. The repair is usually done behind
th spermatic cord which is known as Bassini’s operation.
3. Hernioplasty
This means herniotomy + reinforced repair of the posterior wall of the
inguinal canal by filling the gap between the conjoined tendon and inguinal
ligament by autogenous material or by heterogenous material.
LAPAROSCOPIC INGUINAL HERNIA REPAIR
Laparoscopic hernia repair is similar to
other laparoscopic procedures. General anesthesia is given, and a small cut
(incision) is made in or just below the navel. The abdomen is inflated with air
so that the surgeon can see the abdominal organs.
A thin,
lighted scope called a laparoscope is inserted through the incision. The
instruments to repair the hernia are inserted through other small incisions in
the lower abdomen. Mesh is then placed over the defect to reinforce the
abdominal wall.
There are
many things to consider when deciding if you should have inguinal hernia repair
surgery, such as whether your hernia is incarcerated or strangulated and
whether you have other conditions that need to be addressed before hernia
repair surgery is appropriate.
Complications of Inguinal hernia
An untreated hernia may be complicated by:
- Inflammation
- Irreducibility
- Obstruction of any lumen, such as bowel
obstruction in intestinal hernias
- Strangulation : A strangulated hernia is
a serious condition and requires immediate medical attention.
- Hydrocele of the hernial sac
- Haemorrhage
- Autoimmune problems
Incarceration, which is where it cannot be reduced or pushed back into
place, at least not without very much external effort
HOMOEOPATHIC MANAGEMENT
Homeopathy works well
in chronic complaints and tumours. Lots of patients come for Homeopathy
treatment for hernia fearing surgery. In fact, hernia is not at all a disease;
it is just like a tear which surely needs to be stitched. More the tear, more
will be the bulge and there will be more chances for strangulation and pain.
But it is better to opt for surgery to avoid complications. Homeopathy can
reduce the pain, discomfort, complication and recurrence.
Regarding management, hernia in
the initial stages can be managed well with care (restrictions) and homeopathic
medicines. Any way cure is impossible.
Homeopathic medicine
commonly used for treating hernia are Arnica, Causticum, Cascara, Cocculus, Colocynthis, Lycopodium, Mag
carb, Nitric acid, Nux vom, Rhus tox, Silicea, Sulphur, Veratrum album, etc.
Repertory to inguinal hernia
KENT’S REPERTORY
ABDOMEN, HERNIA,.Inguinal
: Æsc., all-c., alum., am-c., apis., asar., aur., berb.,
calc-ars., calc., carb-an., carb-v., cocc., coff., dig., ip., lach., Lyc.,
mag-c., mill., mur-ac., nit-ac., Nux-v., op., petr.,
phos., prun-s., psor., rhus-t., sars., sil., spig., staph., sul-ac.,
sulph., ter., thu., verat., zinc.
strangulated : Acon., all-c., alum.,
ars., Bell., carb-v., cocc., coff., dig., ip., lach.,
mill., Nux-v., Op., plb., rhus-t.,
sul-ac., sulph., tab., verat.
painful : Alum., cic.,
cocc., sil.
children, in : Aur., lyc.,
nit-ac., nux-v.
right : Aur., lyc.
left : Nux-v.
inflammation : Acon., nux-v.,
op., sulph.
with vomiting : Acon., ars.,
bell., lach., tab., verat.
sensitive : Bell., Lach.,
nux-v., sil.
Umbilical : Calc.,
lach., nux-m., Nux-v., op.
Homeopathic medicines
NUX VOMICA
Sudden violent pain in hernial region.
Drawing, tearing and spasmodic constriction in the abdomen , with nausea ,
vomiting of sour mucus. Constipation with ineffectual urging to stool. Slow
protrusion in aged people, with squeezing pain in hernia region, fullness in
abdomen, periodical nausea.Sour taste, and nausea in the morning, after eating.
Weight and pain in stomach; worse, eating, some time after. Flatulence and
pyrosis. Sour, bitter eructations.
OPIUM
Incarcerated and inguinal herniae. Soporous
condition with red face , distended abdomen with flatus. Antiperistaltic motion
, belching and vomiting , bowels absolutely closed with urging to stool and
urine. Stomach.--Vomiting, with colic and convulsions. Fecal vomiting.
Incarcerated hernia. Hungry; no desire to eat.Abdomen is hard and bloated.
Obstinate constipation; no desire to go to stool. Round, hard, black balls.
Feces protrude and recede . Spasmodic retention of feces in small intestines.
Stools involuntary, black, offensive, frothy
SULPHURIC ACID
Colic
with sensation as if hernia would protrude. Inguinal hernia, incarcerated
hernia in old people , coming on in a very gradual manner. Pinched, constricted
feeling in hernia. Sensation of fullness in abdomen periodical nausea and
constipation. Hernia not very sensitive. Hernia on left side of persons of a
melancholy phlegmatic temperament. Periodical transient tearing pains, constant
nausea, belching of sweet, salty or bitter fluid, finally vomiting. Gradual
accumulation of flatus.
4.LYCOPODIUM
Best adapted to
persons intellectually keen, but of weak, muscular power. Dyspepsia due to
farinaceous and fermentable food, cabbage, beans, etc. Excessive hunger.
Aversion to bread, etc. Desire for sweet things. Food tastes sour. Sour
eructations. Great weakness of digestion. Bulimia, with much bloating. After
eating, pressure in stomach, with
bitter taste in mouth. Eating ever so little creates fullness. Cannot eat
oysters. Rolling of flatulence (Chin; Carb). Wakes at night feeling hungry.
Hiccough. Incomplete burning eructations rise only to pharynx there burn for
hours. Likes to take food and drink hot. Sinking sensation; worse
night.Immediately after a light meal, abdomen is bloated, full. Constant sense
of fermentation in abdomen, like yeast working; upper left side.. Pain shooting
across lower abdomen from right to left. Right sided inguinal hernia.Crural
hernia in women. Lacerating , stiching pains. Distension of abdomen with
rumbling of gas.Hot patient with desire for warm food and warm drinks.Easy satiety.Ineffectual
urging.Stool hard ,difficult,smalland incomplete.
COCCULUS INDICUS
Abdomen is distended,
with wind, and feeling as if full of sharp stones when moving; better, lying on
one side or the other. Pain in abdominal ring, as if something were forced
through. Abdominal muscles weak; it seems as if a hernia would take place. Nausea
from riding in cars, boat, etc, or looking at boat in motion; worse on becoming
cold or taking cold. Nausea, with faintness and vomiting. Aversion to food,
drink, tobacco. Metallic taste. Paralysis of muscles preventing deglutition.
Dryness of œsophagus. Seasickness (Resorcin. 1x). Cramp, in stomach during and
after meal. Hiccough and spasmodic yawning. Loss of appetite. Desire for cold
drinks, especially beer. Sensation in stomach as if one had been a long time
without food until hunger was gone. Smell of food disgusts .
CALCAREA CARBONICA
Persons of scrofulous
type, who take cold easily, with increased mucous secretions, children who grow
fat, are large-bellied, with large head, pale skin, chalky look, the so-called
leuco-phlegmatic temperament; affections caused by working in water. Great
sensitiveness to cold; partial sweats. Children crave eggs and eat dirt and
other indigestible things; are prone to diarrhœa. Calcarea patient is fat,
fair, flabby and perspiring and cold, damp and sour Aversion to meat, boiled
things; craving for indigestible things-chalk, coal, pencils; also for eggs,
salt and sweets. Milk disagrees. Frequent sour eructations; sour vomiting.
Dislike of fat. Loss of appetite when overworked. Heartburn and loud belching.
Cramps in stomach; worse, pressure, cold water. Ravenous hunger. Swelling over
pit of stomach, like a saucer turned bottom up. Repugnance to hot food. Pain in
epigastric region to touch. Thirst; longing for cold drinks. Aggravation while
eating. Hyperchlorhydria
Abdomen sensitive to
slightest pressure. Cutting in abdomen; swollen abdomen. Incarcerated flatulence.
Inguinal and mesenteric glands swollen and painful. Cannot bear tight clothing
around the waist. Distention with hardness. Increase of fat in abdomen.
Umbilical hernia. Trembling; weakness, as if sprained. Crawling and
constriction in rectum. Stool large and hard (Bry); whitish, watery, sour.
Constipation; stool at first hard, then pasty, then liquid.
SILICEA
Disgust for meat and
warm food. On swallowing food, it easily gets into posterior nares. Want of
appetite; thirst excessive. Sour eructations after eating. Pit of stomach
painful to pressure. Vomiting after drinking .Pain or painful cold feeling in
abdomen, better external heat. Hard, bloated abdomen. Colic; cutting pain, with
constipation; yellow hands and blue nails. Much rumbling in bowels. Inguinal
glands swollen and painful. Rectum feels paralyzed. Stool comes down with
difficulty; when partly expelled, recedes again. Great straining; rectum
stings; closes upon stool. Feces remain a long time in rectum. Constipation
always before and during menses; with irritable sphincter ani.Silica patient is
cold, chilly, hugs the fire, wants plenty warm clothing, hates drafts, hands
and feet cold, worse in winter. Lack of vital heat. Prostration of mind and
body. Great sensitiveness to taking cold. Intolerance of alcoholic stimulant.
ZINCUM MET
Painful pressing in
left groin asif hernia would occur.Drawing pain in left inguinal region while
sitting.Hiccough, nausea, vomiting of bitter mucus. Burning in stomach,
heartburn from sweet things. Cannot stand smallest quantity of wine. Ravenous
hunger about 11 am. Great greediness when eating; cannot eat fast enough.
Atonic dyspepsia, feeling as if stomach were collapsed.Pain in abdomen after a
light meal. Pain in spot beneath navel. Gurgling and griping; distended.
Flatulent colic, with retraction of abdomen.Hard, small, constipated stool.
PLUMBUM MET
Right sided
strangulated hernia.Severe pain with continual vomiting of feculent matter.
Contraction in œsophagus and stomach; pressure and tightness. Gastralgia.
Constant vomiting. Solids cannot be swallowed.Excessive colic in abdomen,
radiating to all parts of body. Abdominal wall feels drawn by a string to
spine. Pain causes desire to stretch. Intussusception. Abdomen retracted.
Obstructed flatus, with intense colic. Colic alternates with delirium and pain
in atrophied limbs.Constipation; stools hard, lumpy, black with urging and
spasm of anus. Obstructed evacuation from impaction of feces. Neuralgia of
rectum. Anus drawn up with constriction. The great drug for general sclerotic
conditions. The blood, alimentary and nervous systems are the special seats of
action of Plumbum. Constrictive sensation in internal organs.
NITRIC ACID
Umbilical and
inguinal hernia in children.Pain in abdomen when walking;must bend
forward.Stinging soreness when touched.Great hunger, with sweetish taste.
Longing for indigestible things-chalk, earth, etc. Pain in cardiac orifice.
Dyspepsia with excess of oxalic acid, uric acid and phosphates in urine and
great mental depression. Loves fat and salt.Great straining, but little passes,
Rectum feels torn. Bowels constipated, with fissures in rectum. Tearing pains
during stools. Violent cutting pains after stools, lasting for hours.
Hæmorrhages from bowels, profuse, bright. Hæmorrhoids bleed easily. Diarrhœa,
slimy and offensive. After stools, irritable and exhausted. Colic relieved from
tightening clothes.
LOBELIA INFLATE
Incarcerated
hernia. Languor, relaxation of muscles, nausea, vomiting and dyspepsia are the
general indications that point to the use of this remedy, in asthma and gastric
affections. Best adapted to light complexioned fleshy people. Acidity,
flatulence, shortness of breath after eating. Heartburn with profuse flow of
saliva. Extreme nausea and vomiting. Morning sickness. Faintness and weakness
at epigastrium. Profuse salivation, with good appetite. Profuse sweat and prostration
BELLADONNA
Strangulated hernia.Loss of appetite.
Averse to meat and milk. Spasmodic pain in epigastrium. Constriction; pain runs
to spine. Nausea and vomiting. Great thirst for cold water. Spasms of stomach.
Empty retching. Abhorrence of liquids. Spasmodic hiccough. Dread of drinking.
Uncontrollable vomiting.Abdomen is distended, hot. Transverse colon protrudes
like a pad. Tender, swollen. Pain as if clutched by a hand; worse, jar,
pressure. Cutting pain across; stitches in left side of abdomen, when coughing,
sneezing, or touching it. Extreme sensitiveness to touch, bed-clothes, etc
.Stools is thin, green, dysenteric; in lumps like chalk. Shuddering during
stool. Stinging pain in rectum; spasmodic stricture.
VERATRUM ALBUM
Incarcerated
hernia,not inflamed;cough impulse present,anti peristaltic action;great
thirst,nausea,hiccogh and cold sweat.Voracious appetite. Thirst for cold water,
but is vomited as soon as swallowed. Averse to warm food. Hiccough. Copious
vomiting and nausea; aggravated by drinking and least motion. Craves fruit,
juicy and cold things, ice, salt. Anguish in pit of stomach. Great weakness
after vomiting. Gastric irritability with chronic vomiting of food.
Sinking
and empty feeling in abdomen. Cold feeling in stomach and abdomen. Pain in
abdomen preceding stool. Cramps, knotting abdomen and legs.
PREVENTION
Indirect hernias in children cannot be prevented. To reduce the risk of
inguinal hernia as an
adult, you can:
v
Exercise
regularly to strengthen abdominal muscles.
v
Avoid
strain which can increase the abdominal pressure such as
Ø Weight lifting
Ø Chronic cough.
Ø Passing urine with great difficulty (enlarged
prostate)
Ø Straining at stool due to constipation,
piles, fissure, etc.
Ø Gaining weight
Ø Taking full and heavy meal
v
Give
support to the part
Ø With hand while coughing or passing stool or
urine to avoid increase in size
Truss / bandage / padding / belt can be used as a supporter
Images from:
physiosupplies.com.au
urologyhealth.org
medicaltourismco.com
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