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Can coughing give you a hernia: Cough-induced abdominal intercostal hernia

Содержание

Cough-induced abdominal intercostal hernia

JRSM Short Rep. 2010 Aug; 1(3): 23.

University Hospitals of Leicester, Leicester, UK

Copyright © 2010 Royal Society of Medicine PressThis is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc/2.0/), which permits non-commercial use, distribution and reproduction in any medium, provided the original work is properly cited.This article has been cited by other articles in PMC.

Cough-induced abdominal intercostal hernias are extremely rare, with only seven cases described in the literature. We report the case of a 55-year-old man with a painless right-sided abdominal lump, who had previously fractured a rib due to severe coughing. A chest X-ray was inconclusive, but ultrasound and computed tomography scans showed herniation of the liver between the seventh and eighth ribs on the right.

Case report

A 55-year-old man presented with a five-week history of a painless enlarging lump in the right upper quadrant. He recalled being told he had a fractured rib several years earlier after a particularly severe coughing episode related to chronic obstructive pulmonary disease (COPD).

Physical examination revealed a soft reducible mass on the lateral aspect of the right chest between the seventh and eighth ribs. The mass measured 10 cm × 8 cm. A cough impulse was felt, as well as a foreshortened rib anteriorly. No bowel sounds were audible over the mass.

The man had an eight-year history of COPD, and had continued to smoke 30 cigarettes a day. This required long-term inhaled corticosteroid therapy. He had a number of co-morbidities including obesity, hypertension, kypho-scoliosis and longstanding back pain. He was registered disabled, with dyspnoea and back pain limiting his exercise tolerance to 20 yards on the flat.

Chest radiographs were inconclusive, showing an old fracture of the eighth rib and right lower chest wall deformity. An ultrasound scan found a swelling with deviation of the antero-lateral abdominal wall in keeping with a hernia. Computed tomography revealed a defect in the right lower chest wall between the seventh and eighth ribs with the liver herniating through it (Figure ). There was also a defect in the 11th rib posteriorly.

CT scan showing herniation of the liver through the seventh intercostal space

As multiple co-morbidities put him at high risk for surgical intervention, it was decided not to operate but to follow him up clinically with advice to report any symptoms promptly.

Discussion

Most intercostal hernias involve penetrating or blunt abdominal injury, and so cough-induced abdominal intercostal hernia is a rare occurrence. To date, there are only seven cases described in the literature.

All of these occurred in patients over the age of 50 years, only two of them in women. Four of the cases were on the right, and three on the left. The hernial contents in these patients were lung in two, liver in two, small bowel in two, and stomach in one case. All had predisposing factors such as pneumonia, COPD, asthma and steroid therapy.

The first case was reported by Testlin and Ledon in 1970. The patient, who 25 years earlier had been involved in a car accident while a prisoner of war in Poland, developed pneumonia associated with a severe cough with pain and bruising in the lower right ribcage. The enlargement appeared over the same location a few days later, and was found to be caused by herniation of the inferior lobe of the right lung. The hernia was repaired and the breach sutured up.1

There are two previous cases involving herniation of the liver. The first was recorded in 1993, in a 75-year-old woman with asthma. The woman also reported a recent injury to the right side of her chest wall. Chest radiograph and computed tomogram confirmed both lung and liver herniation between the ninth and tenth ribs, with associated rib fractures. The hernia was reduced and a Gore-Tex® (polytetrafluoroethylene) mesh sewn onto the extrathoracic wall of the defect.2

One case occurred in a 51-year-old smoker who had experienced a severe coughing spell two months earlier, and DEXA scan later revealed low bone mineral density. In this patient, magnetic resonance imaging (MRI) was used to show protrusion of the liver through the chest wall. Initial surgery using endogenous tissue reinforcement failed, requiring the patient to undergo a second procedure four months later, this time with insertion of a Marlex mesh.3

Similar instances have taken place in patients with COPD, sarcoidosis and severe asthma exacerbation. Following incarceration, two of these patients were treated with and two without mesh repair.4–7

Development of an intercostal hernia may occur acutely or over a number of years. Chronic severe coughing can tear the intercostal muscles, and even fracture underlying ribs. Positive intrathoracic pressure which occurs during expiration, coughing, vomiting and defecation, then forces the contents out through weakened areas of the chest wall.

The chest wall is anatomically weaker from the chostochondral junction to the sternum anteriorly due to lack of external intercostal muscles, and from the costal angle to the vertebrae posteriorly due to lack of internal intercostal muscles. 8 Areas which have previously suffered trauma are particularly susceptible, something we noted in a number of the cases we reviewed. As in any intercostal hernia the hernial contents are at risk of subsequent incarceration and strangulation, but there is little evidence as to the frequency of this complication.9

Intercostal hernias are suggested by the patient’s history and examination, the usual finding being a reducible bulge on the thoracoabdominal wall. Both ultrasound and CT have been used successfully to show the hernia. Ultrasound will not determine the exact contents of the hernia, and so CT may be preferable when contemplating surgery. Chest X-ray is unlikely to provide enough information on the hernia itself, but may show evidence of previous injury. The unusual site for such a lump as well as the absence of any history of trauma may cause diagnostic difficulty, but careful examination and appropriate use of imaging can overcome this. Incarceration is the key indication for surgical intervention. One approach to treatment has been to reduce the hernia and suture the defect, with rib approximation if appropriate. However, this has been associated with recurrence, and reinforcement with a prosthetic mesh may be preferred.

DECLARATIONS

Competing interests

None declared

Ethical approval

Written informed consent to publication has been obtained from the patient or next of kin

Contributorship

ATC reviewed the evidence, drafted and revised the paper; EM performed the literature search and revised the paper

References

1. Testelin GM, Ledon F, Giordano A A propos d’un cas de hernie intercostale abdominale. Mem Acad Chir (Paris) 1970;96:569–70 [PubMed] [Google Scholar]2. Fiane AE, Nordstrand K Intercostal pulmonary hernia after blunt thoracic injury: two case reports. Eur J Surg 1993;159:379–81 [PubMed] [Google Scholar]3. Losanoff JE, Richman BW, Jones JW Recurrent intercostal herniation of the liver. Ann Thorac Surg 2004;77:699–701 [PubMed] [Google Scholar]4. Croce EJ, Mehta VA Intercostal pleuroperitoneal hernia. Thorac Cardiovasc Surg 1979;77:856–7 [PubMed] [Google Scholar]5. Cole FH, Miller MP, Jones CV Transdiaphragmatic intercostal hernia. Ann Thorac Surg 1986;41:565–6 [PubMed] [Google Scholar]6. Rogers FB, Leavitt BJ, Jensen PE Traumatic transdiaphragmatic intercostal hernia secondary to coughing: case report and review of the literature. J Trauma 1996;41:902–3 [PubMed] [Google Scholar]7. Kallay N, Crim L, Dunagan DP, Kavanagh PV, Meredith W, Haponik EF Massive left diaphragmatic separation and rupture due to coughing during an asthma exacerbation. South Med J 2000;93:729–31 [PubMed] [Google Scholar]8. Unlu E, Temizoz O, Cagli B Acquired spontaneous intercostal abdominal hernia: Case report and a comprehensive review of the world literature. Australasian Radiology 2007;51:163–7 [PubMed] [Google Scholar]9. Nielsen JS, Jurik AG Spontaneous Intercostal hernia with subsegmental incarceration. European J Cardiothorac Surg 1989;3:562–4 [PubMed] [Google Scholar]

Inguinal Hernia

A Bulge Through the Abdominal Wall

A hernia is a bulging of connective tissue (fascia) through a weak area or tear in the wall of muscle that holds the intestines in place. Although there are several types of hernias, the most common hernia is an inguinal hernia, an intestinal bulge through the abdominal wall muscle in the groin area.

Inguinal hernias are about 10 times more common in men than women, and the risk is higher in people who are obese, are chronically constipated, or have a constant cough. A small inguinal hernia may not cause symptoms. More commonly, the patient notices heaviness or pain in the groin area, especially when lifting a heavy object, straining, or coughing. A bulging out of the hernia can often be seen.

Although patients with an inguinal hernia can usually push the bulging tissue back through the muscle wall, most inguinal hernias eventually require treatment with a minor surgical procedure to avoid future

herniation of the intestinal tissue. If a segment of the intestines pushes through the muscle wall and becomes “strangled,” that is, the blood supply to the tissue is cut off, that part of the intestinal tissue can

die. This situation is a medical emergency, requiring immediate surgical repair. If the herniated tissue cannot be pushed back behind the muscle wall, symptoms of nausea and vomiting develop, or the hernia becomes dark red or purple, it is necessary to seek immediate medical attention.

Surgery Is the Most Common Treatment for Hernia

It is estimated that each year, five million Americans develop hernias, but less than one million undergo hernia repair surgery. Although hernia repair was once a major surgical procedure, modern techniques mean that in almost all cases, this surgery is done on an outpatient basis. The surgery itself usually lasts about one hour, and the patient is allowed to go home a few hours later. Return to everyday activities after surgery is often within a week or so, with certain activities restricted for a month or six weeks. During the procedure, the surgeon repositions the herniated intestine behind the abdominal muscle wall and closes the tear or weak area in the wall to keep the intestine in place. It can be performed by using a small incision (open repair) or by laparoscope (a minimally invasive instrument). In general, hernia surgery is a very successful procedure with few risks.

Causes:

Inguinal hernias can be present at birth, especially in boys, if the abdominal muscle wall does not develop correctly. The hernia can often be seen while the infant or small child is coughing, crying,

or straining during a bowel movement. Hernias that develop during adulthood may be a result of the muscle weakness that accompanies aging. Hernias are made worse with heavy lifting, constant cough-

ing, or straining on the toilet. As a result, such factors as smoking, bronchitis, or chronic constipation increase the risk of inguinal hernias.

Symptoms:

An inguinal hernia may not cause noticeable symptoms and may only be discovered during a routine physical exam of the abdomen. In most cases, however, these hernias are obvious when

standing up straight, coughing, or straining while lifting or going to the bathroom. The most common symptoms are a bulging out of an area of the lower abdomen, accompanied by pain or a feeling

of heaviness in the groin area. More Common in Men: Males of all ages are at higher risk than females for inguinal hernias, but family history also puts a person at greater risk. Any condition that causes a chronic cough, such as smoking, bronchitis, or cystic fibrosis, increases the chance of inguinal hernias. Frequent straining during urination or bowel movements is another risk factor, as are increased weight and pregnancy, which increase the pressure on the abdominal wall muscles. Jobs that require significant lifting can also increase the risk of hernia development.

Surgery and Treatment:

Once an inguinal hernia is discovered, it is usually corrected surgically unless it is very small and not causing symptoms. There are two types of hernia operations—herniorrhaphy (traditional open surgery) and hernioplasty (laparoscopic repair in which a mesh “patch” covers the area). If a bulging hernia can be felt in the lower abdomen, it can often be gently pushed back behind the abdominal muscle wall while the patient is lying down. Hernias that cannot be pushed back in place can result in strangulation of the intestinal tissue, a serious complication that can be life-threatening. OTC analgesics can be used to ease discomfort before and after surgery.

Prevention:

Hernias may be prevented by avoiding strain on the abdominal muscle tissue. Lifestyle changes such as avoiding the strain of heavy lifting, maintaining a healthy weight, eating a diet rich in fiber to avoid constipation, and smoking cessation to prevent a chronic cough are all ways to help prevent the development of hernias. Most doctors do not recommend the use of truss supports to treat

inguinal hernias; if support is needed to prevent a hernia from bulging, surgery is the best solution.

What is a Hernia? Types, Symptoms, Treatment and Prevention

Hernias are tears in tissue that internal organs slip through. Hernias can be painful, but some people with hernias may not experience symptoms.

Doctors can diagnose hernias with physical exams in most cases. Many patients will realize they have a hernia because of the characteristic bulge.

Hernia repair is one of the most frequent surgeries performed in the U.S. There are more than 1 million hernia repairs each year. About 900,000 of those procedures use hernia mesh.

What Causes Hernias?

A combination of muscle weakness and tears cause hernias. Hernias may happen suddenly or develop slowly over a long time.

Am I at Risk?

Hernias are one of the most common anatomical conditions people suffer. The chance of someone having a hernia at some point in their life is about 10 percent. The likelihood is higher for men (27 percent) than for women (3 percent). Obesity plays a role in developing and treating hernias. So does smoking.

Tips for Prevention

Coughing, body weight and strain on the body all help cause hernias. Addressing these can help prevent hernias.

Control coughing
Treating persistent coughs can help prevent hernias. Smoking can increase hernia risk because of the coughing it causes. Quitting or avoiding the habit can reduce hernia risk.

Avoid muscle strain
Lift heavy objects with the knees, never with the back. People should avoid trying to lift any weight too heavy for them.

Lose weight
Excess body fat can strain muscle tissue. Maintaining a healthy weight can cut strain.

Signs of a Hernia

People who suffer a hernia may not experience signs that something is wrong. Pain is the most likely symptom someone with a hernia experiences. Different types of hernias may share certain symptoms. But some symptoms may be unique to a particular type of hernia.


Typical Hernia Symptoms

  • Pain in the abdomen, testicle or pelvic region

  • Abdominal discomfort

  • Distended abdomen

  • Discomfort or tenderness in the groin

When to See a Doctor

People should seek medical attention before a hernia becomes serious. In some cases, the intestines can become trapped in the hernia. This can cut off blood flow. If this happens, a surgeon may have to remove part of the intestines.


Hernia Symptoms That Need Immediate Medical Attention

  • A painful hernia that cannot be easily pushed back into the abdomen

  • A hernia that turns red, purple, dark or discolored

  • Inability to pass gas or have bowel movements

Diagnosis

Doctors diagnose most hernias with a physical examination. Patients often sense that they have a hernia on their own.

The most obvious sign is a bump under the skin at the hernia site. This can show up even if a person experiences no other hernia symptoms.

A doctor may use X-rays to diagnose a hiatal hernia or to look for bowel obstructions. An ultrasound can help diagnose umbilical hernias in children and femoral hernias in adults.

Common Hernia Types

There are several types of hernias. Inguinal and umbilical hernias account for most of them. Symptoms can vary based on type and location in the body.

What Is an Inguinal Hernia?

Inguinal hernias happen in the groin. The intestine or bladder juts through the abdominal wall. Inguinal hernias are the most common type of hernia. They are more common in men. About 1 in 4 men (27 percent) will have one in their lifetime, according to the National Institute of Diabetes and Digestive Kidney Diseases. Not all people with inguinal hernias experience symptoms.


Symptoms Of Inguinal Hernias

  • Burning, aching or a sensation of heaviness or weakness in the groin

  • Pain when coughing or during physical exertion

  • Swelling of the scrotum in men or boys

Types

There are two types of inguinal hernias: Direct and indirect. A doctor can determine which one a patient may have. If these hernias get worse, they may turn into incarcerated or strangulated hernias.

Direct Inguinal Hernia
Caused by a weakness in the abdominal wall that occurs over time, usually from repeated heavy lifting or straining. These hernias almost always occur in adult males.

Indirect Inguinal Hernia
Caused by abdominal wall defects present during birth. These hernias may occur in infants, but some people born with this defect might not have a hernia for many years.

Incarcerated and Strangulated Inguinal Hernias

Incarcerated hernias occur when tissues or organs from a direct or indirect hernia get stuck outside the abdominal wall. Incarcerated hernias can turn into strangulated hernias.

Strangulated hernias occur when the abdominal wall traps and squeezes internal organs, cutting off blood flow. This can cut off blood flow in the small intestine or cause bowel blockages.

Strangulated hernias require emergency surgery.

Illustration of a strangulated hernia

What Is an Umbilical Hernia?

Umbilical hernias are most common in infants. They can sometimes heal themselves by the time the child turns 4. But they require surgery if they happen in adults.


Symptoms Of Umbilical Hernias In Infants

  • Most often painless

  • Swelling over the belly button that bulges when the baby cries, strains or sits up

  • Bulge may flatten if the baby lies on its back or is quiet

Umbilical hernias form around the navel. These happen when muscle around the belly button does not close after birth. Organs push through the abdominal lining around the navel. Umbilical hernias appear as an outward bulge.

Umbilical hernias are very small. They range from less than one-third of an inch to about two inches wide. People with an umbilical hernia may never notice they have one. Doctors or other health care workers are most likely to discover them in patients.

Umbilical Hernia in Adults

While most common in children, umbilical hernias still occur in adults. About one in 10 adult abdominal hernias are umbilical hernias, according to the American College of Surgeons. For adults, umbilical hernias can be far more serious.

An umbilical hernia squeezing the intestine can cause a medical emergency. Adults may experience sudden pain and vomiting. It requires immediate surgery.


Symptoms of Umbilical Hernias In Adults

  • Visible bulge on the abdomen

  • Bulge is more prominent when coughing or straining

  • Pain or pressure at the hernia site

What Is a Hiatal Hernia?

Hiatal hernias occur when part of the upper stomach presses into the chest. The exact cause of these hernias is unknown, but it may be due to weakness in the diaphragm.

The diaphragm is the sheet of muscle dividing the chest from the abdomen. Hiatal hernias are common and the risk of developing one increases as a person ages.

Most hiatal hernias occur in people older than 50, but some children are born with them.

By themselves, hiatal hernias seldom cause symptoms. But people who suffer them may experience pain and discomfort. This is from stomach acid, bile or even air flowing upward from the stomach into the esophagus.


Symptoms Of A Hiatal Hernia

  • Chest pain

  • Heartburn that gets worse when bent over or lying down

  • Difficulty swallowing

Lawsuit Information

While hernia mesh can prevent hernia recurrence, it can also cause serious complications. Learn more about the lawsuits being filed.

View Lawsuits

What Are My Treatment Options?

Hernia treatments depend on the hernia’s severity and the patient’s pain.

Monitoring
It is possible to live with some hernias. Doctors may suggest “watchful waiting.” The doctor and patient watch a hernia to make sure it does not get worse. There is a strangulation risk. The hernia may squeeze the intestine. If this happens, a surgeon may have to remove part of the intestine.

Diet and Lifestyle
Losing weight or stopping smoking may prevent a hernia from getting worse. These can reduce strain from extra weight or persistent coughing. Dietary changes can also treat hiatal hernia symptoms.

Medication
Doctors may recommend medicines to treat hiatal hernias. Medications include proton pump inhibitors (PPIs) to control stomach acid. These can present their own complications. If medication alone cannot relieve a hiatal hernia, a patient may need surgery.

Surgery
Surgery is the only permanent fix for a hernia. Doctors recommend surgery if the hernia gets larger or a patient is in pain.

Hernia Surgery

There are two main types of hernia surgery: open and laparoscopic.

Open surgery involves cutting into the layers of skin and other tissue around the hernia.

Fact

Inguinal hernia repair is one of the most common surgeries in the U. S.

Laparoscopic is a minimally-invasive technique. A doctor makes small incisions in the area around the hernia. The doctor inserts medical instruments through these incisions to perform the surgery.

Surgeons can repair hernias using pure-tissue techniques or hernia mesh.

Pure-tissue techniques involve suturing together the damaged tissue. Sometimes this will include different layers of tissue.

Most hernia surgeries in the U.S. rely on hernia mesh. Hernia mesh surgery may involve either an open or laparoscopic method. A surgeon places the mesh around the hernia. He attaches it using surgical staples, tacks or sutures. Over time, tissue grows into the mesh’s holes. This adds strength to the repair.


Please seek the advice of a medical professional before making health care decisions.

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Symptoms, Causes, Diagnosis, & Treatment

What Is an Inguinal Hernia?

Inguinal hernia is when a piece of your intestine or part of the membrane lining your abdominal cavity — the space that holds organs like your stomach, small intestines, liver, and kidneys — pokes through a weak spot in your abdominal muscles near your groin. 

It’s named for the inguinal canal. That’s a passage in your lower abdominal wall that houses blood vessels and nerves. It’s home to the spermatic cord in a man, and to ligaments that support a woman’s uterus.

An inguinal hernia could be a serious health problem, so don’t ignore symptoms like a pain in your groin when you cough or lift something heavy. A physical exam is usually all it takes to diagnose the problem. If the hernia is large enough, you’ll need surgery to fix it.

Inguinal Hernia Signs and Symptoms

You could have a direct inguinal hernia if you:

  • Hurt when you cough, bend, or lift something heavy

  • Feel pressure, weakness, heaviness, or a dragging sensation in your groin

  • Have swelling around your testicles

  • Feel a burning or aching sensation at the hernia’s bulge

You may be able to gently push the bump back up into your abdomen to relieve some of the discomfort.

Inguinal Hernia Causes and Risk Factors

A baby can get an indirect inguinal hernia if the lining of their abdomen doesn’t fully close while they’re developing. What’s left is an opening at the upper part of the inguinal canal. That’s where a hernia can take shape.

Older adults usually get a direct inguinal hernia because the muscles of their abdominal wall can weaken.

Women rarely have this type of hernia. The broad ligament of the uterus is right behind the abdominal wall, which supports it and shields the inguinal canal.

Men don’t have that barrier, so stress and gradual weakening of their abdominal muscles over time make it more likely something can push through to the inguinal canal.

Who gets them?

It happens in 2% to 3% of male babies, but less than 1% of baby girls. About 1 in 4 males will have an inguinal hernia at some time in their life. It’s most common in men over the age of 40.

Abdominal surgery can make you more likely to develop a direct inguinal hernia. A family history of this condition raises your odds, too.

Smokers may have a higher chance of having inguinal hernias, along with other health problems.

Inguinal Hernia Diagnosis

See your doctor if you have symptoms of an inguinal hernia. They’ll check your groin area for swelling or a bulge. They’ll probably ask you to stand and cough. This can make a hernia more obvious.

If the doctor doesn’t see any swelling in the area, they may order imaging tests, like an abdominal ultrasound, CT scan, or MRI.

Inguinal Hernia Treatment

If you have an inguinal hernia, a high-fiber diet with plenty of veggies, fresh fruits, and whole grains may help you avoid constipation, which can lead to painful symptoms.

Surgery is the only way to fix an inguinal hernia. The doctor will push the bulging tissue back inside and strengthen your abdominal wall with stitches and perhaps mesh. They might be able to do this through a small cut in your belly using a special tool, a procedure called laparoscopy. You’ll probably hurt less and heal faster than if you have traditional surgery.

An inguinal hernia can be quite painful, but it’s definitely treatable. If you think you have one, see your doctor. It won’t get better on its own.

Inguinal Hernia Complications

If you don’t treat an inguinal hernia it could lead to problems like:

  • Pressure and pain on the surrounding areas.Most inguinal hernias get larger over time if you don’t fix them with surgery. In men, large hernias can bulge down into the scrotum, causing swelling and pain.

  • Incarcerated hernia.This happens when the protrusion (and contents) of the hernia get trapped in the weak point of your abdominal wall. It can cause bowel obstruction, with severe pain, nausea, vomiting, and the inability to have bowel movements.

  • Strangulated hernia.When an incarcerated hernia cuts off the blood flow to part of your intestine, it’s called strangulation. This could lead to death of the affected bowel tissue. This situation is life-threatening and requires surgery immediately.

Inguinal Hernia Prevention

You can’t prevent being born with a weak abdominal wall. But you can take steps to avoid having problems because of it, such as not smoking and keeping your weight in check.

If you have abdominal surgery, be careful afterward:

  • Use your legs, not your back, when lifting.

  • Avoid lifting heavy things.

Try not to strain when you poop.

Hernia – NHS

A hernia occurs when an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall.

A hernia usually develops between your chest and hips. In many cases, it causes no or very few symptoms, although you may notice a swelling or lump in your tummy (abdomen) or groin.

The lump can often be pushed back in or disappears when you lie down. Coughing or straining may make the lump appear.

Types of hernia

Inguinal hernias

Inguinal hernias occur when fatty tissue or a part of your bowel pokes through into your groin at the top of your inner thigh.

This is the most common type of hernia and it mainly affects men. It’s often associated with ageing and repeated strain on the tummy.

Femoral hernias

Femoral hernias also happen when fatty tissue or part of your bowel pokes through into your groin at the top of your inner thigh.

They’re much less common than inguinal hernias and tend to affect more women than men.

Like inguinal hernias, femoral hernias are also associated with ageing and repeated strain on the tummy.

Umbilical hernias

Umbilical hernias occur when fatty tissue or part of your bowel pokes through your tummy near your belly button.

This type of hernia can occur in babies if the opening in the tummy that the umbilical cord passes through does not seal properly after birth.

Adults can also be affected, possibly as a result of repeated strain on the tummy.

Hiatus hernias

Hiatus hernias occur when part of the stomach pushes up into your chest by squeezing through an opening in the diaphragm, the thin sheet of muscle that separates the chest from the tummy.

This type of hernia may not have any noticeable symptoms, although it can cause heartburn in some people.

It’s not exactly clear what causes hiatus hernias, but it may be the result of the diaphragm becoming weak with age or pressure on the tummy.

Other types of hernia

Other types of hernia that can affect the tummy include:

  • incisional hernias – where tissue pokes through a surgical wound in your tummy that has not fully healed
  • epigastric hernias – where fatty tissue pokes through your tummy, between your belly button and the lower part of your breastbone
  • spigelian hernias – where part of your bowel pokes through your tummy at the side of your abdominal muscle, below your belly button
  • diaphragmatic hernias – where organs in your tummy move into your chest through an opening in the diaphragm; this can also affect babies if their diaphragm does not develop properly in the womb
  • muscle hernias – where part of a muscle pokes through your tummy; they also occur in leg muscles as the result of a sports injury

When to seek medical advice

See a GP if you think you have a hernia. They may refer you to hospital for surgical treatment, if necessary.

You should go your nearest A&E straight away if you have a hernia and you develop any of the following symptoms:

  • sudden, severe pain
  • being sick
  • difficulty pooing or passing wind
  • the hernia becomes firm or tender, or cannot be pushed back in

These symptoms could mean that either: 

  • the blood supply to a section of organ or tissue trapped in the hernia has become cut off (strangulation)
  • a piece of bowel has entered the hernia and become blocked (obstruction)

A strangulated hernia and obstructed bowel are medical emergencies and need to be treated as soon as possible.

Assessing a hernia

A GP will usually be able to identify a hernia by examining the affected area.

In some cases, they may refer you to a nearby hospital for an ultrasound scan to confirm the diagnosis or assess the extent of the problem.

This is a painless scan where high-frequency sound waves are used to create an image of part of the inside of the body.

Once a diagnosis has been confirmed, a GP or hospital doctor will determine whether surgery to repair the hernia is necessary.

A number of factors will be considered when deciding whether surgery is appropriate, including:

  • the type of hernia – some types of hernia are more likely to become strangulated or cause a bowel obstruction than others
  • the content of your hernia – if the hernia contains a part of your bowel, muscle or other tissue, there may be a risk of strangulation or obstruction
  • your symptoms and the impact on your daily life – surgery may be recommended if your symptoms are severe or getting worse, or if the hernia is affecting your ability to carry out your normal activities
  • your general health – surgery may be too much of a risk if your general health is poor

Although most hernias will not get better without surgery, they will not necessarily get worse.

In some cases, the risks of surgery outweigh the potential benefits.

Surgery for a hernia

There are 2 main ways surgery for hernias can be carried out:

  • open surgery – where a cut is made to allow the surgeon to push the lump back into the tummy
  • keyhole (laparoscopic) surgery – this is a less invasive, but more difficult, technique where several smaller cuts are made, allowing the surgeon to use various special instruments to repair the hernia

Most people are able to go home the same day or the day after surgery and make a full recovery within a few weeks.

If your doctor recommends having surgery, it’s important to be aware of the potential risks, as well as the possibility of the hernia coming back.

Make sure you discuss the benefits and risks of the procedure with your surgeon in detail before having the operation.

More information

To find out more about some common types of hernia surgery, see:

Video: what is a hernia?

Watch this animation to see how a hernia occurs and the procedures used to treat it.

Media last reviewed: 1 April 2021
Media review due: 1 April 2024

Page last reviewed: 19 June 2019
Next review due: 19 June 2022

Coughing-induced bowel transection in a patient with an incarcerated inguinal hernia: a case report | Journal of Medical Case Reports

Inguinal hernia repairs comprise a large portion of general surgical procedures. There are more than 20 million hernias estimated to be repaired annually around the world [2, 8]. In the USA, an inguinal herniorrhaphy is the most common elective operation performed with approximately 700,000 cases annually [2, 8].

The vast majority of hernias are repaired electively to prevent complications. Although complications are rare, they might be severe if not promptly addressed. Incarceration, strangulation and bowel perforation are known complications of inguinal hernias. Expectedly, intestinal perforation is higher in patients with inguinal hernias compared with the general population [11]. This is typically the result of an incarcerated hernia leading to strangulation. Small bowel tears and perforations have been reported in the setting of an inguinal hernia, usually following direct trauma to the patient’s abdomen or groin [12, 13]. To the best of our knowledge, small bowel perforation or transection has not been reported following a non-traumatic insult to the hernia such as coughing.

Non-traumatic events leading to intestinal transection are rare events. Experimental models demonstrated that blunt trauma to an inguinal hernia could produce enough force (300mmHg) to lead to intestinal pressures of 260mmHg that can cause intestinal disruption [14]. By contrast, urodynamic testing comparing voluntary cough to laryngeal cough reflex revealed that the maximal intraluminal pressure generated was only 110mmHg [15]. This pressure is not generally sufficient to cause intestinal disruption.

In the present case, it is possible that the chronic incarceration of the hernia might have led to bowel edema, weakening of the bowel wall and the observed transection. There were no other identifiable risk factors in this patient that could have led to this outcome.

In the present report, we elected to proceed with the repair of the inguinal hernia during the same operation. Although the timing of hernia repair in regards to the index operation is controversial, the status of the patient is a universal issue of concern in determining whether to proceed with a repair or not. However, if hemodynamic stability is well established, some authors favor a delayed repair [12, 16] and others prefer a repair in the same setting [17, 18]. Because the patient in this report had physical examination findings consistent with peritonitis, there was a clear need for operative intervention and the hernia was repaired because the patient was hemodynamically stable. In addition, the patient did not have any comorbid conditions that could lead to cardiopulmonary morbidity related to increased operative times. A balance between two operations and increased morbidity in a lengthy operation must be carefully considered on a case-to-case basis.

This operation would be classified as a contaminated case based on wound infection classification. Thus, the use of synthetic mesh was considered a poor option as this leads to high rates of infection, bleeding and fistula formation [19]. A tissue repair has been advocated in this setting [20]. However, tissue repair is associated with a high rate of recurrence. Because the transversalis fascia in this patient was obliterated, a tissue repair was not optimal. We thus elected to repair the floor with biologic mesh (AlloDerm®), which has been described in similar settings [21].

Can sneezing cause a groin hernia

Surprisingly the answer is yes! Violent sneezing attacks can lead to a groin hernia and as we move into the allergy season for grasses and weeds, it’s best to manage hay fever symptoms such as fierce and frequent sneezing to prevent this possibility. 

What is a groin hernia?

A groin hernia is the protrusion of an internal body part (fat, intestines or abdominal structure) through a weakness in your abdominal muscle or surrounding tissue wall. A groin hernia can be inguinal (common) or femoral (less common) and refers to the area of your groin it appears in. Hernias can occur on one or both sides (bilateral) of the groin.

How will I know if I have a groin hernia?

A groin hernia may cause no or very few symptoms. Most commonly a swelling in your groin will appear. The lump can sometimes be pushed back in or it may disappear when you lie down. It can reappear if you sneeze, cough or strain on the toilet. You may feel a dull ache that is more pronounced when doing physical activity.

What causes a groin hernia?

A groin hernia may be present at birth or it can develop later in life either gradually or suddenly. It is caused by a weakening of your abdominal wall and this can be triggered by one or a combination of many things including: genetics, age, smoking, or additional strain on your abdominal wall due to lifting, coughing and sneezing.

When should I see a doctor?

If you think you may have a groin hernia, you should seek medical advice. Most groin hernias are diagnosed by a physical examination and your clinical history. Sometimes your doctor may not be certain you have a hernia, for example if you don’t have a swelling and you have substantial pain. If this is the case, then further diagnostic investigations such as MRI and ultrasound will be required.

If you have a hernia and you develop sudden severe pain, vomiting, constipation or wind or your hernia is tender, firm or cannot be pushed back in, then you should go immediately to your nearest A&E department as you may have a strangulated or obstructed hernia.

What treatment is suitable for a groin hernia?

Surgery is the only cure for a hernia but not all hernia’s need to be surgically repaired. Once your doctor has diagnosed you to have a hernia, they will consider a number of factors to determine whether you need a hernia repair. These include: the type, location and severity of your hernia and the chance of it becoming strangulated or causing a bowel obstruction, your symptoms and their impact on your daily life and your general health.

Millions of hernia operations are performed each year, making hernia the world’s most common of all surgical operations. Well over 100,000 of them are performed in the UK¹.

Hernia repair at North Downs Hospital

Here at North Downs Hospital we offer local appointments with experienced and highly skilled general surgeons who can diagnose and surgically repair a groin hernia. Our professional general surgery team work together to offer you first class care. You can book an appointment by calling 01883 348981.

We also offer allergy testing if you are sneezing and you think it might be related to an increase in pollen. Please call our outpatient department on 01883 348981 to make an appointment.

References

¹ https://www.hernia.org/

Treatment of intervertebral hernia

  1. Home
  2. Paid services
  3. Complex programs
  4. Treatment of intervertebral hernia

INTERVERTICAL DISC HERNIATIONS ARE SEVERE DEFAULS.

In a healthy patient, the intervertebral discs are cartilaginous bodies that connect the vertebrae to each other and perform the function of shock absorption. This is possible due to the specific structure of the discs: inside the disc consists of a slightly compressible nucleus pulposus, which is bounded by a dense annulus fibrosus.

The appearance of a hernia may be associated with age-related changes, but this disease affects people not only of old age. The first symptoms of hernia development can appear at a young age, and the disease can progress over a decade, until the pain becomes unbearable, and the pathology does not give complications. If the disease is not properly treated, the patient runs the risk of becoming disabled.

If you have:

  • Increasing back pain.
  • Worsening pain when coughing or sneezing.
  • Numbness or tingling sensation in the spine.
  • Muscle weakness.
  • Weight loss of one limb – arms or legs.

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Diagnosis is made by a neurologist or neurosurgeon when these symptoms are present. Imaging methods play a decisive role in the diagnosis: MRI, CT, spondylography.Also, in order to establish the degree of damage to nerve fibers in a certain area, it may be necessary to conduct electroneuromyography, a study aimed at measuring the speed of movement of nerve impulses.

The diagnosis of a herniated disc means that the fibrous ring of the intervertebral disc has ruptured, resulting in a protrusion. The resulting hernia, bulging back and to the side, presses on the root of the nerve at the site of its exit from the spinal canal.The pinched nerve root sends pain impulses to the brain, which are perceived by a person as pain in the area, the sensitivity of which is provided by this nerve. Compression of the root causes inflammation, accompanied by edema. This explains why pain and loss of sensation do not appear immediately after the onset of the disease.

By size, it is possible to conditionally divide intervertebral hernias:

prolapse – protrusion of the hernia by 2-3 mm,

protrusion – protrusion of the hernia from 4 to 15 mm,

extrusion – prolapse of the nucleus of the intervertebral disc beyond the border (overhang in the form of a drop) …

In advanced cases, there may be atrophy of the surrounding tissues and a complete loss of mobility of the spine in the affected area.

The most common localization of a hernia is the lumbar spine – this is the most vulnerable part of the spinal column, experiencing maximum stress. In advanced stages, it can cause paralysis. Less common is a hernia of the cervical spine – characterized by pain in the arm, the development of weakness in the arms and legs, pelvic disorders. Rarely enough, a thoracic hernia develops, which is characterized by pain in the thoracic region, difficulty in straightening the back, occurs in people over 35-40 years old and with injuries.

Herniated discs are one of the most common causes of temporary disability and often disability of a patient.

Treatment

For minor hernias, conservative treatment can be dispensed with, which is aimed at relieving pain, removing tissue edema, restoring normal mobility of the spine. It is better to abandon the idea of ​​resorting to traditional medicine right away – in the case of a hernia, this can be dangerous to health.Surgical treatment is indicated in the presence of pain resistant to treatment or in severe movement disorders.

During surgery, the affected area of ​​the spinal disc is removed. Competent rehabilitation after treatment is of great importance – a person must limit physical activity. However, during the rehabilitation period, it is necessary to engage in gentle therapeutic exercises, which will help to return to a normal lifestyle.

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Hernia of the esophageal opening of the diaphragm.How the methods of treatment in the clinic

arise

Hernia of the esophagus (hernia of the esophageal opening of the diaphragm) is the movement of the stomach (less often other organs) through the opening in the diaphragm that passes the esophageal tube into the abdomen from the abdominal cavity to the chest. Part of the stomach can be fixed in this opening (fixed hiatal hernia), or moved to the posterior mediastinum and back (sliding hiatal hernia). Other types of hiatal hernia are rare.Often this pathology is combined, or rather is one of the causes, gastroesophageal reflux disease (GERD).

The patient suffering from this disease is associated with two main reasons:

  • The first reason is the “breakdown” of a complex locking mechanism, which does not allow the contents of the stomach to enter the esophagus and even into the pharynx. In this case, there are:
    • Painful burning sensation behind the breastbone
    • Bitterness in the mouth
    • Unexplained cough at night – in a horizontal position the contents of the stomach more easily flow into the esophagus
  • The second reason is the entrapment of an internal organ in the opening of the diaphragm, which causes chest pain.This pain is very similar to pain in a heart attack, but it occurs both during physical exertion, which is typical for “heart” pain, and at night at rest

The path of a patient with a “diaphragmatic hernia” to a surgeon is often long and complicated. This is due to the fact that conservative treatment has been carried out for a long time, not always with the correct diagnosis. A practical definition of the moment when, without the help of an operation, treatment loses its prospects, is possible only by a surgeon who is constantly dealing with this pathology.Despite the rather clear indications for surgical treatment, the decision should be strictly individual.

If you suffer from heartburn and / or chest pain, conservative treatment does not work – seek advice. Not all patients need surgical treatment, but with clear indications for surgical treatment, the operation either completely eliminates suffering or dramatically improves the quality of life.

Diagnostics and treatment of osteochondrosis of the thoracic spine

What is thoracic osteochondrosis and how does it arise

Osteochondrosis of the thoracic region is characterized by the occurrence of destructive-dystrophic processes in the middle section of the ridge.The destruction is located between the 8th and 19th vertebra. To find out which vertebra is affected, it is necessary to conduct accurate diagnostic studies. Osteochondrosis of the thoracic region is often accompanied by formidable complications, including prolapse or hernia. Without complications, the disease is rare, since the destruction of cartilage tissue inevitably leads to the destruction of the entire vertebral frame.

With osteochondrosis of the thoracic region, destructive processes occur in the cartilaginous tissue, caused by persistent metabolic disorders.When a patient develops a circulatory disorder or age-related wear of the joints, the fibrous ring located in the cavity of the intervertebral disc begins to collapse, losing its normal structure. Since the destruction is slow, then at the initial stages microcracks appear, through which the nucleus pulposus seeps.

As the internal component seeps, the annulus fibrosus begins to weaken, resulting in gradual stretching and rupture. When the nucleus pulposus protrudes, an intervertebral hernia occurs, which is the most common complication of osteochondrosis.Pathology involves damage to cartilage tissue, which causes significant discomfort. Severe back pain is also associated with neurological syndromes that develop from pinching or irritation of the nerve roots.

Symptoms of chest osteochondrosis

At the initial stage, the patient does not feel discomfort, therefore, at this stage, the disease can only be detected by chance. The disease has many symptoms that can be disguised as other pathologies.

Symptoms of breast osteochondrosis can be felt by the following manifestations:

  1. Breathing is difficult.Problems arise, manifested by shortness of breath and a feeling of shortness of breath. This indicates damage to the thoracic vertebrae and spinal cord.
  2. The main symptom is pain in the chest area. There is also a pressing feeling in the heart, rather reminiscent of an ischemic attack.
  3. Discomfort occurs when the back bends. As the disease progresses, the pain in this position increases.
  4. Against the background of deteriorating blood circulation, there is a feeling of coldness in the lower or upper extremities.
  5. Pain in the chest against the background of emerging intervertebral hernias. Discomfort is often felt more strongly on the left or right side of the affected area.
  6. Discomfort in the throat and problems with swallowing. If there is irritation of the nerve endings in the upper part of the thoracic region, a cough appears.
  7. Women may experience chest pains that are not associated with cyclical changes or hormonal imbalances.
  8. Tingling or burning sensation appears in the area of ​​the legs and feet.
  9. Hair and nails become brittle, dull.
  10. Herpes zoster occurs less often.
  11. Pain in the back and chest occurs simultaneously.
  12. Less commonly, there is discomfort in the stomach, liver or pancreas.
  13. The onset of stiff pain in the ribs, indicating intercostal neuralgia.
  14. There are signs of chest chondrosis and compression – a similar pathology.
  15. There are problems in the work of the gastrointestinal tract.Feels nausea, heaviness in the stomach.
  16. In men, several libido may fall. Problems arise in the genitourinary sphere.
  17. When standing or sitting for a long time, severe discomfort occurs.
  18. Severe headache occurs, accompanied by dizziness. Migraines with aura may appear.
  19. The patient often develops intercostal neuralgia.
  20. Pain can radiate to the neck or lower back.

In case of detection in the aggregate of thoracic osteochondrosis and its signs or some of them, it is necessary to urgently consult a therapist, neurologist, orthopedist.Also, such symptoms should be alerted in the absence of problems with the gastrointestinal tract, cardiovascular system and lungs.

Symptoms of the acute and subacute stages also exist. If, with an exacerbation of osteochondrosis of the thoracic region, the patient experiences severe pain that deprives the patient of working capacity, and he can only observe bed rest, then the subacute course is sluggish and does not significantly limit the patient’s motor activity.

A clear sign of a sluggish lesion – no acute pain.Symptoms in the subacute stage are erased. No discomfort with basic body movements, including inhaling, sneezing or turning. A person does not suffer from pain in a dream, so the process of falling asleep is facilitated.

In order for the subacute course of the disease not to worsen and go into remission, important rules must be observed:

  1. Lifting weights is prohibited.
  2. Do not bend over sharply.
  3. It is forbidden to be in a sitting or standing position for a long time. A person often unconsciously in this state takes a pose that is harmful to the spine, so there is an excessive load on the ridge, which entails another exacerbation.
  4. Avoid hypothermia. It has been proven that non-compliance with a comfortable temperature regime for the body turns into an exacerbation of the inflammatory process. Dampness is also harmful to joints.

The duration of the subacute course is individual. If you follow medical recommendations, the patient will get rid of discomfort completely within 2-3 weeks. If conservative treatment and rest do not help, and the patient begins to suffer from nausea, dizziness and weakness, an urgent need to consult a specialist.Such symptoms indicate a re-exacerbation.

Degrees of development of osteochondrosis of the thoracic region

There are 4 clinical stages of the disease, during the onset of which the patient develops signs of pathology:

  1. No clinical symptoms at the initial stage. The first stage occurs against the background of the appearance of destructive processes in the cartilage and bone tissue. At the first stage, there is also no rupture or stretching of the fibrous ring, so there are no hernias either.They can detect initial protrusion and signs of cartilage degeneration.
  2. The second stage presents with minor pain or discomfort. An attentive patient seeks a doctor, therefore, osteochondrosis of the thoracic region is detected in a timely manner. Persons who do not want to visit a specialist can still endure the second stage, using available remedies, but self-medication will not be enough for a long time. At this stage, the most common neurological symptoms may appear, including headache, burning sensation in the interscapular zone, pain in the neck, surges in blood pressure.Also at this stage, there is an increase in degenerative destruction in the spine: the fibrous ring protrudes, which leads to the appearance of an intervertebral hernia of the thoracic region.
  3. The third stage is already difficult for the patient. Persistent neurological syndromes develop, including constant radiating pain in the shoulder blades, arms, collarbone and lower back. The patient may show somatic and autonomic disorders, indicating a disturbance in the functioning of the nervous system. The patient is often tormented by nausea, incessant headaches, dizziness, back aches.Disguised cardiac, gastroenterological or pulmonary signs of the disease may also appear. At this stage, there is an active demineralization of bone and cartilage tissue. There is a tendency to injury.
  4. The last stage is the fourth. Against the background of osteochondrosis and hernia, irreversible consequences arise – the mobility of the intervertebral discs is completely lost, and the cartilaginous tissue in the place of a prolonged course of inflammation is replaced by osteophytes. To remove them, an operation is required.

In order not to run the body to a state similar to stage 3 or 4, it is better to visit a doctor at the slightest sign. The sooner the disease is detected and therapy is started, the faster the patient will return to normal and learn to live with osteochondrosis. The pathological destructive process cannot be completely stopped, but it can be slowed down by leading a healthy lifestyle, using medications and performing daily gymnastics. The later the patient turns to the doctor, the harder it is to stop the severe pain syndrome associated with degeneration of cartilage tissue.

Risk factors and causes of disease

There is no exact cause of destructive changes in the spine. A large role in the appearance of pathology is attributed to a hereditary factor. It has been proven that individuals with physical inactivity are more likely to have back problems than those who exercise regularly. Also, excessive physical activity can provoke the destruction of cartilage at an early age.

Thinning and destruction of intervertebral discs is closely related to spinal overload.If the muscles are not strong enough, and the back is subjected to regular overload, the destruction of cartilage tissue occurs.

What causes can cause osteochondrosis:

  1. Obesity. With overweight, there is strong weight pressure on the spine. The result is premature destruction of bone tissue.
  2. The presence of anomalies in the structure of bones and cartilage. Such problems are laid even during the period of intrauterine development.
  3. Congenital asymmetry of intra-articular fissures in the intervertebral joints of the type of tropism anomaly, contributing to the occurrence of a degenerative-dystrophic process in the spine.
  4. The presence of muscle spasm, spondylosis, chronically persistent trigger points and vascular disorders in the thoracic region. These pathologies also contribute to the appearance of osteochondrosis of the thoracic region.
  5. Prolonged exposure to vibration on the spine in a sitting position. An example of work is a minibus or bus driver.
  6. Frequent physical stress associated with heavy lifting. Examples are work as a loader or professional sports activity.
  7. Smoking and alcohol abuse. People with unhealthy lifestyles are more likely to have a lack of minerals in their bodies and poor circulation, leading to back problems.
  8. Sedentary lifestyle. With insufficient physical activity, an accelerated leaching of calcium occurs, which is associated with poor metabolic processes. As a result, bones become brittle. Also, muscle tissue atrophies, due to which the load on the spine increases greatly.The result is pain, frequent discomfort with minimal physical exertion.

Due to the intervertebral discs, sufficient mobility of the ridge is ensured. The intervertebral discs play a shock-absorbing role. With the development of osteochondrosis, an accelerated process of demineralization occurs, vital moisture from the joints is lost. This leads to discomfort, decreased mobility in the spine.

Risk factors for breast osteochondrosis include:

  1. Advanced age.In older people, natural degeneration occurs, therefore, after 40 years, the disease is found more often.
  2. Female In girls, there are periods that contribute to the active leaching of calcium from the bones – pregnancy and menopause. Without adequate pharmacological support, spinal diseases are prone to occur.
  3. The presence of hormonal disorders, endocrinological diseases. If the patient has diabetes mellitus or uncompensated hypothyroidism, intervertebral disc degeneration may occur at an early age.
  4. Prolonged immobilization. If the patient is sick and has to lie down for a long time, atrophic processes occur in the muscles, which causes back pain.
  5. Previous back injuries. When the ligaments and tendons are stretched, the risk of osteochondrosis in the thoracic region increases.
  6. Presence of scoliosis. Poor posture in the future provokes serious spinal problems, including osteochondrosis and hernia.

Diagnosis of thoracic osteochondrosis

If the patient suspects back problems, it is necessary to consult a physician.The doctor conducts a general examination of the patient, asks about complaints, measures blood pressure. If there is a suspicion of a neurological problem, the patient is referred to a narrow specialist – a traumatologist, neurologist or orthopedist. All complaints and information about the patient is recorded in the medical record.

At an appointment with a specialized specialist, they also ask about complaints, conduct an initial diagnosis of the patient. Based on a visual examination, a set of diagnostic measures is prescribed, including:

  1. Radiography.With the help of an X-ray, you can assess the condition of the skeletal system in general terms. If the patient has a hernia or osteochondrosis, hints of pathology can be noticed – the distance between the intervertebral discs will be reduced, and darkening is sometimes noticed at the site of the alleged hernia. If the results of the image do not suit the specialist, you have to continue looking for the cause of the pain and discomfort.
  2. CT or MRI. The most accurate diagnostic methods that allow you to accurately examine the state of the focus of inflammation in the picture.A more detailed image can be seen on MRI, but if there are contraindications (the presence of a pacemaker or prostheses in the joints), computed tomography is prescribed. CT is an improved version of X-ray that allows you to see in detail the bone, tendon and ligament. The image renders the image in the form of a three-dimensional image, so the details of the damage are clearly visible.
  3. Biochemical and general blood test. Analytical data are necessary to assess the patient’s health status.If an increase in leukocytes, ESR is found, then this indicates an active inflammatory process in the body. With active destruction of bone tissue, reduced levels of calcium and a deficiency of cholecalciferol (vitamin D3) are found in the blood.
  4. Spine scintigraphy. The research method reveals active destruction of bone tissue. Weak bone tissue is highly susceptible to fragility. The method will reveal the tendency and signs of degeneration.

To diagnose a disease, you need to see an experienced specialist.The disease is not always manifested by back pain at the level of the shoulder blades. More often the patient goes to a cardiologist, pulmonologist and even a gastroenterologist, but the reasons for the discomfort of internal organs are not found. Ultimately, the patient ends up in the neurology department, where spinal problems are diagnosed. The disease affects not only the musculoskeletal system, but also the central nervous system. For the final diagnosis, a complete clinical picture is needed, taking into account several laboratory research methods.

Thoracic osteochondrosis of the spinal column requires differentiation along with the following pathologies:

  1. Dyshormonal spondylopathy.
  2. Pathologies of the urinary system, including urolithiasis, cystitis or pyelonephritis.
  3. Diseases of the cardiovascular system, excluding sinus arrhythmia, tachycardia and angina pectoris.
  4. Diseases of the gastrointestinal tract, including chronic pancreatitis, stomach and duodenal ulcers, irritable bowel syndrome.
  5. Previous injuries, fractures.
  6. Tumors in the chest, including malignant course.
  7. Rheumatoid arthritis (determined by a blood test for C-reactive protein, rheumatic test and ESR).
  8. Osteomyelitis of the spine.
  9. Acute inflammatory process.
  10. Ankylosing spondylitis.
  11. Spondylolisthesis.

Treatment of osteochondrosis of the thoracic spine

To slow the progression of the disease, an integrated approach to therapy is required.At the initial stages, only conservative therapy is shown, consisting of the use of medicines and physiotherapy methods of treatment. In advanced cases, when the patient has large hernias and a pronounced degree of bone degeneration, an operation is prescribed. Do not self-medicate at home. Folk remedies do not eliminate osteochondrosis of the thoracic spine.

In what cases surgery is performed

Launched osteochondrosis of the thoracic region negatively affects the patient’s quality of life.If the patient has constant discomfort that interferes with normal life, taking into account the lack of effect of medication treatment, then they can offer a surgical solution to the problem.

Absolute indications for surgery include:

  1. Lack of sensitivity in the bladder and intestines.
  2. If sensitivity in the legs disappears and the patient loses the ability to move independently.
  3. Paralysis due to strong proliferation of hernia.

In other cases, the patient makes the decision to remove the hernial formation independently.If the disease really brings severe anguish and the patient’s condition does not improve against the background of conservative treatment, doctors recommend surgery.

Drug treatment of osteochondrosis of the thoracic spine

During an exacerbation, the attending physician prescribes various drugs necessary for use in order to relieve the inflammatory process. The acute period is characterized by severe pain that can only be relieved with the help of medication.If enough medication is taken, the patient gets better. Only an experienced specialist can prescribe drugs; self-medication is unacceptable.

Osteochondrosis of the thoracic spine is treated with the following medications:

  1. Non-steroidal anti-inflammatory drugs, pain relievers or analgesics. These medicines are designed to quickly relieve back pain associated with an active inflammatory process. The effect of taking pills or injections is felt the next day.Taking any medication from the NSAID group is accompanied by side effects with prolonged use, therefore, experts recommend limiting the use of drugs to the minimum period of time, no more than 1-2 weeks. Painkillers are most detrimental to the gastric mucosa, causing gastropathy and inflammation. Patients at risk are given certain medications designed to protect the gastrointestinal mucosa. Examples are proton pump inhibitors, H2 histamine receptor blockers, antacids.For persons with ulcers and gastritis, it is better to avoid the use of NSAIDs or take modern analogues with a selective effect – Nimesil, Lornoxicam or Movalis. Also, for pain associated with chest osteochondrosis, Ketorol, Analgin and Diclofenac are prescribed.
  2. Muscle relaxants. These drugs are very effective in treating muscle spasticity. Relieve pain associated with muscle tension. They act on trigger points located in the pinched muscle tissue. The more a person overstrains, the higher their number.Muscle relaxants well remove tightness in the muscles, and therefore exhibit an analgesic effect. You need to take medications in a course, the average duration of therapy is at least 2-4 weeks. Examples of medicines are Baclofen, Midocalm and Sirdalud.
  3. Vitamins of group B. Prescribe B1, B6, B12 in the form of injections with a combined composition. In large doses, these substances have an analgesic effect and have a positive effect on the nervous system. Neurotrophic drugs are effective in treating pain associated with pinched nerve roots.With the help of nutrition, it is impossible to replenish the norm of these substances necessary to achieve a therapeutic effect, therefore they are prescribed in the form of medicines. The average length of one course of injections is 2-3 weeks. Then, if necessary, they switch to tablets. Examples of trade names are Neuromax, Neurorubin, and Milgamma.
  4. Anti-inflammatory ointments, gels. If the pain is tolerable, and systemic forms of NSAIDs are contraindicated, external drugs are prescribed. The advantage of external agents is that they do not cause side effects.In rare cases, skin allergies may appear, but the ointment will not cause gastrointestinal or laboratory blood deterioration. Another advantage of outdoor products is the possibility of long-term use. You can rub in the gels for up to 4 weeks, after which they take a break. The scheme and duration of therapy is determined by the attending physician.
  5. Honroprotectors. These are complex substances used to nourish the cartilage tissue of the joints. The main active ingredients are chondroitin sulfate and glucosamine hydrochloride.It is necessary to use medications for a long course, at least six months, after which they take a break of 2-3 months and the course of therapy is repeated. Within 2-3 months, injectable forms of release are used, as they are better absorbed. Then they switch to supportive treatment, including the use of tablets. Examples of medicines are Dona, Mukosat, Hondrogard. It is important to understand that medication does not stop the destruction of cartilage tissue. They only create additional nutrition, which slows down the degenerative processes occurring in the bones and joints.
  6. Complex preparations of calcium and vitamin D3. It has been proven that residents of northern latitudes do not receive enough vitamin D3, because solar activity is low all year round in this region. To get rid of hypovitaminosis, it is necessary to take cholecalciferol supplements in winter and autumn in courses while solar activity is minimal. Without this vitamin, the assimilation of calcium and other minerals is impossible. Due to a long calcium deficiency, bone tissue thinning occurs over time, so a person suffers from osteochondrosis and other complications.Calcium and D3 are better absorbed in combination, therefore complex preparations are prescribed. The dose and course of administration should be prescribed by the attending physician. Examples of medicines – Calcemin Silver, Calcium D3 Nycomed.

Homeopathy, antispasmodics and complex multivitamins can be prescribed as an adjunct to treatment.

Conservative therapy of chest osteochondrosis

During the recovery period, the patient should pay sufficient attention to rehabilitation. The more carefully the patient maintains health, the less frequent attacks of the disease will occur.

The most effective conservative treatment methods include:

  1. LFK. With the help of exercises, the patient learns to keep his back straight, strengthens the muscle corset. Physiotherapy can be done at any age, several times a week. The complex is selected individually, taking into account the anatomical characteristics of the patient. Begin execution gradually, spending at first no more than 5 minutes a day. As physical qualities improve, the patient learns to do more difficult exercises over a longer period of time.
  2. Support corset. Anatomical devices serve to support weakened muscles, if there are contraindications for strengthening them. The patient chooses a bandage depending on the height and type of appointment. The attending physician must select the appropriate model. The duration and pattern of wearing is assigned individually, depending on the purpose. You cannot wear a corset around the clock, otherwise your back muscles will become even weaker.
  3. Massage. In medical practice, massages are one of the most popular and at the same time effective methods of conservative treatment, in the presence of osteochondrosis of the thoracic region in a patient.During the recovery period, the muscles need additional support. Useful when blood flow temporarily improves and overextended muscles are unclenched using the correct technique. You need to attend specialist sessions several times a year in courses.
  4. Physiotherapy. Physiotherapy procedures are widespread in trauma, orthopedic and neurological practice. With the help of procedures, local blood flow is improved, systemic drugs are used externally and the apparatus acts on damaged tissues.As a result, the muscles are warmed up, and the chronic inflammatory process is eliminated in the affected area. Examples of medical procedures – magnetotherapy, shock wave therapy, electrophoresis.

Less commonly prescribed manual therapy and acupuncture.

Editorial Opinion

Osteochondrosis of the thoracic region is a serious disease if it is started. To prevent the disease from proceeding acutely, it is necessary to comprehensively treat the pathology. To learn more about the information on diseases of the spine, it is recommended to study other articles on our resource.

90,000 Umbilical hernia. Full description: causes, symptoms, diagnosis, treatment

One of the most common hernia-type diseases is an umbilical hernia. Under this malaise, there is a condition in which the internal organs, often the omentum and intestines, exit through a weakened opening, called the umbilical ring, outside the abdominal wall under the skin.

It manifests itself as an abnormal protrusion localized in the umbilical region, which disappears or decreases in size when taking a horizontal position.

There is a hernia in adults, both among men and women. However, women who have given birth are most often diagnosed.

Regardless of the manifestation, medical history and age, the treatment of an umbilical hernia is exclusively a surgeon. You should contact a specialist at the first manifestations of the disease and the occurrence of discomfort.

Symptoms of the disease

If you pay close attention to your health, systematically observe the changes occurring in the body, it is quite easy to notice visual symptoms and the growth of an umbilical hernia.The main manifestations of the disease:

  • Initial signs include a protrusion or enlargement of the navel, which is not painful, but accompanied by redness of the skin. Contacting a specialist at this stage allows you to solve the problem. The surgeon “removes” the tumor, which allows to stop further development, without further negative consequences.
  • Drawing pains during intense exertion or lifting a heavy thing are also characteristic of an ailment.
  • Any tension of the abdominal muscles, cough, sports activity, even bowel movements, especially with constipation, cause unpleasant pulling pain.
  • The gastrointestinal tract ceases to function normally if a fragment of the intestine enters the hernial sac. Nausea and periodic constipation are added to problems with the gastrointestinal tract.

What to do if you notice the first symptoms of an umbilical hernia

When the initial signs of an umbilical hernia appear, you should make an appointment with the surgeon. A visit to a specialist should not be delayed, because the progression of a hernia is fraught with serious consequences.The main danger in the absence of treatment is the infringement of the internal organs of the abdominal region, which over time leads to impaired blood flow and the course of necrotic processes in the tissues of the cavity. Lack of action leads to peritonitis, which already requires serious surgical intervention.

One should not hope for a fabulous recovery with the help of herbs, lotions or “reinsurance”. It is strictly forbidden to lift heavy objects or subject the body to increased stress.Infringement occurs unexpectedly, even from an attack of coughing, straining of the abdominal muscles during bowel movements, falling or even laughing. So when the first signs of an umbilical hernia appear or visualize, in order to preserve your health, exclude subsequently “serious surgery” and save your money, you should immediately contact a specialist and resolve the issue in one day.

Self-reduction of the infringement is prohibited. After all, it is accompanied by a piercing pain in the navel, staining the hernial sac in a dark red bloody shade, raising the temperature and pouring blood into the tumor.In this case, concomitant symptoms of intoxication often occur: vomiting, fever, body aches, nausea and headaches. From this moment on, the only correct solution is urgent hospitalization in a day hospital.

Methods for diagnosing a hernia

First of all, after detecting a problem, they turn to a surgeon. After a visual examination, the doctor directs the patient for research. This is important because stomach cancer and its metastasis to the navel are manifested by similar symptoms.

To detect the disease, the following diagnostic tests are prescribed:

  • Ultrasound examination, which allows you to obtain information about the presence, content, size of education, quantity and presence of the adhesive process.
  • Computed tomography is necessary for mild symptoms to see if there is a problem in 3D.
  • X-ray of the duodenum and stomach.
  • Herniography. The technique consists in the introduction of an X-ray contrast substance into the abdominal cavity, which stains the hernial sac and formation, and the umbilical hernia is clearly detected on the X-ray.
  • EGDS, esophagogastroduodenoscopic diagnostics.
  • Fibrogastroduodenoscopy, which is an effective study of parts of the digestive tract.
Treatment of an umbilical hernia in our clinic

Primary symptoms indicating the presence of an ailment such as an umbilical hernia must be confirmed by a specialist after a thorough examination.Only the surgeon, after a visual examination, correct palpation of the formation and a survey, will be able to establish the initial diagnosis. The exact diagnosis and state of development of an umbilical hernia is established only after receiving diagnostic images and the result of the necessary tests. Further treatment depends solely on the degree of development of the pathology.

The main and only reliable method of getting rid of a hernia is surgery. Patients who wish to safely get rid of a neoplasm must rely exclusively on traditional medicine.Today, there are no variations of getting rid of an umbilical hernia in traditional medicine, and it has not been proven. It is not provided and is strictly forbidden to “correct” education, as this can provoke significant complications.

A modern surgical room, fully equipped with the latest medical technology, experienced surgeons working for over 10 years, first-class diagnostic equipment and a day hospital with caring honey. staff – this is what allows our patients to heal and feel our care and support.

Today, there are several ways to remove education:

  • Traditional medicine provides for the possibility of treating an umbilical hernia using hernioplasty. This is possible in the case when the process is not started and proceeds without phenomena associated with infringement and death of tissues. Removing the neoplasm with this method does not hurt, because the procedure is performed under local anesthesia or epidural anesthesia. In the conditions of stationary treatment, the tissues of the umbilical ring are sutured in several layers.
  • Often, the navel is also removed, and obese patients can additionally get rid of the fat apron. Depending on the name of the materials used during the operation, there are several types of hernioplasty: tension, laparoscapia and tension-free type of surgery.

  • Plastic with mesh implants. Thanks to the placement of the mesh under / over the aponeurosis, the rehabilitation period is reduced to a month.This technique has more sparing statistics regarding relapses: only about 1% of patients are treated with secondary formation of an umbilical hernia.

There are a number of patients who cannot undergo surgery. These include pregnant women, people with oncopathologies and with inflammatory processes in the body. In such situations, the surgeon prescribes non-operative treatment depending on the age, clinical case and stage. This can be wearing a bandage, using a patch, doing exercises to strengthen muscles, physiotherapy.However, such actions must be carried out strictly under the supervision of a physician, and the patient must also systematically carry out preventive measures.

In order to inexpensively eliminate an umbilical hernia, one should once resort to an operation performed by highly qualified specialists who use advanced equipment and modern technologies, such as in our clinic. This will reduce the cost of relapses, as well as avoid repeated surgery.It is easy to be healthy, it is enough to seek professional help in a timely manner!

Consultation can be obtained by phone: +7 (495) 961-27-67


Causes of the umbilical formation

The main reasons that do not depend on the conditions and mode of human activity, provoking the manifestation of the disease, are:

  • Pregnancy and subsequent childbirth.Constant pressure on the abdominal walls during fetal development contributes to the development of an anomaly. An umbilical hernia may present with a protruding navel.
  • Congenital malformation of the umbilical ring.
  • Work related to weight lifting.
  • Traumatization of the umbilical region.
  • There are also common lifestyle reasons:
  • Excessive physical activity.
  • Sedentary lifestyle and, as a result, obesity.
  • Incorrect power supply.
  • Recurrent constipation.
  • Underdevelopment of the abdominal muscles, weakness of the connective tissues.
  • Ascites.
  • Disruption of the digestive tract.
  • Previous surgical invasions of the peritoneal organs and the lack of following the recommendations of specialists in the postoperative period.
  • Severe hacking cough.
  • Neglect of prostate adenoma disease.

Consultation can be obtained by phone: +7 (495) 961-27-67


Complications of the disease

Even if an umbilical hernia does not cause discomfort and anxiety, at some point it can manifest itself and cause significant inconvenience. If the formation is not treated in a timely manner, a protracted illness is manifested by the following complications:

  • Infringement when the contents of the hernial sac are compressed by the hernial orifice and necrosis begins in the peritoneal organs.
  • Addition of secondary infection, the beginning of the acute inflammatory process of a part of the hernial sac organ.
  • The development of coprostasis, during which stagnation of feces occurs, especially if intestinal loops are drawn into the pathology.

Our doctors will help you:

Consultation can be obtained by phone: +7 (495) 961-27-67


90,000 Cough. Harm and benefit.- Into-Sana

Cough is a physiological defense mechanism that protects the respiratory tract from irritating factors: internal (mucus, sputum, pus) or external (foreign bodies, dust).

Most of the cough receptors are found in the larynx, trachea and the division of the bronchi. They are also found in the pleura, the lower part of the esophagus, stomach, in the external auditory canals, etc. By the way, there are no cough receptors directly in the lungs.This is why sometimes pneumonia can go away without coughing.

Cough can be acute (up to 2 weeks), protracted (up to 2 months) and chronic – if the cough lasts more than 2 months. Acute cough is most often caused by a viral infection, sinusitis, allergic rhinitis and exacerbation of chronic lung diseases. Tobacco smoking is the most common prerequisite for chronic cough. The smoke of cigarettes, firstly, has a direct irritating effect on the respiratory tract, and secondly, it causes an inflammatory reaction in the mucous membrane and provokes the release of mucus and inflammatory reagents.

Other causes of chronic cough: bronchial asthma, leakage of mucus from the nasopharynx, reflux of gastric contents. Also, a cough can be the result of mechanical irritation of receptors by a neoplasm, side effects of drugs (for example, ACE inhibitors), or develop as a result of helminthiasis.

Thus, cough plays a significant positive role in maintaining our health:

  • protects our respiratory tract when inhaling foreign bodies;
  • helps to remove mucus in inflammatory diseases;
  • prevents the infection from descending down the respiratory tract;
  • reports a disease or some changes in our body (for example, it can occur with helminthiasis, heart problems).

But at the same time, coughing can have negative consequences – throat irritation, shortness of breath. Frequent hacking cough in severe cases can lead to pulmonary emphysema, hemorrhage in the sclera, deterioration of cerebral circulation, dizziness.

It is often the cause of insomnia, urinary and fecal incontinence, vomit, and increased degree of hernias. In addition, coughing causes psychological discomfort and depression. In pregnant women, coughing can cause increased uterine tone.

Cough is a symptom. Therefore, it should be treated when there is a threat of complications. Usually, you need to treat the cause that caused it.

If a cough has arisen against the background of ARVI, it is moist and gradually decreases, then with the help of expectorant syrups and herbs, it can be easily dealt with.

Dry cough is more often caused by receptor irritation. If it interferes with sleep, strong and harsh, then cough remedies are used. They suppress the cough reflex.

Means used for dry cough should not be taken with a wet one, since sputum stagnation in the respiratory tract provokes infectious complications and their passage down the bronchial tree.

In general, if a cough develops, it is advisable to see a doctor.

Should be of particular concern:

  • prolonged cough – more than three weeks;
  • temperature rise for more than three days;
  • streaks of blood in sputum or sputum of the color of rust;
  • chest pain;
  • shortness of breath at rest or on exertion;
  • nausea and vomiting.

The appearance of such symptoms requires immediate medical attention!

In addition, it should be remembered that chronic cough is one of the symptoms of pulmonary tuberculosis. At the onset of the disease, this disease can proceed even without coughing. Therefore, do not neglect the annual prophylactic chest X-ray (fluorography).

Our body has good compensatory and defense mechanisms, such as coughing. Provided that it is in good physical and psychological condition, the body is able to cope with many diseases on its own.

Remember, the foundation for successful self-regulation is quitting smoking (both active and passive), daily exercise and a healthy diet.

Simply put, do not complicate the work of the body and do not interfere with his work.

Be healthy and take care of yourself!

Ka to treat an inguinal hernia? Surgical treatment of an inguinal hernia in the TERVE clinic in Krasnoyarsk

The only way to treat a hernia is surgery.Wearing bandages can only partially alleviate the symptoms of the disease, but does not eliminate the cause of the hernia and does not reduce the risk of entrapment.

Inguinal hernia symptoms:

  • protrusion in the groin area, which increases with straining, lifting weights
  • discomfort, pain, feeling of pressure or heaviness in the groin

If these symptoms appear, see a surgeon. The hernia cannot disappear on its own and will only increase over time, threatening the development of infringement.Symptoms are also more likely to progress, and if at first patients are worried about only a little discomfort, then over time it can turn into pain.

If the hernia has stopped adjusting, severe pain, nausea or vomiting appear, you should immediately call an ambulance!

Causes of hernia:

Two groups of risk factors play a role in hernia formation:

  • predisposing – the presence of weak points of the anterior abdominal wall, weakness of the connective tissue;
  • producing – conditions leading to an increase in pressure inside the abdominal cavity and the “pushing” of organs outside it: lifting weights, persistent coughing in chronic lung diseases, constipation, difficulty urinating in diseases of the prostate gland, ascites, etc.d.

Why is an inguinal hernia dangerous?

The most formidable complication of a hernia is an infringement of the internal organs located in the hernial sac. This life-threatening condition requires immediate surgery to remove the inguinal hernia, since a violation of the blood supply to the strangulated organ leads to its necrosis and peritonitis.

Inguinal hernia diagnostics:

In most cases, an examination by a qualified surgeon is sufficient for diagnosis.If in doubt about the diagnosis, the small size of the hernia, or to choose the procedure that is optimal for a particular case, an ultrasound examination (ultrasound), magnetic resonance imaging or computed tomography (MRI or CT) is performed.

Preparation for an operation to remove an inguinal hernia:

In the process of preparing for a planned operation for an inguinal hernia, the surgeon and the anesthesiologist will tell you in detail about the upcoming operation and anesthesia, and will give all the necessary recommendations.

General Recommendations:

  • Avoid drinking alcohol the day before surgery
  • Eliminate food and water intake from the night before surgery

Inguinal hernia surgery in TERVE:

Which method should you choose? Only a surgeon can unambiguously answer this question by examining the patient and analyzing the features of a particular case.The best technique is the one that works best for the patient.

What does optimal mean?

  • ensuring reliable closure of the hernial orifice;
  • with a minimum likelihood of relapse;
  • with the most comfortable course of the postoperative period and quick rehabilitation it.

How is this achieved?

In the vast majority of cases, the abdominal wall defect is closed with mesh implants without any tension (as opposed to using the patient’s own tissues).This significantly reduces the likelihood of hernia recurrence. The implants we use meet strict criteria: reliability, minimal reaction of the body, lack of discomfort in the long term. Implant fixation is carried out using modern absorbable materials. For inguinal hernias, we give preference to individually selected implants that correspond to the anatomical features of the area.

Recovery after an operation to remove an inguinal hernia.
In the first hours after surgery:

  • you can drink water in small quantities;
  • you may experience pain – in this case, the nurse will carry out the necessary pain relief in consultation with your doctor.

After discharge (usually the day after inguinal hernia surgery):

  • Take the drugs recommended by your doctor
  • The diet should include a sufficient amount of foods high in fiber and liquid
  • You can take a shower the next day after surgery

Restriction of physical activity:

  • Avoid heavy lifting (more than 5-7kg) for several weeks after inguinal hernia surgery; sometimes doctors recommend extending this period to three months
  • sports (running, swimming) can be resumed after 4-6 weeks
  • weight exercises are best postponed for 3 months

Risks of self-healing inguinal hernia:

One of the most popular self-treatment methods for hernias is wearing a bandage.However, a bandage does not heal a hernia – it does not decrease over time, but it necessarily becomes larger. Moreover, the delay in contacting a specialist can lead to sad consequences, namely, to the infringement of the hernia. This will be evidenced by a sharp pain in the hernia and the inability to correct it, nausea, vomiting, stool retention. Moreover, if you do not take emergency measures, complications may develop, such as necrosis of the loop of the small intestine or the development of intestinal obstruction.
We recommend to all our patients not to bring the situation to an emergency and remember that a hernia can only be treated surgically, and the sooner the better.

90,000 Treatment of protrusion of the cervical spine in Moscow in the Dikul clinic: prices, appointments

The cervical spine is the most mobile part of the spine. In addition, the neck is a complex anatomical area where the vessels, trachea, and esophagus pass. Therefore, disc protrusion in the cervical spine is often the cause of both neurological symptoms and vascular disorders associated with exposure to the vertebral arteries. As a rule, disc protrusion is associated with degenerative-dystrophic changes in the spine (osteochondrosis).Degenerative processes in the spine tend to progress. Therefore, timely and adequate treatment of protrusion of the cervical spine allows not only to relieve symptoms, but also to prevent the transformation of protrusion into a herniated disc and avoid the need for surgical treatment.

But there may be other reasons for the development of disc protrusion. Inflammation, damage, or degeneration of the disc can cause a range of symptoms that vary depending on the severity of the pathology.A protruding disc can lead to neck pain radiating to the arm, numbness, tingling, motor problems, muscle spasm, or some combination of these symptoms. The most common degenerative changes and disc protrusion occur at the C5-C6 and C6-C7 levels. Medical statistics indicate that disc protrusion in the cervical spine occurs in 60% of people over 40 years old. It is worth noting the fact that representatives of the stronger sex get sick more often.

Reasons

  • Degeneration or wear resulting in disc destruction.
  • Repetitive flexion (extension) and twisting movements, especially in combination. These movements have the greatest effect on the outer annulus of the disc.
  • Discs are most susceptible to injury while sitting or tilted, as pressure on the disc is displaced forward and the force vector shifts the disc contents posterolaterally to the thinner and weaker portion of the annulus fibrosus.
  • Fall or injury, like a car accident.
  • Repetitive stress injuries when working with hands over the head or while doing weightlifting.
  • Genetic factors can, to a certain extent, contribute to the early development of degenerative changes in the discs (osteochondrosis).
  • Smokers are more prone to early development of disc degeneration
  • Infection (discitis)

Symptoms

Protruded discs in the cervical spine are quite common and most of them are not symptomatic. Symptoms of disc protrusion depend on the location of the bulge and the soft tissue structures that are affected.The process may involve: the back of the head, neck, arms, shoulder girdle and hands. Symptoms can range from mild discomfort to severe and persistent.

The following symptoms are most common:

  • Pain in the neck, head, shoulder and arm, aggravated by minimal stress on the arm, coughing, sneezing;
  • Cracking and pain in the neck when turning or tilting the head;
  • Muscle spasm and changes in posture;
  • Numbness, tingling in the hands or feet, burning between the shoulder blades;
  • Headache that usually begins in the neck and extends to the occiput and temples;
  • Dizziness and even fainting on sudden turning of the head;
  • Decreased range of motion in the neck, difficulty moving the head and neck;
  • Prolonged sitting may cause neck and arm pain;
  • Neck pain or radicular pain radiating to the arm if the disc compresses the nerve root.
  • Weakness, muscle atrophy, or loss of strength in the arms can occur when a motor neuron is compressed.
  • Feeling weak and tired;

Other symptoms of cervical disc protrusion: tinnitus, decreased visual acuity and hearing, and sometimes pain in the region of the heart.

Red flags for neck pain

A serious underlying cause is more likely in people with:

  • The onset of symptoms appeared before the age of 20 or after the age of 55.
  • Weakness associated with more than one myotome or sensory disturbance involving more than one dermatome.
  • Intense or increasing pain.

Red flags suggesting possible malignancy, infection or inflammation:

  • Fever.
  • Unexplained weight loss.
  • History of inflammatory arthritis.
  • History of malignant neoplasms, drug abuse, tuberculosis, AIDS or other infection.
  • Immunosuppression.
  • Pain that gets worse, is very intense and / or disturbs sleep.
  • Lymphadenopathy.
  • Local punctual tenderness over the vertebral body.

Red flags suggesting myelopathy (spinal cord compression):

  • Progression of symptoms.
  • Gait disorder; weakness or impaired motor function in the hands; loss of control / bladder / bowel.
  • Lhermitte’s symptom (flexion of the neck causes sensations of electric shock that spread down the spine and into the limbs).
  • Pathological symptoms in the lower extremities (Babinsky reflex, hyperreflexia, clonuses, spasticity) and in the upper extremities (atrophy, hyporeflexia).
  • Various sensory changes (loss of proprioception is more noticeable in the arms than in the legs).

Red flags indicating the possibility of severe skeletal injury:

  • Trauma history.
  • Previous neck surgery.
  • Osteoporosis or risk factors for osteoporosis.
  • Increase and persistence of pain.

Red flags indicating vascular insufficiency:

  • Dizziness and dimness before the eyes (compression of the vertebral artery) on movement, especially when the neck is extended.
  • Dizziness, syncope episodes.

Differential diagnosis of neck pain

As a rule, most back pain is associated directly with changes in the discs (protrusion, disc herniation), however, medical imaging methods must be used for an accurate diagnosis.

Differential diagnoses include:

  • Cervical spondylosis.
  • Traumatic prolapse of the intervertebral disc.
  • Neck pain: acute neck deformity, postural neck pain or pain associated with whiplash
  • Headache.
  • Reflected pain – for example, from the shoulder.
  • Malignant tumors: primary tumors, metastases or myeloma.
  • Infections: discitis, osteomyelitis or tuberculosis.
  • Fibromyalgia.
  • Vascular insufficiency.
  • Psychogenic neck pain.
  • Inflammatory diseases (eg rheumatoid arthritis).
  • Metabolic diseases: Paget’s disease, osteoporosis.

Diagnosis of disc protrusion

Radiculopathy neck pain and no red flag symptoms generally do not require imaging or other special tests.However, for verification purposes, the doctor may prescribe the following research methods:

Blood tests can be ordered to rule out infectious or inflammatory diseases (a decrease in hemoglobin can be a sign of anemia; an increase in ROE can be a sign of both infection and inflammation; rheumatoid factor levels and HLA-B27 determination can indicate systemic connective tissue diseases ).

Medical imaging techniques are very important, but they should be interpreted in light of the clinical picture, as positive results are quite common in people without any complaints:

• Radiography .A plain cervical spine x-ray can be used to assess chronic degenerative changes, metastatic tumors, infection, spinal deformity, and motor segment stability. Interpretation of research results is often difficult because degenerative signs are almost universal in people over the age of 35.

• MRI. This imaging method can be prescribed if radiography has not allowed to determine the genesis of symptoms.MRI should be done to diagnose disc protrusion (herniation) and compression of nerve structures.

• CT myelography can be used if there is any contraindication to MRI.

• EMG (ENMG ) – these methods can be informative in the presence of radiculopathy or the need to determine the level of damage and differentiation of cervical radiculopathy from nerve compression syndromes.

Treatment

As a rule, the treatment of protrusion of the cervical spine uses conservative methods, and surgical treatment is rarely required.Conservative treatment can relieve symptoms and stop the progression of the disease.

The doctor prescribes a course of treatment for the patient, taking into account the clinical picture, age, gender and characteristics of the body. Treatment of protrusion of the cervical spine can take up to one and a half months. The patient undergoes procedures 2-3 times a week. Neck pain usually resolves after 1 to 2 weeks of treatment. The following methods can be used in the course of treatment:

Medication:

      • Analgesics and muscle relaxants can relieve pain and muscle spasms.
      • If pain is chronic and severe, pain relief may be enhanced by the addition of amitriptyline or gabapentin.
      • Diazepam for 3-7 days may be useful in patients with severe muscle spasm.

Manual therapy

The doctor, using hand manipulations, relieves muscle spasm, pain, restores joint mobility and relaxes muscles.

Osteopathy

Osteopath identifies problems in the body using palpation diagnostics, restores joint mobility, relieves muscle tension.

Apitherapy

The doctor puts the bee at a point with increased blood and lymph flow. Bee sting treatment relieves pain and inflammation, kills bacteria, and tones the nervous system.

Hirudotherapy (treatment with leeches)

When bitten, a leech introduces various enzymes into the bloodstream (primarily hirudin). Hirudotherapy reduces swelling and inflammation, strengthens blood vessels, and accelerates the movement of blood and lymph.

Reflexology (acupuncture)

Doctor – reflexologist acts with needles on biologically active points.Acupuncture relieves pain, inflammation and spasm of blood vessels, improves tissue nutrition.

Therapeutic massage

The massage therapist uses various methods of affecting soft tissues. Massage relieves pain and tension in muscles, improves posture, relieves headaches. A head or neck massage may be prescribed to the patient, depending on the need.

The specialist performs massage with smooth movements. The procedure relieves headaches, relaxes the nervous system and normalizes blood pressure.

Physiotherapy

Exposure to laser, ultrasound, electric current and other physical factors relieves pain, improves blood circulation and tissue nutrition, and accelerates the removal of toxins.

Mud therapy

Healing mud contains biologically active substances and minerals. Mud wraps stimulate metabolism, improve tissue nutrition, and eliminate toxins.

Active oxygen therapy

Ozone-oxygen mixture is administered intravenously or in the form of microinjections.Ozone destroys bacteria and viruses, removes toxins, improves the functioning of the immune system.

Kinesiotaping

The doctor applies adhesive tapes (tapes) to certain parts of the patient’s body. The method is used to relax muscles, treat sprains and muscle injuries in joints.

Plasmolifting

The doctor is giving patients injections of his own plasma. The procedure restores the tissue around the joints and spine, reduces pain and inflammation, and helps to move more freely.

exercise therapy

Physical exercises, which are individually selected by the exercise therapy doctor for each patient, combine stretching exercises, isometric exercises and resistance exercises, which allows you to restore range of motion and strengthen the muscles of the cervical spine and shoulder girdle to support, stabilize and reduce stress loads of the discs and neck …

Surgical treatment

The most common disc-related surgery is discectomy, in which the disc is removed through an incision.In the cervical spine, discectomy can be performed either from the front or from the back. In some cases, a vertebral fusion surgery may be recommended. Most patients who underwent discectomy recover fairly quickly after surgery with a course of physical therapy. Discectomy is usually performed when a herniated disc is present, as most protrusions of discs can be successfully treated conservatively.

Forecast

In most cases, disc protrusions are successfully treated without surgery and patients return to normal work and life.