Hernia problems symptoms: The request could not be satisfied
Swelling, Constipation, Abdominal Pain & More
Signs and Symptoms of a Hernia
Symptoms depend on the type of hernia. In some cases, you may not have any symptoms.
For inguinal, femoral, umbilical, and incisional hernias, symptoms may include:
- An obvious swelling beneath the skin of the abdomen or the groin. It may be tender, and it may disappear when you lie down.
- A heavy feeling in the abdomen that sometimes comes with constipation or blood in the stool.
- Discomfort in the abdomen or groin when lifting or bending over.
- A burning or aching sensation at the bulge
- Weakness or pressure in your groin
- A hard time swallowing
- Shooting pain
- Pain and swelling around the testicles
Symptoms of a hiatal hernia may include heartburn and upper abdominal pain.
Strangulated hernia symptoms
Usually, you can push a hernia in. But sometimes, you can’t. It can get stuck in your abdomen. If the trapped part gets cut off, or strangulated, from blood flow, it’s a serious situation and can be life-threatening.
Call your doctor right away if you have any of the symptoms of a strangulated hernia, including:
- Nausea, vomiting, or both
- Sudden pain that gets worse quickly
- A hernia bulge that turns red, purple, or dark
- Not being able to poop or pass gas
Hernia Signs and Symptoms in Children
Hernias are common in kids, especially babies. They can happen when part of their abdominal wall is weak at birth. If your child has one, you’ll usually notice a bulge in their groin area or around their bellybutton. Your baby may also cry a lot and refuse to eat. Hernias often bulge when your child cries, coughs, or strains to poop. You may also notice that their belly is tender to the touch.
When to See a Doctor
You should see a doctor if you:
- Suspect that you have a hernia
- Can’t get the hernia to go back in or it goes soft; seek medical care right away, as this is an incarcerated hernia and can lead to organ strangulation.
- Have a painful or noticeable bulge in your groin on either side of your pubic bone
- Know you have a hernia, and you have symptoms of a strangulated hernia. Seek medical care right away.
Types, Treatments, Symptoms, Causes & Prevention
Common types of hernia
What is a hernia?
A hernia occurs when an internal organ or other body part protrudes through the wall of muscle or tissue that normally contains it. Most hernias occur within the abdominal cavity, between the chest and the hips.
The most common forms of hernia are:
- Inguinal hernia: In men, the inguinal canal is a passageway for the spermatic cord and blood vessels leading to the testicles. In women, the inguinal canal contains the round ligament that gives support for the womb. In an inguinal hernia, fatty tissue or a part of the intestine pokes into the groin at the top of the inner thigh. This is the most common type of hernia, and affects men more often than women.
- Femoral hernia: Fatty tissue or part of the intestine protrudes into the groin at the top of the inner thigh. Femoral hernias are much less common than inguinal hernias and mainly affect older women.
- Umbilical hernia: Fatty tissue or part of the intestine pushes through the abdomen near the navel (belly button).
- Hiatal (hiatus) hernia: Part of the stomach pushes up into the chest cavity through an opening in the diaphragm (the horizontal sheet of muscle that separates the chest from the abdomen).
Other types of hernias include:
- Incisional hernia: Tissue protrudes through the site of an abdominal scar from a remote abdominal or pelvic operation.
- Epigastric hernia: Fatty tissue protrudes through the abdominal area between the navel and lower part of the sternum (breastbone).
- Spigelian hernia: The intestine pushes through the abdomen at the side of the abdominal muscle, below the navel.
- Diaphragmatic hernia: Organs in the abdomen move into the chest through an opening in the diaphragm.
How common are hernias?
Of all hernias that occur:
- 75 to 80% are inguinal or femoral.
- 2% are incisional or ventral.
- 3 to 10% are umbilical, affecting 10 to 20% of newborns; most close by themselves by 5 years of age.
- 1 to 3% are other types.
Symptoms and Causes
What causes a hernia?
Inguinal and femoral hernias are due to weakened muscles that may have been present since birth, or are associated with aging and repeated strains on the abdominal and groin areas. Such strain may come from physical exertion, obesity, pregnancy, frequent coughing, or straining on the toilet due to constipation.
Adults may get an umbilical hernia by straining the abdominal area, being overweight, having a long-lasting heavy cough or after giving birth.
The cause of hiatal hernias is not fully understood, but a weakening of the diaphragm with age or pressure on the abdomen could play a part.
What are the symptoms of a hernia?
A hernia in the abdomen or groin can produce a noticeable lump or bulge that can be pushed back in, or that can disappear when lying down. Laughing, crying, coughing, straining during a bowel movement, or physical activity may make the lump reappear after it has been pushed in. More symptoms of a hernia include:
- Swelling or bulge in the groin or scrotum (the pouch that contains the testicles).
- Increased pain at the site of the bulge.
- Pain while lifting.
- Increase in the bulge size over time.
- A dull aching sensation.
- A sense of feeling full or signs of bowel obstruction.
In the case of hiatal hernias there are no bulges on the outside of the body. Instead, symptoms may include heartburn, indigestion, difficulty swallowing, frequent regurgitation (bringing food back up) and chest pain.
Diagnosis and Tests
How is a hernia diagnosed?
It is usually possible to see or feel a bulge in the area where a hernia has occurred by physical exam. As part of a male’s typical physical exam for inguinal hernias, the doctor feels the area around the testicles and groin while the patient is asked to cough. In some cases, soft-tissue imaging like a CT scan will accurately diagnose the condition.
Management and Treatment
What kind of doctor do you see for a hernia?
When you have a hernia, treatment will start with your primary care provider. If you need surgery to repair the hernia, you’ll be referred to a general surgeon. In fact, ventral hernia repairs are one of the most common operations U.S. general surgeons perform.
If you think you have a hernia, don’t wait to seek help. A neglected hernia can grow larger and more painful — this can lead to complications and possibly emergency surgery. Early repair is more successful, less risky and offers a better recovery and outcome.
How is a hernia treated?
Hernias usually do not get better on their own, and surgery may be the only way to repair them. However, your doctor will recommend the best therapy to address your hernia, and may refer you to a surgeon. If the surgeon thinks it is necessary to repair your hernia, then the surgeon will tailor the method of repair that best meets your needs.
In the case of an umbilical hernia in a child, surgery may be recommended if the hernia is large or if it has not healed by the age of 4 to 5 years old. By this age, a child can usually avoid surgical complications.
If an adult has an umbilical hernia, surgery is usually recommended because the condition will not likely improve on its own and the risk of complications is higher.
One of three types of hernia surgery can be performed:
- Open surgery, in which a cut is made into the body at the location of the hernia. The protruding tissue is set back in place and the weakened muscle wall is stitched back together. Sometimes a type of mesh is implanted in the area to provide extra support.
- Laparoscopic surgery involves the same type of repairs. However, instead of a cut to the outside of the abdomen or groin, tiny incisions are made to allow for the insertion of surgical tools to complete the procedure.
- Robotic hernia repair, like laparoscopic surgery, uses a laparoscope, and is performed with small incisions. With robotic surgery, the surgeon is seated at a console in the operating room, and handles the surgical instruments from the console. While robotic surgery can be used for some smaller hernias, or weak areas, it can now also be used to reconstruct the abdominal wall.
Each type of surgery has its advantages and disadvantages. The best approach will be decided by the patient’s surgeon.
What can happen if a hernia is not treated?
Other than umbilical hernias in babies, hernias will not disappear on their own. Over time, a hernia can grow larger and more painful or can develop complications.
Complications of an untreated inguinal or femoral hernia may include:
- Obstruction (incarceration): Part of the intestine becomes stuck in the inguinal canal, causing nausea, vomiting, stomach pain, and a painful lump in the groin.
- Strangulation: Part of the intestine is trapped in a way that cuts off its blood supply. In such cases, emergency surgery (within hours of occurring) is necessary to prevent tissue death.
How can a hernia be prevented?
- Maintain ideal body weight by eating a healthy diet and exercising.
- Eat enough fruits, vegetables and whole grains to avoid constipation.
- Use correct form when lifting weights or heavy objects. Avoid lifting anything that is beyond your ability.
- See a doctor when you are ill with persistent coughs or sneezing.
- Don’t smoke, as the habit can lead to coughing that triggers a hernia.
Outlook / Prognosis
What can be expected following surgical treatment for a hernia?
After surgery, you will be given instructions. These include what diet to follow, how to care for the incision site, and how to take care to avoid physical strain. Hernias may recur regardless of the repair operations. This is sometimes caused by inherent tissue weakness or protracted healing. Smoking and obesity are also major risk factors for hernia recurrence.
The esophagus sphincter muscle normally closes tightly. With a hiatal hernia, the sphincter’s new position may keep it from completely closing. The back flow of digestive juices may damage the esophagus.
What is a hiatal hernia?
A hiatal hernia occurs when the upper part of the stomach pushes through an opening in the diaphragm and into the chest cavity. The diaphragm is the thin muscle wall that separates the chest cavity from the abdomen. The opening in the diaphragm is where the esophagus and stomach join.
Who is at risk for developing a hiatal hernia?
A hiatal hernia can develop in people of all ages and both sexes, although it frequently occurs in people age 50 and older. Hiatal hernia occurs more often in overweight people and smokers.
Symptoms and Causes
What causes a hiatal hernia?
The most common cause of a hiatal hernia is an increase in pressure in the abdominal cavity. Your abdominal cavity is the space in the middle of your body that holds several organs, including the:
- Lower part of the esophagus and stomach.
- Small intestine, colon and rectum.
- Gallbladder, pancreas and spleen.
This pressure can build up from things like:
- Straining during a bowel movement.
- Heavy lifting.
- Physical strain.
There are also other reasons a hiatal hernia could develop. You may experience a hiatal hernia during pregnancy, if you are obese, or if there’s extra fluid in your abdomen.
Increased pressure in the abdomen (arrows) causes part of the stomach to push through the diaphragm and into the chest cavity.
What are the symptoms of a hiatal hernia?
Many people with a hiatal hernia never have symptoms. Some people with hiatal hernia have some of the same symptoms as gastroesophageal reflex disease (GERD). GERD occurs when digestive juices move from the stomach back into the esophagus. Symptoms of GERD include:
- Bitter or sour taste in the back of the throat.
- Bloating and belching.
- Discomfort or pain in the stomach or esophagus.
Although there appears to be a link between hiatal hernia and GERD, one condition does not seem to cause the other. Many people have a hiatal hernia without having GERD, and others have GERD without having a hiatal hernia.
Another symptom of a hiatal hernia is chest pain. Since chest pain can also be a symptom of a heart attack, it’s important to contact your healthcare provider or go to the emergency room if you experience any chest pain.
Diagnosis and Tests
How is a hiatal hernia diagnosed?
Several tests can be done to help diagnose a hiatal hernia. These include a barium swallow test, an endoscopy procedure, esophageal manometric studies, a pH test and gastric emptying studies.
- A barium swallow involves drinking a special liquid, then taking X-rays to help see problems in the esophagus (such as swallowing disorders) and the stomach (such as ulcers and tumors). It also shows how big the hiatal hernia is and if there is twisting of the stomach as a result of the hernia.
- An endoscopy is a procedure in which the inside of the upper digestive system is viewed with an endoscope (a long, thin, flexible instrument about 1/2 inch in diameter).
- An esophageal manometry measures the strength and muscle coordination of your esophagus when you swallow.
- A pH test measures the acid levels in the esophagus and helps determine which symptoms are related to acid in the esophagus.
- Gastric emptying studies examine how fast food leaves the stomach. Results from this test are especially important in patients who have nausea and vomiting. There could be other causes of the nausea and vomiting besides a hiatal hernia.
Management and Treatment
How is a hiatal hernia treated?
Most hiatal hernias do not cause problems and rarely need treatment. However, since some patients with a hiatal hernia have symptoms of GERD, treatment starts with methods used to manage GERD. These include making such lifestyle changes as:
- Losing weight if you’re overweight.
- Decreasing the portion sizes of meals.
- Avoiding certain acidic foods—such as tomato sauce and citrus fruits or juices—that can irritate the esophageal lining.
- Limiting fried and fatty foods, foods or drinks containing caffeine (including chocolate), peppermint, carbonated beverages, alcoholic beverages, ketchup and mustard, and vinegar.
- Eating meals at least three to four hours before lying down, and avoiding bedtime snacks.
- Keeping your head six inches higher than the rest of your body when lying on your back. Raising the level of your head helps gravity keep your stomach’s contents in the stomach. Raising the head of your bed by angling your mattress works best—piling your pillows doesn’t work as well because it makes you crunch your middle instead of simply angling your body upwards.
- Quitting smoking.
- Not wearing a tight belt or tight clothing that can increase the pressure on the abdomen — such as control top hosiery and body shapers.
- Taking medications after eating to reduce acid in the stomach. These over-the-counter medications include antacids, Gaviscon®, or H-blockers (such as Pepcid AC® or Zantac®).
Sometimes, a medication called a proton-pump inhibitor might be used to treat hiatal hernia. This medication is another way to decrease the amount of stomach acid you have, which can help prevent reflux. When you take this medication, your body doesn’t make as much stomach acid as normal. This is similar to H-blocker medications.
Can over-the-counter medications help relieve my hiatal hernia symptoms?
In many cases, over-the-counter medications can help you with some symptoms of hiatal hernia. Antacids are the most common medication you might use for relief. However, if you take over-the-counter medications for longer than two weeks without any improvement, see your healthcare provider. Prescription medications are typically the next step. These can include:
- Pantoprazole (Protonix®).
- Rabeprazole (Aciphex®).
- Esomeprazole (Nexium®).
- Omeprazole (Prilosec®).
- Lansoprazole (Prevacid®).
When is surgery for a hiatal hernia needed?
If the portion of the stomach entering the esophagus is being squeezed so tightly that the blood supply is being cut off, you’ll need to have surgery. Surgery may also be needed in people with a hiatal hernia who have severe, long-lasting (chronic) esophageal reflux whose symptoms are not relieved by medical treatments. The goal of this surgery is to correct gastroesophageal reflux by creating an improved valve mechanism at the bottom of the esophagus. Think of this valve as a swinging door. It opens to let food pass down into the stomach and then closes to keep stomach contents from going back up the esophagus. When this valve doesn’t work correctly, your stomach contents can go the wrong way and damage your esophagus. If left untreated, chronic gastroesophageal reflux can cause complications such as esophagitis (inflammation), esophageal ulcers, bleeding or scarring of the esophagus.
How is surgery for a hiatal hernia performed?
Surgery for repairing a hiatal hernia involves:
- Pulling the hiatal hernia back into the abdomen.
- Improving the valve at the bottom of the esophagus.
- Closing the hole in the diaphragm muscle.
During surgery, your surgeon will wrap the upper part of the stomach (called the fundus) around the lower portion of the esophagus. This creates a permanently tight sphincter (the valve) so that stomach contents will not move back (reflux) into the esophagus.
Called a fundoplication, there are two versions of this surgery. An open fundoplication surgery involves a larger incision. This type of procedure may need to be done in some very severe cases and it allows for greater visibility during surgery. However, open surgeries require a longer recovery time in the hospital. In many cases, the surgeon will decide to use a laparoscopic approach instead.
A laparoscopic surgery is done through several small incisions instead of one big cut. This is considered a minimally invasive option. The specific laparoscopic procedure used to repair a hiatal hernia is called the Nissen fundoplication. This procedure creates a permanent solution to your hiatal hernia symptoms. During the procedure, your surgeon will make five or six tiny incisions in the abdomen. The laparoscope (a tool that allows the surgical team to see your internal organs on a screen in the operating room) and other surgical instruments are inserted through the small incisions. The fundus is wrapped around the esophagus and the sphincter is tightened during surgery. The advantages of laparoscopic surgery compared to an open surgery include:
- Smaller incisions.
- Less risk of infection.
- Less pain and scarring.
- A shorter recovery.
Outlook / Prognosis
How effective is surgery for a hiatal hernia?
A laparoscopic repair of hiatal hernia and reflux, called Nissen Fundoplication, is very effective in most patients. This surgery requires general anesthesia and a short stay in the hospital. If you need to have an open surgical procedure, the recovery time will be longer and you may need to stay in the hospital for several days. After surgery, most patients no longer require long-term treatment with prescription or over-the-counter antacid medications.
Umbilical Hernia Surgery for Children: Cause, Repair, Recovery
What is umbilical hernia surgery?
Umbilical hernia surgery is a procedure to repair a hernia in a child’s abdominal (belly) area.
The procedure is typically short (around an hour) and successful. Children often return to their regular activities within a few days.
What is an umbilical hernia?
An umbilical hernia is an unusual bulge that you can often see or feel over the belly button (the umbilicus). An umbilical hernia develops when part of the intestine, together with fat or fluid, forms a sac. This sac pushes through an opening in the muscle of the abdominal wall. Usually, hernias do not cause pain in children.
Why do children get umbilical hernias?
Sometimes, a child is born with an opening in the abdominal wall. This problem happens as the baby develops during pregnancy — the abdominal wall muscles don’t fully close around the organs.
A hernia happens when the intestine starts to push through the opening. You may see the bulge in the belly button all the time. Or you may only notice it when your child is straining those muscles in some way — either by crying, coughing or straining while pooping.
How common are umbilical hernias?
Umbilical hernias occur in 1 out of 6 children. They affect boys and girls equally. They’re more common in babies born prematurely.
Does an umbilical hernia need treatment?
An umbilical hernia may not need any treatment. If it does, surgery can repair it.
Most of the time — in more than 90% of cases — umbilical hernias heal on their own by the time a child is three or four years old. Your healthcare provider will likely recommend waiting until that age to do surgery.
Your child is more likely to need surgery if the hernia is:
- Larger than two centimeters, around ¾ inch.
Larger and incarcerated hernias are less likely to heal on their own and will probably need hernia repair surgery.
What’s an incarcerated hernia?
An incarcerated hernia is more severe. It happens when the intestines get trapped in the muscles and cause pain and tenderness. A healthcare provider needs to examine the hernia to prevent damage to the intestines. The child may be in pain. The bulge is often red and firm.
How long does umbilical hernia surgery take?
Umbilical hernia repair takes about an hour. It’s usually an outpatient procedure, so you can take your child home the same day as the surgery. Premature infants and children who have other medical conditions may need to spend a night in the hospital so the care team can observe them.
What happens before umbilical hernia surgery?
On the day of the surgery, your child will need to follow a strict diet. Doing so helps reduce the risk of vomiting and aspiration (inhaling fluids) while they’re under anesthesia. Your child’s surgeon will review the exact guidelines with you before the procedure.
What happens during umbilical hernia repair?
Your child will receive general anesthesia. This medication relaxes their muscles and puts them to sleep. They’ll be asleep and not feel any pain during the procedure.
Then the surgeon will:
- Make a small incision at the bottom of the belly button.
- Find the hernia sac containing the bulging intestine.
- Push the intestine back into the right place behind the muscle wall.
- Remove the remaining hernia sac.
- Reinforce the muscle wall with stitches to prevent another hernia.
- Sew the skin around the belly button to the muscle beneath it.
How do I care for my child after umbilical hernia surgery?
Children often feel fine by the evening after surgery or the next morning. They can eat their regular foods as soon as they are ready.
To help them as they recover:
- Use pain medicine: Your provider may give you prescription pain medicine. Many parents find that their child only needs a few doses of this pain medication. After that, you can use over-the-counter pain relievers to keep your child comfortable.
- Give them a sponge bath: For the first few days after surgery, use a sponge bath rather than a tub bath. Your provider will let you know when it’s safe for a tub bath.
- Restrict certain activities: Don’t let them do anything that may damage the procedure site. They should avoid bike riding, jungle gyms, wrestling or organized sports. At the follow-up visit, your provider will let you know when your child can resume those activities.
- Help prevent constipation: Straining on the toilet can cause pain around the surgical area. Make sure your child drinks plenty of water and eats vegetables, fruits and high-fiber foods. This diet can prevent constipation.
Take care of the wound area as it heals:
- The incision site should heal in about four to six weeks. During the year after surgery, the area will get softer and continue to fade.
- Avoid tight, rough or scratchy clothing that can rub against the incision.
- Protect the skin around the wound from the sun. The new skin can burn easily.
Risks / Benefits
What are the advantages of umbilical hernia repair?
Umbilical hernia surgery has several benefits.
- Resolves the problem: A hernia repair procedure is the only way to fix a hernia that hasn’t closed on its own.
- Has quick recovery: Children are often back to regular activities in a few days or a week.
- Reduces the risk of pain and complications: If a child doesn’t undergo hernia repair surgery, the hernia may start to get bigger and cause pain. It may even become incarcerated (when the intestines are squeezed in the hernia sac). If that happens, your child can experience pain and vomiting, and they may need emergency surgery.
What are the risks of umbilical hernia surgery?
Hernia repair surgery is very safe. There is a low risk of complications. But any surgery comes with risks. Complications of hernia repair include:
- Infection of the wound.
- Hematoma, a collection of blood around the hernia site.
Recovery and Outlook
What is the recovery time after umbilical hernia treatment?
Your child will be back to their regular activities within a few days. Some children may take up to two weeks to recover if they had a larger or more complex hernia.
You usually return to your child’s provider for a follow-up appointment around three to four weeks after surgery. The provider examines the surgery site and asks how the recovery is going.
When can my child return to school or day care?
Your provider will help you figure out when it’s safe for your child to go back to school. Providers usually recommend keeping children home for a few days or up to a week. This gives them time to recover from the procedure and regain their strength.
When to Call the Doctor
When should I call my child’s provider after umbilical hernia surgery?
Some minor swelling or discoloration around the surgery site is normal. But call your provider if your child has:
- Excessive swelling.
- Inability to urinate.
- Increasing pain.
Will an umbilical hernia come back?
Umbilical hernia repair surgery has high success rates. In rare cases, it may recur (come back). Your child’s provider will discuss treatment options if that happens.
A note from Cleveland Clinic
Umbilical hernia surgery for children is a short, safe procedure that has good results. After umbilical hernia repair, your child will be back to their regular activities within a few days. An umbilical hernia is when part of the intestine pushes through an opening in the abdominal wall. In about 95% of cases, umbilical hernias go away on their own by the time a child is three or four. But sometimes the hernia doesn’t go away or the hernia may be larger and more complex. In these situations, your provider will recommend umbilical hernia surgery. During the procedure, the surgeon pushes the intestine back inside the abdomen. If you notice a bulge around your child’s belly button area, talk to your provider.
Hernia Complications and How to Deal With Them
Except in the case of umbilical hernias — which are present at birth and usually disappear by age 3 or 4 — hernias don’t go away on their own.
If left untreated, it’s common for a hernia to get bigger and more painful. And the longer you have a hernia, the greater your risk of developing complications.
There are two main complications that can develop in untreated hernias: obstruction (also known as incarceration) and strangulation. (1)
A hernia becomes obstructed when part of your intestine gets stuck in the muscle layer it’s pushing through.
For inguinal hernias, the section of intestine gets trapped in an area of muscle called the inguinal canal.
Symptoms of an obstructed hernia may include:
An obstructed hernia, if left untreated, can develop into a strangulated hernia. (1,3)
A hernia becomes strangulated when blood flow to the obstructed (trapped) section of your intestine or other tissue is cut off.
This condition can be life-threatening if it isn’t treated promptly. It requires emergency surgery within a matter of hours to prevent death of the trapped tissue. (1)
Symptoms of a strangulated hernia may include:
- Sudden abdominal or groin pain that gets worse
- Bulge under the skin that turns red, purple, or dark
- Bulge that grows quickly or hardens
- Inability to pass stool or gas, despite the urge (3,4,5)
If you experience symptoms of a strangulated hernia, it’s crucial to call your doctor right away. You can also call 911 or go to the nearest emergency room. (4)
When you arrive at your doctor’s office or at the emergency department with these symptoms, your doctor will give you a physical exam and may order imaging and blood tests.
Imaging tests can confirm that you indeed have a strangulated hernia, while blood tests can check for any infection that may have developed as a result. (6)
To repair a strangulated hernia, your surgeon will relieve pressure on the trapped tissue and evaluate how damaged it is.
If tissue death or severe damage has occurred, it may be necessary to remove the previously trapped tissue — which often means removing part of your intestine. (7)
Hernia Mesh Side Effects | Various Complications & Treatments
The most serious complications after hernia mesh surgery can be deadly.
At the very least, they can cause severe pain. They almost always need revision surgery to correct.
The most serious complications of hernia mesh are also some of the most common.
Hernia mesh complications include:
More than 90 percent of the 1-million-plus hernia surgeries performed every year in the U.S. rely on hernia mesh for repairs.
Nearly one-third of people who undergo hernia surgeries experience some sort of complication, with excessive pain being the most frequent complaint, according to one study.
Many people who have experienced serious complications after hernia surgery are filing hernia mesh lawsuits against the manufacturers of their mesh.
Mesh failure, bowel obstruction and organ perforation are among the injuries claimed in hernia mesh lawsuits.
Hernia Mesh Adhesion
The U.S. Food and Drug Administration describes adhesions as “scar-like tissue that sticks tissues together.”
Chronic, often severe, pain may be a patient’s only symptom of a mesh adhesion. The condition can also lead to life-threatening bowel obstructions.
Madris Tomes, founder of adverse event reporting group Device Events, details the most frequently reported hernia mesh complications.
Complication Reported to FDA
An Atrium C-QUR TacShield became attached to the patient’s small intestine. Doctors had to remove it 12 days after it was first implanted.
Intraperitoneal surgery is a technique that leaves mesh in contact with the intestines. The intestines and the repair stick together around the mesh.
Manufacturers have developed different materials or coatings to prevent adhesion. But the problem still occurs in some surgeries.
A 2009 study in the British Journal of Surgery found that the body absorbs the coating over time. The mesh then comes in contact with the intestines.
Researchers found that the coating reduced adhesions for up to a week. But after a month, there was no advantage in preventing them.
Bowel Obstruction from Hernia Mesh
Hernia mesh can cause a bowel obstruction if it adheres to the intestines. Mesh sometimes creates obstructions when it migrates in the body. If it moves, the device can entrap loops of the intestines.
Bowel Obstruction Symptoms
Inability to pass gas or stool
Bowel obstructions are a dangerous condition. They need immediate treatment.
Left untreated, an obstruction can cut off blood flow, causing part of the intestine to die.
Surgeons may have to remove part of the intestine if mesh causes a bowel obstruction.
The FDA cites recalled mesh as a major cause of bowel perforation and obstruction.
Hernia Mesh and Bowel Perforation
Bowel perforation happens when hernia mesh punctures or erodes into the bowel.
Mesh may also perforate the abdominal wall or another organ in the abdomen.
Bowel Perforation Symptoms
Severe abdominal pain
A bowel perforation allows fecal matter and bacteria into the abdominal cavity. This can cause peritonitis.
Peritonitis is a dangerous form of inflammation.
Perforation can also cause sepsis, a sometimes fatal bloodstream infection.
People should consider any bowel perforation a life-threatening medical emergency.
Complications from Infection
Antibiotics can treat minor infections around the suture site on the skin.
Deep, chronic infections around hernia mesh are harder to treat.
Patients often need surgery to remove the mesh.
This is usually accompanied with intravenous antimicrobial treatments.
Chronic infection symptoms may not occur until years after hernia mesh surgery.
Symptoms of Chronic Mesh Infections
Other flu-like symptoms
Hernia Mesh Rejection
Materials in hernia surgical mesh may sometimes trigger the body’s immune response.
This can cause the body to reject the mesh.
Patients should seek medical attention if they experience mesh rejection symptoms.
Mesh Rejection Symptoms
- Extreme swelling at the surgical site
Tenderness or pain
Hernia Mesh Migration
If hernia mesh detaches after surgery, there is a risk it can migrate through the abdomen.
It can lead to adhesions, fistulas, abscesses and bowel obstruction or perforation.
Complication Reported to the FDA
An Ethicon Physiomesh implant detached and migrated. It attached to the patient’s intestine and the skin. Doctors had to remove the mesh and part of the patient’s intestine.
Detachment is more likely to happen in laparoscopic (minimally invasive) hernia surgery techniques.
Migration may result in excess pain, or it may be symptom-free until it causes more severe damage.
People filing hernia mesh lawsuits claim their mesh failed and caused serious complications, including mesh migration, bowel obstruction and chronic pain.
Hernia Recurrence After Hernia Mesh Surgery
One of the most common complications of hernia surgery is that hernias can come back.
Doctors call this “recurrence.”
Surgeons began using hernia mesh to overcome this problem. The idea is that mesh can further reinforce weakened tissue.
But using mesh is no guarantee against recurrence.
“A study of 3,200 patients found hernias were less likely to return if repaired with hernia mesh. But the study also found the risk of long-term complications off-set that benefit.”
Mesh detachment or migration can let a hernia return. A patient’s health and lifestyle can also affect the chances of recurrence.
How to Tell if Hernia Mesh Ripped
Pain or a hernia coming back may be signs that hernia mesh ripped. But these symptoms may be related to other complications, too. In some cases, surgery may be the only way to tell for certain if hernia mesh ripped or tore.
Hernia mesh may rip from the sutures or tacks holding it in place in the days immediately after surgery. This is rare and most likely to happen if the patient lifts a heavy weight or overexerts him or herself physically. If this happens, it can cause hernia recurrence.
Surgeons will set limits on physical activity for patients in the weeks during their first few weeks of recovery from hernia mesh surgery. This gives time for scar tissue to form around the mesh. This helps to strengthen the hernia repair.
If mesh shrinks, it may also rip lose from sutures or tacks. This can result in mesh migration.
Over time, mesh may erode in the body. If this happens, it may break into pieces. The edges can cut or perforate tissue.
When Can Hernia Mesh Complications Occur?
Hernia mesh complications can happen shortly after surgery or years later.
A 2016 study found that the number of complications increased over the course of five years.
Out of 3,242 study participants, 1,050 required another abdominal surgery.
“This [study] calls into question the current practice of liberal use of mesh, even for repair of small hernias, when mesh is the norm for all incisional hernia repairs of any size.”
How to Tell If Hernia Mesh Failed
Typically, when hernia mesh fails, people experience symptoms. Some hernia mesh complications share symptoms. But some symptoms are unique to a particular complication.
Contact a Doctor Immediately If You Experience These Symptoms
- Difficulty urinating or passing gas and stool
Excessive pain, bruising, or swelling
High fever (101 degrees)
Increased redness or drainage from the incision
Nausea, vomiting or other flu-like symptoms
Stiffness in the abdomen
Hernia mesh complications can be hard to diagnose. People who experience these symptoms should tell their doctors that they have hernia mesh.
Diagnosing Hernia Mesh Complications
There are several diagnostic tests doctors can use to detect hernia mesh complications.
Treatment for Hernia Mesh Complications
Depending on the complication, a surgeon may decide to perform surgery to remove the mesh.
Doctors may rely on surgery, medication or a combination of both to treat an adhesion or fistula.
Surgery may be the only option for patients with bowel or abdominal perforation.
Surgeons will have to remove the mesh and repair the hole.
They may also remove the damaged section of the bowel.
8 Silent Signs You Have A Hernia: Surgical Consultants of Northern Virginia: Bariatric & General Surgery
Most of us think of a hernia as a visible bulge in the abdomen. This is certainly true, but there are other symptoms of a hernia that can present as something entirely different. Be cautious, and don’t ignore them or self-diagnose thinking your symptoms are insignificant.
Some untreated hernias can be quite dangerous. Let’s look at 8 silent signs you may have a hernia.
Easy To Miss Signs Of A Hernia
Pain In the Pelvic Area
Because they rarely cause a bulge, some hernias in women are diagnosed as fibroids, ovarian cysts or endometriosis based on the region of pain. Although they may cause pain in the leg or back, a MRI is usually required to identify these small but very painful hernias.
Women are also prone to umbilical hernias near the belly button. A hearty laugh accompanied by pain can be a hidden sign of this type of hernia.
A feeling of muscle fatigue and weakness in the upper leg and groin can be a sign of a hernia.
Nausea And Vomiting
Although not usually thought of as a symptom of a hernia, an upset stomach can indicate a serious condition known as an incarcerated hernia. In this case the hernia doesn’t return in place by a gentle push, and can require immediate medical attention.
A fever with a hernia is a bad combination. This can indicate a “strangulated” hernia which is not getting enough blood flow. Call Dr. Brett Sachse at Surgical Consultants of Northern Virginia immediately.
Pain Under Certain Conditions
If you have pain while lifting heavy objects, or pressure in your abdomen when you bend down, this could be a silent sign of a hernia. Other common signs can be pain when you cough, or tightness in the groin or abdomen.
Be aware that constipation may mean there is blockage in the large intestine interfering with digestion. Additionally it will be difficult to pass gas.
Of course many issues can cause heartburn, but a hernia could be one of them. A hiatal hernia in the upper abdomen can cause a feeling like heartburn along with chest pain. It allows stomach acid to leak into the esophagus causing inflammation which mimics heartburn.
An inguinal hernia can cause someone to feel like they had an enormous meal when in fact they did not. This very common type of hernia can also make you feel bloated accompanied with pain in the groin and lower abdomen.
Some of these easy to miss signs of a hernia can be potentially dangerous if not treated. Speak to Dr. Brett Sachse at Surgical Consultants of Northern Virginia in Reston VA if you suspect you may have a hernia.
90,000 Herniated disc: causes, symptoms and treatment
Back pain is a frequent companion of people with a sedentary lifestyle. But if you do not visit the doctor on time, then even due to the usual scoliosis, a complication may arise – a herniated disc. It will be much more difficult to get rid of such a disease.
What is an intervertebral hernia?
Intervertebral discs reduce pressure between the vertebrae. A hernia is a process in which their nuclei protrude into the spinal canal.This is due to the destruction of the annulus fibrosus: it normally surrounds the disc and evenly distributes pressure. If it collapses on one side, then the nucleus of the intervertebral disc comes out.
In this case, the pain occurs due to pinching of the nerve roots near the vertebra. And due to the connection of nerve fibers with the spinal cord, the pain is not concentrated in the damaged area of the back, but can also spread to the arm or leg.
Symptoms of the disease
A herniated disc can develop anywhere in the spine.Localization will be indicated by shooting or pulling pain at the site of destruction of the cartilage. The area may enlarge and begin to hurt more with movement. In addition, the following symptoms indicate a hernia:
- aching pain in limbs, shoulders or chest;
- decreased mobility of the spine;
- decreased sensitivity and weakness in the muscles in the legs or arms;
- neurological disorders: headaches, insomnia, changes in blood pressure, weakness, dizziness;
- Disorders of the functions of the genitourinary system and intestines.
Which of the symptoms will appear depends on where the hernia is located. Shoulder pain, numbness and weakness in the arms are a sign of damage to the cervical spine. With the destruction of the intervertebral disc in the lower back, problems with the intestines and pelvic organs will begin. Numbness and pain in this case will spread to the hips, feet or legs completely.
What causes a herniated disc?
Degenerative processes of the intervertebral discs, like many other diseases of the spine, are caused by our unnatural position of the skeleton.The lumbosacral region is most susceptible to the process of destruction: the entire mass of a person presses on it from above.
Of course, if you are a happy owner of excellent health and athletic build, and also lead an active lifestyle, you have nothing to fear. But if you have already been diagnosed with diseases of the spine (for example, osteochondrosis), your back muscles are poorly developed, or you have recently been injured, then the future likelihood of a hernia is very high.
In addition, excess weight contributes to the destruction of the fibrous rings.The vertebrae are already under tremendous pressure, and if the body weight is exceeded, they may simply not be able to withstand the high load. Also, the development of a hernia is influenced by factors such as the weakening of the body due to old age, autoimmune diseases and impaired metabolism. All this affects the strength of the cartilage and bones in the spine.
Diseases of the spine, including hernias, are dealt with by an orthopedist and a neurologist. You can also meet with other specialists: the neurosurgeon will conduct the operation if it is necessary.And with conservative treatment, you will be referred to a physiotherapist, massage therapist and exercise therapy specialist.
Visual examination has little to do with diagnosing a hernia. Of course, the doctor will ask you about the symptoms, but some of them overlap with other diseases. Since chest pain and numbness in the extremities can cause diseases of the internal organs or the brain, you will first be referred for an x-ray of the spine. According to its results, one can understand whether there is a problem in the vertebrae or similar symptoms were caused by completely different diseases.
If the X-ray confirms the deformation of the intervertebral disc, then you will be referred for more precise examinations to examine the spinal cord and nearby nerves:
- MRI of the spine is considered the best type of diagnosis, since the image will show soft tissues, nerve roots and the structure of the spinal cord,
- CT of the spine is much more often used in cases of suspected injuries. CT is faster than MRI, but it has contraindications.
How can a hernia be cured?
Small protrusions in the intervertebral discs are treated conservatively.You may be advised of various drugs:
- painkillers will help to cope with discomfort and discomfort,
- anti-inflammatory will stop pathological processes,
- vitamin and mineral complexes help to strengthen cartilage and bone tissue.
The best treatment for the initial form of hernia is physiotherapy: massage, electrophoresis, manual therapy. Physiotherapy exercises, as well as the prophylactic use of a corset and a bandage to restrict mobility, proved to be excellent.
If the therapy has not brought any improvement for several months, then an operation is performed at any stage of the disease. If the disease has not been started, then rehabilitation will not take long.
Prevention and recommendations
Like other degenerative diseases of the spine, the main prevention of hernias is a healthy active lifestyle. For discomfort and mild pain, do not hesitate to see a doctor. Any damage to the back can lead to destruction of the vertebrae and intervertebral discs.
With an already diagnosed hernia, on the contrary, you should take care of your back and not overload it. Boys with a hernia of the spine are usually exempted from military service. And women who want to have children are advised to wear special support corsets. If you have already received treatment and are now only maintaining a healthy state, then you will have to moderately limit your mobility and be careful with lifting weights. Even if you feel well, you should strictly follow the recommendations of your doctor in order to avoid complications, urgent surgery and long rehabilitation after.
90,000 symptoms, causes, diagnosis and effective treatment of intervertebral hernia
Hernia of the spine is a disease of the musculoskeletal system that does not tolerate self-medication. Timely referral to a neurologist is important.
What is a spinal hernia?
Hernia of the spine is a painful disease. With it, the integrity of the outer shell of the intervertebral disc – the annulus fibrosus – is violated. Scar tissue forms instead of elastic fibers. The intervertebral discs are displaced relative to their usual position.The nucleus of the intervertebral disc begins to bulge into the spinal canal. Protrusions can be both in both directions, and only in the right or left side.
If left untreated, the annulus ruptures. Nuclear fluid enters the spinal canal and compresses the nerve endings. With advanced stages of the disease and the absence of timely assistance, a hernia leads to a complete loss of mobility.
Most often, a hernia of the spine affects the lumbosacral region.65% of all hernias are hernias in the lumbar region and sacrum. Hernia of the thoracic region is also quite common. Less often, when a hernia is detected, the lesions relate to the cervical spine and coccyx. They account for about 5-6% of all cases of spinal hernias.
Why does the disease occur?
The following reasons lead to the onset of the disease:
- Static overloads , i.e. overloads that are associated with a long stay in one position.Moreover, both sitting and standing postures are equally harmful. The greatest occupational risk is experienced by workers on the assembly line, drivers, seamstresses, shoe collectors.
- Dynamic overloads associated with heavy lifting. Movers, slingers, miners, metal cutters, stampers, pressmen and bricklayers are especially susceptible to them. The work performed by personnel in these specialties especially contributes to the protrusion of the intervertebral discs in the lumbar region.
- Genetic predisposition and individual anatomical features of the structure of the endplates on the vertebrae.In this case, most often the patient is diagnosed with a hernia between the 1st and 3rd vertebrae of the lumbar spine or the 11th and 12th thoracic vertebrae.
- Injury. Fractures, spinal bruises, 90,090 subluxations of individual vertebrae. This is due to the fact that with a fracture and injury of the spine, the surrounding tissues are affected, scars and adhesions are formed, and with subluxations, the vertebrae are displaced. In addition, with subluxation, in most cases, the size of the intervertebral foramen decreases. All conditions are created for the formation of hernias in the lumbar region and neck.
- Presence of osteochondrosis . If it is left untreated, the cartilaginous tissue is rapidly depleted, the intervertebral gap decreases and the outer membrane of the intervertebral disc ruptures. Especially often, against the background of osteochondrosis, a hernia of the lumbosacral spine develops.
- Presence of scoliosis. The danger of scoliosis is that the spinal column is not just curved, it is deformed. Especially scoliosis contributes to the progression of hernias in the thoracic spine.
- Unbalanced diet . Lack of nutrients for the body is a blow to muscle, cartilage tissue and a direct cause of dystrophies.
- Excess body weight . Excessive body weight is especially dangerous for the lumbar spine. Extra pounds put excessive pressure on the lower back. It leads to deformation of the vertebrae, and an intervertebral hernia appears in the lumbar region.
Symptoms of a spinal hernia
Symptoms of a vertebral hernia are divided into two types – general (they can bother the patient if there is a hernia in any part of the spine) and local – indicating a problem in a specific area of the spine: thoracic, cervical, etc.
General symptoms are pain in the spine or part of it, aggravated by physical exertion and weakening after immobile rest, a feeling of strong muscle tension and burning of the skin. Many patients also complain of creeping creeps and swelling.
Local – these are symptoms that indicate a problem in a specific area (neck, lower back, tailbone).
Symptoms of a hernia in the cervical spine
The most common symptoms of a hernia in the cervical spine are:
- Unpleasant sensations, a feeling of squeezing in the neck area, in some cases – the appearance of protrusions on the neck.
- Severe headaches, especially of a throbbing character in the temporal and occipital regions.
- Dizziness caused by compression of the vertebral artery and accompanied by tinnitus, double vision.
- Weakness and feeling of lack of oxygen. With problems of the cervical spine, oxygen is really not enough. A hernia creates obstacles in its path to the brain.
- Increased blood pressure, accompanied by head cramps.
If osteochondrosis has already been diagnosed, and a person may not go to a doctor, he may think that he has an exacerbation of osteochondrosis, but the classical treatment regimen for osteochondrosis with a hernia is ineffective.
Symptoms of a hernia in the lumbosacral region
- Numbness extending from the lower lumbar region to the thighs.
- Acute, shooting pain in the lower back when lifting loads.
- Problems with urination (sometimes incontinence, sometimes urinary retention).
- Weakness in the legs, a feeling that “the legs are not obeying”, paralysis (with neglected hernias).
Very often with a hernia in the lumbosacral region, a person says: “I tore my back.”Feelings are just like that.
Symptoms of a thoracic hernia
What makes a thoracic hernia different?
- Burning and pain in the chest, many patients feel that the heart hurts.
- Pain in the shoulder blades, worse during brisk walking, walking up stairs and other movements that require deep, intense breaths in and out. With them, shortness of breath also increases.
- Deterioration of the thyroid gland.
- Unpleasant sensations in the abdomen,
- Loss of sensitivity of the skin in the area of the shoulder blades and below.
Symptoms of tailbone hernia
Symptoms of tailbone hernia are less pronounced compared to symptoms of hernia in other parts of the spine. Very often she did not manifest herself at all. It happens that a person is injured, he has developed a hernia, but the person does not even suspect about it, and only in certain circumstances (for example, when sitting on a hard surface) coccyx pains appear.
In women, a tailbone hernia can appear during painful sensations during pregnancy, during childbirth, in the postpartum period.
Often, the symptoms of a tailbone hernia are very close to bowel diseases, hemorrhoids. There is pain in the anus, there are problems with stool (severe constipation or alternation of constipation and loose stools).
Any of the above signs require immediate medical attention and diagnosis.
When a hernia occurs, a comprehensive diagnosis is important. The sooner the diagnosis is made and treatment is started, the lower the risks of complications such as the formation of fistulas and immobilization of the spine.
Diagnosis of spinal hernias is based on several stages. What is included in them?
- Medical examination. Oral questioning of the patient. For an accurate diagnosis, an accurate picture is important – when the symptoms of the disease appeared, what is the nature of the pain, are there any other concomitant diseases.
- Assessment of skin sensitivity, motor activity. The doctor probes the neck, back, chest, lower back, sacrum, coccyx.Next, the patient is offered to perform a series of movements: raise the leg in a supine position, bend over, sit down, etc.
- Magnetic resonance imaging . The doctor receives information about the structure of the tissues, sees the protrusion of the membrane of the intervertebral disc.
X-ray diagnostic method is informative for determining the position of bones, identifying the causes of hernias. It is indicated for almost all patients with symptoms of a hernia of the spine – except for pregnant women, as well as for patients with bleeding and severe pathologies.Radiography is especially important for patients with hernias resulting from trauma.
Many patients are interested in why both radiography and computed tomography are prescribed in the diagnosis. The fact is that these types of diagnostics complement each other well, and each of them is the most effective for solving its goals. An X-ray allows you to get the most complete picture of the state of the vertebrae and intervertebral discs, tomography – to study the state of the soft tissues of the spine (including muscles and ligaments).
X-ray computed tomography (CT) allows to combine X-ray and tomographic examination in one procedure. In Minsk, CT of the spine sections is available at the 5th Clinical Hospital. The modern equipment of the hospital allows specialists to carry out detailed post-process data processing, to obtain three-dimensional volumetric reconstructions. On their basis, doctors can accurately diagnose, predict which treatment will be most effective.
Methods of treatment
In the early stages, when there is no rupture of the intervertebral disc, non-surgical methods of treatment help – physiotherapy, therapeutic exercises, manual therapy and medication.With a progressive form of the disease, surgical treatment is advisable.
- Wearing special corsets (orthoses). Does not eliminate the hernia itself, but relieves pain, restores the position of the vertebrae, relieves muscle stress. Depending on the problem area, it is recommended to wear a lumbar, chest corset. The most unpleasant moment – long-term wearing of a corset is fraught with muscle atrophy.
- Massage . This non-surgical method can provide a good result if there are no violations of the skin, blood pressure, inflammatory processes, accompanied by an increase in body temperature.The massage uses creams with anesthetic effect, essential oils. Most often, massage is prescribed for hernias in the lumbosacral spine.
- LFK. An alternation of muscle tone and relaxation exercises is recommended. Exercises can be performed only at a time when the severity of the pain syndrome is minimal. But it is important that you train regularly. The best option is to devote 15 minutes to classes every day
The main difficulty is that massage and exercise therapy should be very dosed, otherwise you can provoke a rupture of the intervertebral disc, increase spasms
If non-surgical treatment does not help, in most cases resort to surgical treatment.Operations can be divided into several groups:
- Traditional discectomy . Open surgery, the intervertebral disc, part of it and the vertebral processes that touch the arteries and the spinal cord are removed. For a long time it was considered the most popular way to remove hernias, but due to the large area of damage and the need for general anesthesia and long-term recovery, doctors resort to traditional discectomy less and less.
- Laminectomy . An operation that removes the part of the vertebral arch that presses the nerve root.The operation is abdominal, but less traumatic than traditional discectomy. The operation is performed through a small incision (maximum incision length 10 cm). Depending on the characteristics of the specific situation, it can be performed under general and local anesthesia. Recovery after surgery is fast enough. But on one condition – no complications. And their probability is high. Moreover, it can be both blockage of blood vessels and bleeding.
- Minimally invasive endoscopic hernia surgery. Access to the problem area is provided through a thin tube. The hernia is removed not through an open cavity, but through an endoscope. A huge advantage of the technique – the patient can get up on the day of the operation, the stay in the clinic does not exceed two weeks, there is no risk of adhesion formation.
Open and endoscopic hernia operations are actively practiced in Minsk at the 5th Clinical Hospital. The head of the neurosurgical department, Alexander Baranovsky, and his team are proficient in sophisticated surgical techniques, individually approaching each patient and the severity of the patient’s neurological deficit.
If, for some reason, surgical intervention is unacceptable, or a disease, at the initial stage, treatment can be carried out with medication. What drugs are prescribed?
- Painkillers (mainly in the form of blockades – injections directly into the focus of pain on the spine itself). In particular, X-ray-controlled blockade with local anesthetics and steroid hormones proved to be good in practice.
- Muscle relaxants (muscle relaxants) for relieving muscle spasms. They provide a good result, but with an illiterate selection, they can cause side effects associated with the functioning of the central nervous system. They are selected purely individually – exclusively by a doctor, self-medication is permissible. Not suitable for people with chronic renal or hepatic impairment
- Chondroprotectors. Their use is important for the restoration of contributing cartilage tissue.
In addition, agents for stimulating blood circulation and B vitamins can be prescribed. If painkillers and muscle relaxants are in the form of tablets, preparations are recommended to protect the mucous membrane of the stomach and esophagus.
Another way to combat hernias is manual therapy. It is a non-invasive procedure that focuses on restoring the correct position of the vertebrae (repositioning). The procedure is aimed not easily at eliminating a hernia in one of the departments, but at improving the biomechanics of the entire spine.
A huge advantage from manual therapy – not only the problem with the spine itself is solved, but also the accompanying problems caused by the appearance of a hernia are eliminated. Swelling and inflammation go away.
But with the effectiveness of the technique, manual therapy is not suitable for all patients. There are also so-called reducible and irreducible hernias. Correctable hernias with the help of manual therapy are treated for treatment in a fairly quick time. Irreducible hernias are not treated with manual therapy. This is not only ineffective, but also dangerous.
This is why manual therapy can only be performed after detailed diagnostics and by an extremely experienced specialist. Only he will correctly assess whether it is possible to carry out manual therapy in a particular case, whether it will lead to injury to internal organs, the formation of adhesions and even an infringement of the hernia itself, which can only be eliminated with the help of operations. By the way, part of the operations in the 5th hospital is precisely operations aimed at eliminating the infringement of the hernia, provoked by manual therapy in institutions with low-level specialists
Regardless of the way in which the hernia is removed, restoration is required.What is it built on?
- On medical and electrotherapy, aimed at reducing pain after surgery (especially important for patients who have undergone open surgery).
- Wearing special corsets. It helps to consolidate the effect, maintain the spine in the correct position, relieve the load on the vertebrae, and prevent the recurrence of the disease. If the hernia was removed surgically and the operation was voluminous, then in the first weeks it is recommended to alternate wearing a rigid and semi-rigid corsets, and then wear a semi-rigid one for about three months.If the operation is minimally invasive, then sometimes it is enough just to wear a semi-rigid corset for two months.
- In remedial gymnastics. Exercise therapy is organized strictly under the supervision of a physician. The main exercises for the patient are static movements aimed at keeping the back muscles in a contracted state for several seconds.
- On control of being in an upright position. In the first month after surgery, you can stay upright in a row for no more than 1.5 hours.
The exact recovery time after removal of a hernia depends on age, the presence of concomitant diseases, the method used to treat the hernia.
If your loved ones have faced such a problem as a hernia of the spine, your job involves constant stay in one position, you are at risk. And prevention in this case is required. What does it include?
- Regular exercise, which includes exercises to strengthen the muscle corset and stretching the muscles of the back, as well as, if possible, sign up for a pool and go swimming.
- Proper nutrition. It is important that the body has enough protein and calcium. Therefore, the use of cottage cheese, kefir, chicken meat should be regular.
- Vitamin therapy. If you eat few vegetables, fruits, often catch colds, do not neglect vitamin therapy. A weakened body is a direct target for diseases of the spine.
- Use of food supplements with chondrocytes for the elasticity of connective tissue. Especially if there are signs of osteochondrosis, arthrosis, or have recently been injured.
Weight control. Excess weight is especially dangerous for the spine. After all, it creates additional pressure and load on the vertebrae. And, in the case of the slightest injury, the appearance of a hernia in this case is a natural process. Refrain from high-calorie foods, smoked meats.
symptoms, treatment and operations, prevention – Department of Vertebrology of the Central Clinical Hospital of the Russian Academy of Sciences
The thoracic region of the spine is responsible for support, protection, and mitigation of the force exerted on the spine.This section is the least mobile and has the greatest length in comparison with the rest. The thoracic region consists of twelve vertebrae and alternating discs. Discs are a kind of spacer between the vertebrae that are needed to mitigate pressure and distribute the load correctly. Inside the disc, there is a core made of a gel-like liquid. The semi-liquid contents are protected by a dense annulus fibrosus. The entire system is securely reinforced with ligaments. The vertebrae not only support the body, but also form the spinal canal, which houses the spinal cord.Correct positioning of the vertebrae ensures stability and mobility of the body.
Causes of disc herniation
A herniated disc occurs when the disc is damaged and its gelatinous contents come out. Once in the spinal canal, the tissues begin to put pressure on the nerve roots and spinal cord. Pathology can occur anywhere in the thoracic region. The resulting symptoms will be determined by the location of the hernia.
Bulging can be a consequence of wear and tear, age-related changes, tissue injury. The underlying lesion may involve nerves or the spinal cord.
How a hernia develops
The bulge does not appear immediately. It is preceded by a number of pathological changes that can be eliminated without allowing complications in the form of a hernia.
- The process begins with the fact that the disc is weakened by certain processes in the tissues.This could be due to aging or regular injury.
- Protrusion. This stage is characterized by the smallest bulging of the disc contents into the canal of the spinal column. The violation does not cause compression, is practically not felt by the patient, with the exception of slight painful sensations.
- Extrusion. The semi-fluid core of the disc extends beyond the retaining ring, the connection with the disc is maintained.
- Sequestration. The nucleus is completely detached from the disk and extends outside of it.This is the final stage of hernia formation.
Many of the symptoms of herniated discs coincide with the manifestations of a number of other diseases. It is not necessarily the back that hurts, and not necessarily exactly where the protrusion is. For example, a patient may think that his stomach or heart hurts, but in fact the pain is caused by pressure on the nerve roots and a negative effect on all organs. Diagnostics is difficult and requires experience and in-depth knowledge to determine the source of the problem.
Experienced diagnosticians of the Central Clinical Hospital of the Russian Academy of Sciences recommend that patients with complaints of pain in the abdominal cavity and heart also undergo spinal diagnostics. A hernia is dangerous with consequences, its manifestations can begin with slight discomfort and develop into paralysis.
Symptoms of a hernia of the thoracic spine
The main manifestation of a herniated disc is pain. It manifests itself to varying degrees depending on the degree of development of the pathology. The main manifestations of a hernia are:
- Pain, mainly localized in the area between the shoulder blades, upper back.
- Shingles may appear, similar to intercostal neuralgia.
- Tingling, numbness, and creepy sensations may appear in the abdomen, arms and back.
- The area below the affected area may be partially paralyzed.
- The abdominal and pelvic organs may malfunction due to poor blood supply and muscle tone.
How strongly the described symptoms will be expressed depends on the degree of development of the pathology and the general condition of the body.The stronger the negative effect on the spinal cord and nerves, the more intense the pain and the more significant the disturbance.
Consequences of intervertebral hernia
The sooner the patient seeks a doctor, the less dangerous consequences will be obtained as a result and the easier the recovery will be.
Protection against traumatic factors in the chest area is maximum. Therefore, protrusion in this area is practically excluded. At the same time, the presence of a hernia in this section is associated with a high risk.The risk is due to the small width of the spinal canal, due to which any pinching is accompanied by serious consequences. Internal organs inevitably receive a negative impact with pathologies of the spine in the thoracic region.
What violations can occur:
- Indigestion, constipation and diarrhea.
- Decreased sexual function in men.
- Frequent or rare urination.
- Rapid fatigue of arms and legs, especially if the patient has physical work.
- Paralysis of the part of the body below the affected disc.
- If the problem is located in the upper part of the thoracic region, complete paralysis is not excluded, when the head remains mobile.
- Increased muscle tone that occurs when protruding in the thoracic region inevitably harms the work of all internal organs.
Such symptoms are characteristic of a number of other diseases: angina pectoris, cholecystitis, gastropathy, kidney and cardiovascular diseases.
Making a diagnosis
if the symptoms that the patient has, indicate the presence of a hernia, examination, instrumental examination, as well as the use of a number of diagnostic studies are necessary. A complete picture of the disease will help to see an MRI or CT scan of the spine. These methods not only help to visualize the protrusion and its exact localization, but also make it possible to assess the condition of the surrounding tissues, the width of the spinal canal. During the tomography, the specialist can change the step with which the cut is made in order to get to the desired zone.In addition, tomography does not harm the body and has practically no contraindications for conducting it.
With the help of computer diagnostics, concomitant pathologies are also identified, which play a role in the further treatment of hernia. If routine diagnostics do not provide the information you need, a contrast test may be used. It is rarely prescribed, since it has a number of contraindications and can negatively affect the patient’s health.
First of all, treatment is aimed at eliminating the dangerous effects and providing rest to the damaged area of the spine.In an acute condition, drug therapy is used in combination with other means:
- Taking anti-inflammatory and analgesic drugs. It helps relieve swelling, relieve pain, inflammation.
- Introduction of muscle relaxants to relieve muscle tone and stop its negative effects.
- Conducting drug blockades for quick pain relief.
- Restoration of cartilage tissue using vitamin therapy.
After the pathology goes into remission, rehabilitation begins.The process is controlled by a doctor, the scheme of action is developed individually, taking into account all the features of a particular case. Applicable:
- Massage with muscle relaxation.
- Delicate traction of the spine.
- Techniques for manual therapy.
- Exercises exercise therapy.
If such measures have not brought the expected effect and pain persists, an epidural block is the best choice.Hormonal drugs are injected into the affected area. The effectiveness of this method of treatment has been proven. If the case is serious and the methods described above cannot give a positive result, it comes to the operation. In the area of the thoracic region, such an intervention is associated with a number of difficulties.
Several techniques are used to remove a hernia:
- The safest method of exposure is microdiscectomy. The operation is carried out using the latest equipment and a microscope.Thanks to the accuracy of the movements, the operation is successful, recovery is not difficult, the risk of complications is minimal.
- Discectomy – complete or partial removal of a damaged disc.
- Laminotomy is an operation involving the dissection of several vertebral arches.
How to prevent hernia formation
There are several rules that can be followed to minimize the risk of protrusion of the disc tissue. To keep the spine healthy as long as possible will help:
- Swimming, yoga, gymnastics.
- Frequent long walks.
- Correct posture, well-organized workplace during sedentary work.
- Warm-ups during the day and morning exercises.
- Refusal of junk food, spicy and fried foods.
- A varied menu rich in vegetables and healthy fats.
- Quitting bad habits, especially smoking.
- Timely visit to the doctor when complaints or for prophylaxis.
- Protrusion.The beginning of pathological changes. The annulus fibrosus becomes less elastic, can shift and deform.
- Partial loss of a portion of the disc. This is the second stage in which tissue destruction can occur. This process is inevitably followed by displacement of the gel-like core of the disc.
- Prolapse. The nucleus leaves the disc ring and begins to act on the nerve endings located nearby.
- Sequestration. The process by which a semi-liquid substance from the nucleus enters the cavity of the spinal column.This is accompanied by allergic reactions, nerve connections and blood flow in tissues are disrupted. Due to the constant pressure in the area that is not designed for this, there is a loss of sensitivity and the threat of paralysis.
- The main symptom of a herniated disc is pain. At first, it is not sharp, it can be aching, it disappears when the position of the body changes. The more serious the stage of the process, the stronger the pain. Shooting appears, it hurts the patient to turn the body, the sensations intensify with physical exertion.
- Vertebral Syndrome. Constant pain causes spasms of the muscles in the lower back.The patient cannot move fully, is forced to tilt the body in order to relieve some of the load and reduce pain.
- Damage and death of nerve roots due to constant compression. Compression, which occurs due to tissue protrusion, constantly affects the nerve fibers. This disrupts the blood flow, their functions, and later, dying off occurs altogether. The appearance of such a process is: weakness, decreased tone, loss of sensitivity, the appearance of body asymmetry, decreased sensitivity and skin tone.
- The doctor will determine a sensory disorder.
- The patient’s biomechanics of movements will be changed.
- Tendon reflexes will deviate from normal.
- Blood circulation in the small pelvis is impaired, due to which the organs do not receive proper nutrition. This provokes problems with the excretory system, disruption of the internal genital organs.
- The spine is curved due to muscle tone. This causes compression of internal organs and can provoke other pathologies that are not directly related to the spine.
- Sensitivity decreases, numbness, limitation of body mobility is observed.
- Shoots appear – severe sharp pain during exercise or movement.
- Knee reflexes may disappear, ankle and foot mobility may change.
- The worst consequence is paralysis.
- Taking anti-inflammatory drugs to relieve pain.
- Carrying out novocaine or hormonal blockades.
- Use of muscle relaxants, vitamins.
- Passage of a course of massage, attendance of manual therapy sessions.
- Exercise therapy classes, stretching and muscle relaxation procedures.
- Exposure to physiotherapy.
- Endoscopy – an operation through an incision in the spine using a probe. A camera and instruments are inserted through a small hole, the displaced tissues are removed.
- Endoprosthetics of the disc.The damaged items are removed. In their place, a prosthetic structure is installed.
- Percutaneous discectomy. Access is through a puncture, the deformed core is removed and replaced with a special compound.
- Laser reconstruction – a hernia is removed by evaporation of moisture from the tissue.
- Nutrition and Weight Control.Excess weight increases stress on the spine.
- Quitting bad habits.
- Regular physical activity – morning exercises, warm-up during sedentary work.
- Sleep on a firm mattress, choosing the right pillow.
- Preventive examinations by a doctor, timely seeking medical help in case of alarming symptoms.
- Use the correct techniques when lifting.The waist should not be open, but instead the knees should be open as long as the back is straight and the leg muscles should be used for lifting.
- Being overweight puts pressure on your lower back, so it’s better to maintain a healthy weight.
- Practice good posture when walking, sitting, standing and sleeping.
- Sit with your feet flat on the floor and sleep on a firm mattress, not on your stomach.
- High-heeled shoes should be avoided.
- Stop smoking.
- Eat healthy and balanced food every day.
- To keep your back and leg muscles healthy, you must exercise daily. Exercises like aerobics are a good idea.
- If you are sitting for a long time, stretch.
- Increasing intra-abdominal pressure
- Conditions and diseases associated with the development of connective tissue weakness (obesity, varicose veins of the legs, congenital connective tissue pathologies, hereditary predisposition)
- Patients previously operated on for hernias are also at risk for predisposing factors
- Hernia formation can go unnoticed, or it can be accompanied by intense pain.Subsequently, under the influence of the same factors, a gradual increase in the hernia occurs, up to the release of most of the abdominal organs into the hernial sac.
- Feeling of pressure, weakness or pain in the abdomen, groin or scrotum, arising or worsening with physical exertion, straining.
- Visually defined “bulging”, a bulge on the abdomen, groin, scrotum, appearing or increasing in size with physical exertion, straining. Also, in the area of the above formations, a feeling of discomfort or pain during exercise, coughing, straining may appear.
- Errors related to operational technology
- connective tissue insufficiency
- wound infection during or after surgery
- Excessive physical exertion, especially soon after surgery
- with plastic with own tissues – to close the hernial opening, the abdominal wall tissues around it are used
- with plastic using synthetic materials (or plastic “without tension”) – to close the hernial opening, synthetic prostheses made of surgical threads are used.
90 025 90 000 symptoms, treatment and operations, prevention – Department of Vertebrology of the Central Clinical Hospital of the Russian Academy of Sciences
Among all parts of the spine, the lumbar is most often subjected to hernia formation. This is due to increased stress on the lumbar region. About 70% of all patients who go to the doctor for spinal problems suffer from a lumbar spinal hernia.
How the lumbar disc works
The department is made up of five vertebrae, which are interconnected by intermediate discs.The elements perform very important functions – they absorb the load on the spinal column and distribute it evenly to reduce stress on the other parts. The disc is an annulus fibrosus with a nucleus composed of a jelly-like substance.
Mechanism of formation of intervertebral hernia
The spine is designed for stress. It supports and stabilizes the body in a standing position and provides full freedom of movement. When lifting weights, an uncomfortable body position, strong and stressful loads, he takes on the main effort.The load is especially pronounced when lifting heavy objects with outstretched arms. The heaviest load and, accordingly, wear, falls precisely on the lumbar region. When age-related or pathological changes begin in the body, the tissues change their structure and can no longer perform the functions of depreciation fully. Under the force, they can deform, crumble, which disrupts the functions of the spine and can disrupt the work of the whole organism.
How does a hernia appear
The bulge formation takes place in several stages:
If the call for help occurs on time, when the nerves and spinal cord are not involved in the process, conservative treatment is applied and the patient can be completely cured.
How does a hernia manifest?
At the very beginning of the development of the pathological process, the patient does not feel serious pain, the symptoms are few.The more tissues protrude, the more the patient feels it. There are three groups of symptoms for a herniated disc:
If the bulge has occurred to the rear, any physical work is likely to cause severe compression and paralysis.
Manifestations depending on the location of the hernia
The features of the hernia are determined by its location. In this zone, nerve roots are infringed and a characteristic clinical picture arises. The nerve pinched during the formation of the lumbar protrusion of the spine runs along the inner surface of the leg from the thigh to the ankle.The pain is not necessarily localized along the entire length, it can be reflected in the leg, foot, buttock, and the outer side of the thigh. The lower back may also hurt at one point. As the situation develops, the pain can move lower – to the lower leg, heel and toes. In terms of intensity, it can be constant aching pain or lumbago arising from movement.
Basically, the pain sensations become more intense with prolonged walking, standing, turning the body, bending. It is also painful to lift your leg, do a series of exercises, and ride on rough roads.
At the onset of a hernia, pain can be relieved by lying down by bending one leg at the chest. This will help relieve tension and pressure on the nerve endings. In a more difficult situation, this method will not help. The movements are constrained, their amplitude is greatly reduced, the leg gets tired.
Basically, the patient feels the compression of the spinal cord as tingling, burning, numbness. It dulls the pain. The main symptom that a specialist will pay attention to upon examination is muscle tension on the lateral side of the back, painful when pressed.
Making a diagnosis
The diagnosis is made after examination, examination of the patient. First of all, instrumental diagnostics are carried out to help determine whether tendon reflexes are normal. The patient is asked to raise the straightened leg. Tests for vibration sensitivity, the ability to feel temperature and pain are also performed. If there is a hernia, there will be certain manifestations:
Also, to diagnose protrusion, CT or MRI diagnostics of the spine is performed. These studies will help not only visualize the hernia, but also determine the condition of the surrounding tissues, diagnose the narrowing of the spinal canal, if any. If indicated, contrast myelography may be prescribed. After the examination, you can determine the degree of pathological changes and prescribe adequate treatment.If the nerves are not affected, the patient only complains of pain, conservative therapy is used.
What is the danger of a hernia of the lumbar spine
Any hernia brings not only pain, but also a serious risk of disruption of the body and paralysis. The vertebral protrusion in the lumbar region has a number of dangerous concomitant manifestations:
Conservative treatment of hernia
It is used if the hernia does not compress the nerves and spinal cord. Key points:
Radical intervention is used when it is necessary to release the spinal cord and nerves from the pressure of the bulging tissues. The most popular methods are:
Spinal hernia can be prevented. There are a few simple rules for this:
By contacting a neuropathologist at the Central Clinical Hospital of the Russian Academy of Sciences in time, you can avoid complications and return to a normal lifestyle as soon as possible.
Facts and symptoms of spinal hernia
Herniated disc or spinal hernia refers to a problem that occurs with one of the rubber discs that sit between the vertebrae of the human bones responsible for laying and shaping the spine. As we know, the spinal disc has a soft, enclosed center, which is sometimes called a slipping disc or a ruptured disc. A herniated disc occurs when the nucleus is pushed out of the rupture into the annulus using physical therapy, exercise, stretching, and conservative techniques such as heating and icing.
What is a hernia of the spine?
A spinal hernia is an injury to the connective tissue between the vertebrae and usually causes excessive stress and injury to the spinal cord. This leads to back pain, a sensation of pain in various parts of the person’s body. The problem of a hernia of the spine is associated with the age and aging of a person. The final diagnosis of a spinal hernia is an MRI, and treatment ranges from taking painkillers to surgery. The best defense against a hernia of the spine is maintaining correct posture and core strength, as well as awareness of its mechanism.
Symptoms of a spinal hernia
Signs and symptoms of a hernia of the spine may vary depending on the location of the hernia and the type of tissue. Symptoms include changes such as numbness, tingling, paresthesias, and changes such as muscle. When a herniated disc is in the lumbar region, a person may experience sciatica due to irritation of one or more of the nerve roots of the sciatic nerve. Hernia pain is not like throbbing pain or pain that comes and goes.The problem usually continues and sometimes continues in certain parts and positions of the body. A spinal hernia in the lumbar spine can cause nerve pain that radiates to the lower extremities or groin and can sometimes be associated with bowel and bladder incontinence. Symptoms usually appear on one side of the body. In the event that the hernia is large and presses on the nerves on both sides, both sides of the body will be affected. The main complaint of patients was usually sharp, cutting pain, and in some cases there may be a history of localized pain.It should be noted that the quality of pain can be dull, aching, and even difficult to localize.
Other symptoms may include pain in the arms and legs, numbness, tingling, and weakness causing the person to stumble.
Internal pressure is equalized on parts of the discs when the spine is on a straight model, for example, lying or standing. The internal pressure of the disc can move when a person is sitting or bending over to lift anything from 17 psi to 300 psi.A herniated spine or disc can be the result of general wear and tear, such as sitting, driving, squatting, and even a secondary lifestyle. In addition, a hernia of the spine can occur as a result of lifting heavy loads. Athletes, especially those who play contact games such as rugby, college football, ice hockey and wrestling, are more prone to spinal hernia. A hernia of the spine can occur in the back, especially in the lower back, and can occur in the vertebrae of a person’s neck. As a person ages, the spinal disc loses some of its water content, and this decrease makes the discs less elastic.
The aging process and general wear and tear of the spine can increase the chances of developing a hernia of the spine. A spinal hernia can be caused by repetitive activity and spinal cord injury. People who have physically demanding jobs have a significant risk of back pain and problems. Repetitive lifting, pulling, and bending can increase the risk of a herniated disc, and in some people, these problems are related to their genetics.
A hernia of the spine can be diagnosed with appropriate diagnostic tests.A person may have a spinal hernia but not experience any pain at all. Here are some tests that can help diagnose a herniated disc:
X-rays: This test uses small doses of radiation to produce images of the body. A back x-ray is done to understand and determine the cause of a person’s back or neck pain.
MRI or computed tomography: MRI or magnetic resonance imaging and computed tomography can show more detailed images and help the doctor find back pain.
Myelogram: is an injection of a dye injected into the patient’s spinal canal before undergoing a computed tomography test. The myelogram helps to accurately determine the actual size of the hernia along with its location.
EMG: An electromyelogram is a process that involves placing small needles in various muscles and measuring electrical activity. This test can help determine which nerve root, or rather, roots, are affected by a spinal hernia.
Treatment of spinal hernia
Herniated disc or spinal hernia is mostly self-resolving with conservative treatments that include rest, anti-inflammatory drugs, and physical therapy. For some people, applying ice packs or moist heat to the affected area provided relief from back pain and muscle spasm. In cases where conservative treatment does not match the problem, injections or surgery are recommended.Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and stiffness and keep a person moving. Spine surgery may be required for those who do not respond to nonsurgical treatment and symptoms gradually worsen. The most common surgical options include microdiscectomy, laminectomy, and foraminotomy. A spinal injection is an injection of a drug, such as cortisone, into the lower back that can reduce swelling of the nerve roots and provide mobility.These injections are called epidurals and also nerve blocks.
The spinal cord ends above the waist and the expanded group of nerves continues through the spinal canal. A spinal hernia can rarely compress the entire spinal canal. Emergency surgery is rarely required to avoid permanent weakness or paralysis of a person. Medical attention should be provided if you experience problems such as worsening symptoms such as pain, numbness and weakness, loss of bowel and bladder control.Saddle anesthesia is a type of progressive loss of sensation that affects areas that touch the saddle, such as the inner thighs, the back of the legs, and the area around a person’s rectum.
Prevention is not always possible, but there are several steps a person can take to reduce the risk of a spinal hernia or herniated disc.
As mentioned above, we have read about herniated disc and herniated spine. Prevention was convenient and the person must be conscientious when it comes to the spinal cord and disc, as any serious problem or injury could leave the person paralyzed for the rest of their life.
A spinal hernia surgery is performed at the end when all non-surgical treatments cannot relieve the person’s pain and the patient still complains of back pain. If you have back pain and you are worried about it, see your doctor and have tests like MRI and X-rays to see the real problem causing your back pain. The best exercise for someone with a herniated disc may be yoga, which improves flexibility and offers relief from leg or lower back pain.A herniated disc can heal within a few days and completely resolve in 5-7 weeks. Keep in mind that during your recovery session, make sure you have the correct posture, whether you are sleeping, standing, or sitting.
90,000 All about hernias
go back to the outpatient surgery department
ALL ABOUT HERNIA
What is a hernia?
A hernia is the protrusion of the abdominal organs under the skin through the weak points of the abdominal wall.The exiting organs are located in the hernial sac formed by the peritoneum (the inner lining of the abdominal wall). In the hernial sac, there can be almost any organ of the abdominal cavity (intestinal loops, bladder, less often the stomach or part of it), an omentum, extremely rarely – the liver, spleen.
Fig. Postoperative ventral hernia
Why is a hernia formed?
The abdominal wall, consisting of muscles and aponeuroses, performs a number of functions, one of which is to keep the internal organs in their natural position and resist the intra-abdominal pressure created by them.Under the influence of intra-abdominal pressure in the weakest places of the abdominal wall, a defect (hernial orifice) can form, through which the hernia emerges. This may be facilitated by predisposing factors such as:
1.excessive physical activity
2.severe cough, including chronic (smoker’s cough)
4.diseases in which shortness of breath develops with difficulty breathing out (bronchial asthma)
Who can get a hernia?
A hernia can appear in any person, regardless of gender and age.
External signs and symptoms.
The external manifestations and symptoms of hernias can develop gradually or occur within a short time.
In the presence of any of the above manifestations, it is necessary to consult a doctor. The sooner the diagnosis is made and the treatment is carried out, the higher the chance to prevent the development of complications, sometimes fatal.
More about the types of hernias.
Fig. Classification of hernias of the anterior abdominal wall
Lumbar hernias of the anterior abdominal wall
Under the lumbar hernia of the abdomen (Hernia lumbalis), it is considered a hernial formation on the posterior, lateral walls (in the lumbar region), emerging through various weak points of the lateral parts of the abdominal wall. The main anatomical formations through which lumbar hernial formations arise are the Petit triangle and the Greenfelt-Lesgaft gap, aponeurotic slits.
The Petit Triangle is limited from the back by the outer edge of the vastus dorsi, from the front by the inner edge of the external oblique muscle, from below by the ridge of the ilium. In the area of the Petit triangle, under the superficial fascia and the thin aponeurosis, is the internal oblique muscle.
The Greenfelt – Lesgaft interval has a more quadrangular shape. Its upper border is made up of the lower posterior dentate muscle and the XII rib, medially it is delimited by the longitudinal muscles of the spine, the square muscle of the lower back, the edge of the internal oblique muscle goes in front and below.The shape and size of the gap can vary depending on the length of the XII rib – with a long rib, the Greenfelt – Lesgaft gap is sometimes absent or has the appearance of a gap, and with a short rib it increases in size.
Aponeurotic fissures usually form at the site of the passage of blood vessels and nerves, but can sometimes appear as a result of rupture or abnormal development of the aponeurosis. Among the causal factors contributing to the occurrence of hernial formation in these areas is the weakness of the connective tissue and muscle atrophy, inflammatory processes.Hernial protrusions are more common on the left than on the right, bilateral ones are rare.
Are a complication of hernia surgery.
The causes of recurrent hernial protrusion may be associated with the patient’s lifestyle and structural features of his body.
For example: failure to comply with the terms of the recovery period, when a person begins active physical activity ahead of time.
With age-related changes and a number of pathological conditions, when tissues can become flabby, elasticity and structure change, which also affects the quality and duration of healing after the operation.So in elderly, emaciated or very obese patients, relapses can be observed regardless of the method of operation and the course of the postoperative period
The main reasons for the formation of recurrent hernias:
The only treatment for recurrent hernias is surgery.At the same time, various methods of hernioplasty are selected using various mesh prostheses.
Fig. Removal of old and deformed graft
Fig. Restoration of the integrity of the inguinal canal and reprosthetic hernioplasty according to Liechtenstein
Why is a hernia dangerous?
In addition to the quite obvious inconvenience associated with the presence of a cosmetic defect, decreased physical activity and disability, a hernia carries the risk of developing a number of complications.These include dysfunctions of organs located in the hernial sac – constipation, urinary disorders, when large volumes of organs leave the abdominal cavity – breathing disorders. A formidable complication is the development of hernia infringement.
Infringement – compression of the hernia in the hernial orifice, as a result of which the necrosis of the contents of the hernial sac develops. Infringement is accompanied by sharp pain in the area of the hernial protrusion. The most dangerous in case of infringement is the development of intestinal obstruction (the loop of the intestine is restrained) and the peritonitis following it.This situation requires immediate resolution through an operation. By and large, regardless of which organ is the contents of the hernial sac, the end result without appropriate treatment is the same – peritonitis, the difference is only in time. Peritonitis – inflammation of the peritoneum – is a formidable complication of a large number of diseases, including strangulated hernias, the development of this pathological condition is one of the most difficult problems in surgery. Age, obesity, the presence of concomitant pathology further aggravate this situation.Without surgery, the outcome is one – death. Even if the operation is performed, but more than a day has passed since the beginning of the infringement, up to 30% of patients die in the postoperative period. There is no need to bring such a small problem as a hernia to such a tragic situation.
How is hernia treated?
The only way to treat a hernia in adult patients is to perform an operation (hernia repair).
When to start hernia repair?
Following from the above, the earlier the operation is done, the better.
Is it possible to do without the operation?
For adult patients with hernia, the only treatment is surgery.
Are there any contraindications to the operation?
Hernia repair should not be performed in the presence of severe concomitant pathology, when the operation can only harm, not help. Such cases include: the coming months after myocardial infarction, stroke, a number of other extremely severe concomitant pathologies. It should be remembered that the presence of chronic diseases is not an absolute contraindication to the operation, but only requires appropriate correction in the preoperative period.
Can other surgical interventions be performed simultaneously with hernia surgery?
Yes. Hernia surgery can be supplemented with almost any surgical intervention.
Often, especially in elderly patients, there are several problems that require surgery. In such situations, it is preferable to do with one operation, which combines the elimination of the hernia and any other problem. Performing combined operations is a priority method, since it allows you to solve two (or more) problems in one surgical intervention, relieves the patient from psychoemotional problems associated with the need to undergo several operations.
What types of operations are performed to eliminate a hernia?
Today there are more than 300 methods of hernia repair – ventral, inguinal, umbilical, femoral, postoperative. But all of them, in principle, can be divided into two groups:
Plastics with own tissues is the oldest group of methods, which was born in the second half of the 19th century, it is the most extensive and widespread. Its essence is the closure of the hernial orifice by the patient’s own tissues (muscles, fascia and aponeuroses) in one way or another. The frequency of hernia recurrence after these operations varies from 20% to 70%, depending on the condition of the patient’s tissues, the method of hernioplasty and the correctness of his choice. The main disadvantages are pronounced pain syndrome for the first time days after surgery due to tissue tension and long periods of physical rehabilitation.Intense physical labor is contraindicated for at least 3 months after surgery.
Methods of plastic surgery “without tension” of the patient’s own tissues have existed since the second half of the 60s of the twentieth century. They are distinguished from the methods of plastic surgery with their own tissues by the use of “patches” made of synthetic materials to close the hernia gate. In recent years, these methods have gained great popularity, which became possible due to the creation of perfect synthetic materials and the development of new techniques for closing the hernial orifice, practically guaranteeing the patient against recurrent hernia.The recurrence rate does not exceed 1% in specialized clinics, regardless of the type of hernia. Despite the incision of the skin over the hernia, the pain syndrome after surgery is minimal. no tension of own tissues. Intensive physical labor is possible a month after the operation, household physical activity is not limited. This allows you to perform such operations on an outpatient basis. Another positive aspect is the possibility of performing the operation under local or spinal anesthesia, which is especially important for elderly patients and patients with heart and lung diseases.Due to its reliability and simplicity, the most widespread hernioplasty according to the I.L. Lichtenstein technique – with inguinal hernias. It is applicable for any type and size of inguinal hernias.
Fig. Plastic surgery of the inguinal canal with a mesh polypropylene prosthesis according to Liechtenstein .
Also, mention should be made of laparoscopic (through punctures of the anterior abdominal wall) methods of hernia repair. These are operations that are performed under the control of a laparoscope, a device that allows, using a mini-video camera, to eliminate a hernia from the abdominal cavity without cutting the skin over the hernia.They were born in the early 80s of the twentieth century with the advent of video technology. In most cases, the abdominal wall defect is closed from the inside of the abdominal cavity with a synthetic mesh prosthesis. The frequency of hernia recurrence after this repair is 2-5%, which is determined by the type of hernia and the preparedness of the surgeons. Important advantages of these methods are low trauma, which means insignificant pain syndrome after surgery, short rehabilitation periods (up to a month during physical labor), as well as the possibility of performing bilateral plastic surgery and, if necessary, combined operations in the abdominal cavity through the same punctures of the abdominal wall.The serious disadvantages of the methods of this group include the need for general anesthesia (anesthesia), the need to inject gas into the abdominal cavity to create an operative space (dangerous in patients with diseases of the lungs and heart).
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