Don’t Let a Hernia Put a Strain on Your Life

by Thomas H. Lewis, M.D.

Hernias happen. They happen to overweight, out-of-shape smokers, and they happen to highly trained athletes. They happen to persons who strain too much while lifting, and they happen to those who merely sit in a chair. While they are more common in men, they also occur frequently in pregnant women.

A hernia happens when a small portion of tissue from inside pushes through a weak spot in the abdominal wall. In about 75 percent of cases, this occurs in the inguinal canal, the area where the abdomen meets the thigh. Men are 25 times more likely than women to develop an inguinal hernia, and the bulge sometimes protrudes into the scrotum.

Other abdominal hernias likely to affect women as well as men include femoral (also in the groin, nearer the thigh), umbilical (around the naval) and epigastria (above the stomach).

It was once believed that hernias were caused by heavy lifting, straining, coughing or sneezing. Such activities may well bring on a hernia if a weakness already exists in the abdominal tissue, but the current belief is that the weakness is usually caused by impairment in collagen metabolism.
When the predisposition exists, smoking, infection and obesity–as well as straining–can increase the risk. But even fit, muscular individuals develop hernias.

If you have a hernia, you may not know it until a doctor detects it on a routine examination. When you’re asked during a physical to turn your head and cough, the goal is to feel for a hernia.

A hernia can be seen or felt as a tender bulge or round lump that becomes more prominent when you cough, strain or stand up. In the early stages, it’s possible to push the protruding tissue back in place temporarily. In medical terms, a bulge that can be pushed back in place is known as a “reducible” hernia. When the condition worsens, the lump can no longer be pushed back.

The hard part about dealing with a hernia is the uncertainty about what to do. A break in the abdominal wall will not get better on its own and is likely to get worse. Various trusses, belts and other devices to hold the hernia in have had mixed success. And a serious problem could occur if fatty tissue or an organ gets trapped inside the hernia (known as “incarceration”) and deprived of blood flow (“strangulation”). Because of the risk of gangrene and tissue death, strangulation is a life-threatening condition requiring emergency surgery.

Surgery Now or Later?

Sooner or later, most persons with a hernia have it surgically repaired. This involves re-positioning the internal tissue and repairing the defect in the abdominal wall.

About a million procedures are performed each year; it’s one of the most common types of surgery and one of the safest. Complications include pain, discomfort and recurrence of the hernia.

Because of the risk of strangulation, many persons undergo surgery right away, even if the hernia is not causing pain or other symptoms. A study published in the Journal of the American Medical Association [January 18, 2006] found, however, that immediate action may not always be necessary.
More than 700 men with hernias causing only minimal symptoms were recruited over a five-year period at five academic and community hospitals and randomly assigned either to watchful waiting or traditional surgery. Over a two to three year follow-up period, researchers found that the overall rate of pain and other complications was similar in the two groups and concluded that “watchful waiting is an acceptable option for men with minimally symptomatic inguinal hernias. Delaying surgical repair until symptoms increase is safe because acute hernia incarcerations occur rarely.”

Of the men assigned to watchful waiting, 23 percent crossed over to the surgery group–primarily because their pain had gotten worse and the hernia was protruding more.

Infants and children are more likely than adults to have tissue become trapped (or incarcerated) in a hernia; as a result, they may be advised to have surgery sooner rather than later.

Adults choosing to delay surgery might need to wear a truss, belt or other device in order to handle every day activities without pain or discomfort. It’s important, however, to be instructed in the use of a truss since an improperly worn device could actually increase the risk of incarceration.

While hernia surgery is usually worry-free, recurrence has been a problem. The traditional repair involves suturing together the ends of the defect in the abdominal wall. With the resulting increased tension on the abdominal muscle tissue, another tear is eventually likely to happen.

Newer surgical approaches aim to reduce tension by stitching a mesh patch made of synthetic material into the defect. The recurrence rate has been shown to be dramatically improved over the traditional method of suturing the tissue together. Laparoscopic repair of some hernias is also an option in some patients and should be discussed with your doctor.

As far as the patient is concerned, the best procedure is usually the one with which the surgeon has had the most experience.

If you have a small hernia that doesn’t cause symptoms, there’s no need to let it worry you. When it becomes large enough to cause you pain, the surgeons at Brattleboro General Surgery practice would be glad to consult with you.

Thomas H. Lewis, MD, is a general surgeon on the BMH Medical Staff. He is in the Brattleboro General Surgery practice with Gregory Gadowski, MD, and Joseph Rosen, MD.

Like this:

Like Loading…

Related

How to Prevent a Hernia

Most hernias are inguinal hernias, in which a section of intestine pushes through muscle in your groin area at a location known as the inguinal canal.

Like all hernias, inguinal hernias develop due to a combination of muscle weakness and pressure inside the abdomen. (2)

There’s not a lot you can do to avoid the type of muscle weakness that lead to hernias, but there are steps you can take to reduce pressure in your abdomen.

Steps that may help prevent an inguinal hernia include the following:

Maintain a healthy body weight. When you’re overweight or obese, your abdominal wall is constantly under pressure from your extra body fat whenever you stand or move around. Losing weight is easier to recommend than to actually do, but talk to your doctor about developing an exercise and diet plan that works for you. (2,3)

Get enough of the right exercise. Being physically active in certain ways has been shown to help prevent hernias, but other types of exercise can put too much pressure on your abdomen.

Beneficial exercises may include:

• Yoga
• Pilates
• Sit-ups or crunches
• Light weights
• Aerobic activities, like running or cycling

Activities to avoid include jumping exercises and squats, both of which can increase pressure on your abdominal wall. Fast movements can also lead to muscle tearing.

Any type of exercise than involves very high levels of exertion can also increase your hernia risk. (3)

Ask your doctor about any new type of exercise that you’re considering.

Incorporate high-fiber foods into your diet. Fiber-rich foods can support regular bowel movements and help prevent constipation, which can lead to straining that increases your hernia risk.

Foods that may help in this area include:

• Fruits
• Vegetables
• Whole grains
• Nuts and seeds
• Legumes (dried beans and peas) (2)

If needed, take other steps to avoid constipation. Taking a fiber supplement or bulk-forming laxative, like a preparation containing psyllium, can help keep you regular and prevent straining during bowel movements.

If this doesn’t do the trick, you can try certain other laxatives, like mineral oil, milk of magnesia (magnesium hydroxide), or MiraLAX (polyethylene glycol).

Staying well-hydrated is also essential to avoiding constipation.

Since anesthesia and certain painkillers can cause constipation, it’s important to take extra steps to avoid constipation after any surgery — especially because surgery carries the risk of hernias at the incision site. (3)

Avoid heavy lifting, or do it carefully. If you have to lift a heavy object, bend down with your knees instead of your waist. Make your legs — rather than your torso — do most of the lifting effort.

And if an object is too heavy for you to lift comfortably, know your limits and don’t do it. (1,2)

Don’t smoke. Smoking can cause coughing, which can put pressure on your abdomen and lead to an inguinal hernia, or worsen symptoms in one that you already have. (2)

See a doctor when you have a persistent cough. Because coughing can lead to or aggravate a hernia, it’s important to get this symptom under control whenever you have an infection or another condition that causes it, including asthma.

Sneezing due to allergies can also increase abdominal pressure, so it’s important to control this symptom as well. (1,3)

Get treated if you have an enlarged prostate. Having an enlarged prostate can lead to straining during urination, which can increase pressure in your abdomen.

Signs of enlarged prostate may include waking up twice or more each night to urinate, straining to make your urine flow faster, and straining to empty your bladder at the end of urination. (3)

1 sign you probably have a hernia, Article

The most common types of hernia occur when weak spots in your abdominal wall rupture and allow internal organs, typically part of the bowel, to slip through. It sounds severe but in many cases there is little pain or the pain only occurs during strain.

How to tell you have a hernia

Even if a hernia doesn’t cause pain or discomfort, it almost certainly will cause a lump under your skin where the abdominal wall has torn. These can be hard to spot if they occur in the inguinal canal in the groin area, as most hernias do. The following steps will give some guidance if you suspect you have a hernia but cannot be relied upon for diagnosis. If you have concerns, see a GP.

1. 
   Feel for a lump or swelling around the pubic bone
2. If you find a lump, make note of where it is and lie down 
3. Did the lump disappear or become smaller? If so, it may be a hernia 
4. Do you feel discomfort when coughing or lifting heavy objects? It’s almost certainly a hernia.

Hernias are commonly under-pronounced while lying down as there is less pressure on your abdominal wall from your internal organs. Even a lump that doesn’t reduce in size when you lie down could be a hernia, or it could be something else. Both are good reasons to speak to your doctor.

Hernias can cause sharp pain when your body is under strain. Acts like coughing, sneezing and lifting can pinch the organ trapped in the abdominal wall.

I think I might have a hernia. What happens next?

The simple answer is: tell your doctor as soon as possible, however, many people wait until they experience serious pain or discomfort, or the hernia has grown large. There are many reasons why this is a bad idea. Hernias never repair themselves and generally always get worse with time. The longer you wait, the less surgical options you will have to deal with it.

Detected early, hernias can be repaired using minimally invasive laparoscopic surgery. This is typically easier to recover from than open surgery and has less complications. Delaying treatment may mean open surgery is the only course of action.

There’s also a risk of the hernia becoming strangulated, where the blood supply to the trapped organ is cut off. This is rare, but can be life threatening and may require emergency surgery.

Unfortunately, early stage hernias are not a public health priority so dealing with it quickly might not just be up to you. Nuffield Health can diagnose and repair hernia’s quickly whether you’re privately insured or want to pay for yourself.

What about hernias you can’t see?

Hiatus hernias won’t produce any visible signs on your body but can be uncomfortable for those affected. They occur when part of the stomach pushes up through an opening in the diaphragm. It can lead to gastro-oesophageal reflux disease (GORD) which can cause symptoms like heartburn.

If a hiatus hernia is the cause of your GORD it can diagnosed with an x-ray or endoscopic investigations. Hiatus hernia is most commonly treated with medication or lifestyle changes and doesn’t usually require surgery.

Visit our shop if you’d like to view our range of hernia supports.

Last updated Wednesday 3 February 2021

Inguinal Hernia – Harvard Health

What Is It?

When part of an organ protrudes through an abnormal opening or in an abnormal way, this is called a hernia. A groin (inguinal) hernia occurs when part of the intestine bulges through a weak spot in the abdominal wall at the inguinal canal. The inguinal canal is a passageway through the abdominal wall near the groin. Inguinal hernias are up to 10 times more common in men than in women. About one in four men develop a hernia at some point in life.

There are two types of inguinal hernias:

• Indirect inguinal hernia — This occurs when the internal opening of the inguinal canal, which usually closes around the time of birth, remains open. This allows a portion of the intestine to slip through the inguinal canal. These hernias often are diagnosed within the first year of life, but may not show up until adulthood. This condition affects between 1% and 5% of normal newborns and up to 10% of premature infants.

• Direct inguinal hernia — This occurs when a portion of the intestine protrudes through a weakness in the abdominal muscles along the wall of the inguinal canal. These are common in adults, but rarely occur in children.

In adults, direct and indirect inguinal hernias look and feel about the same. They can occur on one or both sides of the groin. Your doctor may not know which type of hernia you have until surgery is performed. However, both types of hernias are treated in a similar manner.

To continue reading this article, you must log in.

Subscribe to Harvard Health Online for immediate access to health news and information from Harvard Medical School.

• Research health conditions
• Check your symptoms
• Prepare for a doctor’s visit or test
• Find the best treatments and procedures for you
• Explore options for better nutrition and exercise

New subscriptions to Harvard Health Online are temporarily unavailable. Click the button below to learn about our other subscription offers.

Learn More »

Reasons Not to Delay Your Hernia Repair

Hernias will not go away by themselves. Surgery is the only way to repair a hernia. A hernia repair returns the organ or structure to its proper place and fixes the weakened area of muscle or tissue.

Having surgery is a big decision. It can be tempting to put it off, and that may be okay in some cases. Before you decide, make sure you understand the risks and benefits of your decision. Here are some things to consider and discuss with the doctor who is helping you make the decision.

How Is the Hernia Affecting You?

The first thing to consider is whether or not you are experiencing symptoms. Not everyone has symptoms with a hernia, especially small ones. When symptoms occur, the most common one is pain. Others can include a feeling of heaviness or fullness in the belly or groin. Whether you have symptoms or not, a hernia can also interfere with your leisure activities and your work. So you also need to recognize if you are taking time off from work or interests due to your hernia.

Delaying surgery may mean you spend more time away from work and fun instead of returning to activities after recovery.

If you have symptoms, especially pain, your doctor is likely to recommend surgery. But what if you don’t have symptoms or they are minimal? In this case, your doctor may recommend watchful waiting. Before you agree to watchful waiting, be sure your doctor knows the whole story. Be honest about any limitations your hernia puts on your time and activities.

What Are the Risks of Waiting?

1. Hernias can become incarcerated. One potentially serious risk of not fixing a hernia is that it can become trapped outside the abdominal wall—or incarcerated. This can cut off the blood supply to the hernia and obstruct the bowel, resulting in a strangulated hernia. This requires urgent surgical repair. Not all hernias progress to this point, but it is a risk nonetheless. Avoiding an emergency situation that you can’t control is one reason to consider not delaying surgery.

2. Hernias grow. A more likely scenario is that your hernia will continue to grow and weaken with time. This is likely to increase your symptoms, including pain, and cause more changes to your lifestyle. Surgeons know that smaller hernias are easier to repair than larger hernias. Going ahead with surgery instead of delaying it can prevent your symptoms from getting worse. It can also help you avoid losing work or missing activities.

3. Hernias require surgery eventually. Even if you aren’t having symptoms, you may still want to consider having surgery sooner rather than later. Surgery for a hernia is somewhat inevitable in most cases. Research shows that most people with hernias have surgery within 10 years. Keep in mind that delaying surgery until your hernia is larger and the muscles are weaker may make surgery and recovery more difficult. 

4. Your overall health may change. Your age may determine whether waiting is a risk for you. Putting off surgery for years down the road may mean you are not in as good overall health or physical shape. This will also affect your surgery and recovery. So having surgery at a younger age can be beneficial. However, if you are elderly (older than about 75 years of age), not very active, and your hernia isn’t causing problems, it may be better to not fix it. The risks of surgery may outweigh the benefit of repair.

Surgery is never convenient and life is always busy. Being in control of when you have surgery is a huge benefit of not delaying your hernia repair. You can schedule your surgery at your convenience. And if you are a candidate for laparoscopic hernia surgery, you’ll be back to life and work sooner than in years past. Surgery should be easier on you and recovery will likely be smoother at a younger age and with a smaller hernia. Ultimately, your doctor is best able to help you decide whether watchful waiting or surgery is the best option for you.

Battling a Bulging Hernia | NIH News in Health

December 2017

Print this issue

Don’t Ignore Your Groin Pain

Usually, the wall of the abdomen is strong. The muscles keep your intestine in place. But if there’s a weak spot, the intestine can push through and form a hernia. A person may be born with a weakness there, or the weakness may develop over time later in life.

“It’s like when you look at an old tire on a car and you see kind of a bulge on the sidewall of the tire. That’s because there’s a weakness in the wall of the tire. And the air is pushing the wall of the tire outward to create that bulge,” says Dr. Dana K. Andersen, an NIH hernia expert.

A hernia developing in the abdomen is extremely common. Babies, children, and adults get them. Most of the time, hernias are found in men over 40. Can lifting heavy objects give you a hernia? Maybe if you already have a weakness in the wall of your abdomen.

“The majority—three-quarters—of abdominal wall hernias are in the groin,” Andersen says. The groin region is the lower abdomen.

The first sign of a hernia is a small bulge from the lower abdomen. You may notice it only when you stand up, cough, jump, or strain. That’s because those activities increase the pressure within your abdomen. That increased pressure can make a part of your intestine pop out of an area of weakness. When you lie down, the bulge may go away.

If you think you may have a hernia, ask your doctor. A doctor can usually detect a hernia during a physical exam. Your doctor can rule out other conditions that cause bulges or lumps.

If the bulge is very soft, your doctor may be able to massage the intestine back into the abdomen. A small, soft hernia that does not cause pain may not need treatment right away. The doctor may suggest watching and waiting for changes, like pain, to develop. If a hernia is painful or large, your doctor may suggest you see a surgeon for advice. You may need surgery to repair the hernia.

If your doctor can’t massage the intestine back into the abdomen, that means it’s trapped. A trapped intestine is dangerous because its blood supply can be cut off or strangulated.“The rim of the defect is forming a sort of a noose around the abdominal contents,” Andersen explains. “If that noose is tight enough so that the loop of intestine can’t be eased back through the defect, then the concern is that the intestine itself could be injured by strangulation.”

A strangulated hernia can be very serious and even life threatening. Symptoms include severe pain that doesn’t go away, nausea, and vomiting.

Surgery is usually needed if the intestine is trapped—and emergency surgery if it’s strangulated. A hernia is one of the most common reasons for surgery in the United States. “It’s a successful and low-risk procedure done about 800,000 times a year in the United States,” Andersen says.

If you think you may have a hernia, talk with your doctor. And check out the tips in Wise Choices for how to keep a hernia from getting worse. Keep in mind that anyone with sudden pain in the groin should immediately seek medical help.

Hiatal Hernia Diet Tips, Best/Worst Food Choices, and Cooking Advice

Many people with hiatal hernia, a condition in which part of the stomach bulges upward through an opening in the diaphragm, have no symptoms. For those who do, what they eat may make a difference between a good day (or night) and a bad one. Diet can play an important role in controlling the symptoms of hiatal hernia, namely heartburn and acid indigestion.

When you have a hiatal hernia, it is easier for stomach acids to come up into the esophagus, the tube that carries food from your throat to your stomach. This causes a burning feeling in your throat and chest. Certain foods can make these symptoms worse for some people. Fortunately, heartburn symptoms associated with hiatal hernia often can be controlled with diet and lifestyle changes.

Hiatal Hernia: Foods That May Cause Symptoms

The following foods are highly acidic or may weaken the lower esophageal sphincter, making it easier for stomach acids to back up into your esophagus. They may cause heartburn symptoms.

• Citrus foods, such as oranges, grapefruits, and lemons, and orange juice, grapefruit juice, cranberry juice, and lemonade
• Chocolate
• Fatty and fried foods, such as fried chicken and fatty cuts of meat
• Garlic and onions
• Spicy food
• Peppermint and spearmint
• Tomato-based foods such as spaghetti sauce, pizza, chili, salsa, and tomato juice
• Coffee, tea (including decaffeinated versions), and alcohol
• Carbonated beverages
• Dairy products, such as whole milk, ice cream, and creamed food. Try soy milk; it may be a good milk substitute. Also, mild cheeses, like feta or goat, may be enjoyed in moderation.
• Oil and butter

Hiatal Hernia: Foods That Are Less Likely to Cause Symptoms

The following foods are low-acid-producing foods and are less likely to aggravate your hiatal hernia symptoms:

• Bananas and apples
• Green beans, peas, carrots, and broccoli
• Grains, like cereals (bran and oatmeal), bread, rice, pasta, and crackers
• Low-fat or skim milk and low-fat yogurt
• Fat-free cheeses, cream cheese, and fat-free sour cream
• Lean meat, chicken, and fish
• Water
• Pretzels, graham crackers, rice cakes, and baked potato chips
• Low-fat sweets (no chocolate or mint)

You may find that some of the foods listed under “foods to avoid” may not bother you, while others on the “foods to enjoy” list may cause discomfort. Everyone tolerates food differently. To determine the best diet for you, keep a food diary for a few weeks. And then avoid anything that causes you to have symptoms.

Hiatal Hernia: Cooking Tips

A good way to enjoy the foods listed above is to cook them in a healthy way. Here are some heartburn-friendly cooking tips:

• Choose lean meats, such as skinless chicken, meat with little visible fat, ground turkey instead of ground beef, and fish. Lean beef cuts include round, chuck, sirloin, or loin. Lean pork cuts include tenderloin or loin chop.
• Bake or broil foods instead of frying.
• Skim off fat from meat during cooking.
• Go easy on seasoning. Most seasonings are OK as long as they are not spicy but should be used in moderation.
• Substitute low-fat dairy foods, such as low-fat yogurt, for ice cream.
• Steam your vegetables with water only.
• Limit butter, oils, and cream sauces. Use cooking spray instead of cooking oil when sautéing.
• Choose low-fat or nonfat ingredients over full-fat products.
• Get creative. There are all kinds of ways to modify recipes. Don’t be afraid to try new things.

Hiatal Hernia: Lifestyle Tips

In addition to making adjustments to what you eat and how you cook, changing certain habits may lessen heartburn symptoms too, including:

• Do not overeat. Instead, eat small, frequent meals. And take your time. Eating fast can make heartburn symptoms worse.
• Avoid lying down or going to sleep for at least three hours after a meal.
• Do not bend over right after eating.
• Do not smoke.
• Lose weight, if necessary.
• Wear loose-fitting clothes so as to not add extra pressure on your stomach.
• Raise the head of your bed 6 to 8 inches with wood blocks or some other sturdy objects. Propping your head up with pillows probably won’t give you the relief you need.

Continued

If these diet and lifestyle tips don’t help, or you need additional relief, over-the-counter antacids and acid-reducing or blocking drugs may help control your heartburn symptoms. Talk to your doctor to learn more about over-the-counter or prescription medications to treat your symptoms. Surgery may be needed in rare cases.

Hiatal hernia symptoms can be bothersome. But most people feel better after they adjust their diet and lifestyle.

90,000 What to do if you have a herniated disc

Most of the hernias found on MRI are “mute”.

Not all hernias hurt

The absence of clinical manifestations has two explanations: in some cases, the hernias are located so that they do not touch the nerve structures, but more often – the hernias are old and healed for a long time. True, “healed” about a hernia is not said, but the term “fibrotized” is used. But, in fact, fibrotization is healing, about the same as a callus at the site of a former fracture.At the same time, it is difficult to imagine a doctor who confuses callus and a healed fracture with a fresh fracture, but this happens all the time with hernias. Therefore, a disc herniation detected on an MRI should be compared not only with the patient’s complaints of pain, but, first of all, with those symptoms that the doctor will identify. A herniated disc has very clear symptoms. It is the presence of these symptoms, and not pain or an MRI picture, that is a sign of a pinched nerve. But more on that below.

In most cases, a hernia can be dispensed with without surgery.

A herniated disc is capable of healing.

The task of doctors is to avoid surgery and to make sure that the process of hernia repair takes place quickly and without consequences.

“Pitfalls” of disc herniation

There are many pitfalls around a herniated disc.

The main thing is that the diagnosis of disc herniation sounds so frightening that it can be used for unseemly purposes.For example, in order to increase the patient’s motivation through fear of a hernia and persuade him to undergo surgery or unnecessarily expensive treatment.

Another is that along with a “mute” hernia, not “mute” diseases of the spine or muscles often occur, which are accompanied by severe pain. And although the hernia in such cases has nothing to do with it, it is still called the cause of the pain. Why? Hard to say. Some doctors do it out of inexperience. Seeing in the hernia the cause of the pain, they turn their full attention to it and lose sight of other possible causes.The hernia acts on them like a boa constrictor on a rabbit – paralyzing the will to analyze the situation. However, one cannot exclude the selfish intent, which we talked about above – to increase the patient’s motivation.

As you can see, the hernia found on the MRI is a very “convenient” explanation for the pain. There is no need to “dig” into the symptoms and look for the real cause, but you can simply adjust the diagnosis and say: “The cause of your pain is a herniated disc.”

“Establishing an accurate diagnosis” and “adjusting the diagnosis to the detected hernia” are not the same thing.

“Device” and “work” of herniated disc

Visual diagnostic methods, including MRI, do not provide a complete and definitive picture of a hernia. MRI shows only the appearance – the “device” of the hernia, so to speak. But, besides the device, there is also “work” – the effect of the hernia on the body. Unclear? Let’s take a real life example. Let’s say you’ve decided to buy a used car. We found a suitable copy of the ad and came to study it more closely.After evaluating the appearance of the car, you were delighted, deciding that you found exactly what you were looking for. But when I tried to start it, it turned out that the car was not working. Do you feel the difference – APPEARANCE and WORK? These are two completely different properties, which means that they need to be checked in different ways. It’s the same with a hernia. The appearance of the hernia – its size, location, etc., are examined by visual methods – MRI, CT or ultrasound. And the effect of a hernia on the spinal cord, blood vessels or nerve roots (spinal nerves) is her “job”.It is tested by completely different methods – clinical.

Conclusion MRI is not a diagnosis and should be interpreted by the attending physician in accordance with the clinical picture.

Radicular symptoms

Root symptoms are a group of symptoms that only occur together. It does not happen that a hernia causes only pain without causing other symptoms.This is due to the fact that the spinal nerve (root) is mixed – it contains both sensory and motor fibers. Therefore, if a hernia presses on a nerve, all fibers are affected. This, in turn, leads to the obligatory (!) Occurrence of not only sensitive, but also motor symptoms, in the form of weakening of muscles and reflexes. Synonymous with the concept of “radicular symptoms” are the terms “radicular syndrome” and “radiculopathy” – from the Latin word radix – root. Radicular symptoms are listed below.

• Reduction or loss of reflexes;
• Muscle weakness;
• Violation of sensitivity;
• Radicular pain.

That is, in cases where the pain is caused by a hernia, radicular symptoms must appear. And if there are no radicular symptoms in the presence of pain and hernia, then the cause of the pain is not in the herniated disc, but in something else.

The absence of radicular symptoms indicates that the hernia does not press on the nerve.The pain is not due to a hernia.

Whether a nerve is “pinched” or not, we determine NOT by pain, but by the occurrence of radicular symptoms, which are mandatory for these cases. This is important to know. We have already said that in one person, along with a hernia, other diseases can occur. For example, a very “evil” muscle disease – myofascial syndrome, which can cause pain even more than with a herniated disc.

What is myofascial syndrome?

Myofascial syndrome is an extremely painful disease of muscles and muscular membranes – fascia.Myofascial syndrome often occurs in conjunction with a “mute” disc herniation, so the pain caused by myofascial syndrome is mistakenly considered a manifestation of a hernia.

The main difference between myofascial syndrome and hernia is that with myofascial syndrome there are no radicular symptoms.

Myofascial syndrome is characterized by:

• The presence of pain trigger points in the muscles;
• The manifestation of pain at a distance from the affected muscle – the zone of reflected pain;
• Weakening of the working capacity of the affected muscles.

To be sure that the pain is caused by the hernia and not by this disease, it is imperative to check the radicular symptoms. The presence of radicular symptoms indicates that the spinal nerve has been affected, and their absence indicates that nothing is pressing on the nerve – look for the real cause of the pain.

A hernia compression test consists of a neurological examination and manual muscle testing. It can be performed by a qualified chiropractor with a specialization in neurology.Now do you understand how important it is to find an experienced and knowledgeable doctor ?! After all, the exact diagnosis and the results of treatment depend on the doctor, and not on the MRI images!

When choosing a clinic, the main thing is to get to an experienced and knowledgeable doctor.

Which doctor treats a herniated disc?

• Neurosurgeon – if you decide to treat a herniated disc surgically;
• Chiropractor – if you decide to treat a herniated disc without surgery.

The choice is yours.

Curious statistics – disc herniation is more often operated in large cities. Why?

Is it because the larger the city, the more neurosurgeons there are and the more work they need?

How to make an accurate diagnosis?

As you know, the diagnosis is made on the basis of symptoms. A symptom is a symptom of an illness. But, symptoms are subjective and objective.Any sensations of the patient – pain, weakness, etc. Are subjective symptoms. They cannot be measured or weighed. Therefore, we only start from them in search of reasons, but, in no case, do not rely on when making an accurate diagnosis. All diagnostics and all medical expertise are based on this principle. Otherwise, the simulators would have triumphed in the world. But, thank God, there is evidence-based medicine and objective symptoms.

Symptoms

Objective symptoms are those that the doctor detects.And it doesn’t matter what exactly he uses to identify them – only with his own eyes, ears and hands, or with various tools and complex devices.

Objective symptoms are clinical and morphological.

Clinical symptoms of a herniated disc are external manifestations of the disease that a chiropractor detects by examining and testing a patient. The clinical symptoms of a herniated disc are impaired sensitivity, decreased reflexes, strength and muscle tone.

Morphological symptoms are changes in the shape of the disc, vertebra, etc., detected visually, using MRI, X-rays and other devices. The word “morphological” comes from the Greek word “morphe” – form.

Summarize

If you are worried about pain, and a hernia was found on an MRI, do not panic and do not rush to run to the surgeon. Start with a chiropractor. Just try to find an experienced doctor – this is very important for establishing the truth.After all, an experienced chiropractor will be able to see the whole picture of the disease as a whole and either confirm that the pain is caused by a hernia, or refute this and find the true cause of the pain. Otherwise, you run the risk of getting an MRI-tailored diagnosis. There is no need to say that the results of treatment with this approach will be zero. It’s obvious. It is also clear that for a full-fledged result you need to deeply understand all the intricacies of the disease.

We will be able to understand your symptoms, establish an accurate diagnosis and eliminate not only the disease, but also its causes.

Advantages of consultation and treatment at the Spina is Healthy Clinic

• We analyze the problems of each patient thoroughly, taking into account all possible reasons – no formalism.
• High qualifications and extensive practical experience – over 25 years.
• Guarantee of complete and qualified treatment. The word “full-fledged” is the key word in our work.
• Guarantee of an honest relationship.
• Location a stone’s throw from the metro in the very center of Moscow.

What not to do with an intervertebral hernia

Back diseases are increasingly being diagnosed in people of different age groups. One of them is a hernia of the intervertebral region, most often defined in the lumbar or cervical spine. A hernia occurs as a result of the protrusion of the nucleus, which is part of the intervertebral disc, into the spinal canal.

The disease is accompanied by symptoms: severe pain and limitation of movement.As a rule, the disease is aggravated by ignorance of the main contraindications and restrictions in everyday life, which doctors usually warn about. To avoid severe pain and complications, you need to know what can not be done with an intervertebral hernia that has arisen in the area of ​​the spine.

Contraindications for hernia

Avoiding unnecessary dangerous actions in case of illness will make it possible to recover faster and avoid the risk of complications:

• Restriction of physical activity, some of the usual exercises can aggravate the situation.This is especially true for exercises in which there is an axial load on the spine, for example, exercises on the horizontal bar. Active actions associated with a long stay of the body in an upright position are also excluded. We are talking about football, skiing, playing hockey, running. Preference is given to water sports: swimming, water aerobics;
• a visit to the bathhouse, prolonged exposure to the sun and any warming up of the spine can lead to complications. They relate to the weakening of the muscle corset, the displacement of the vertebrae and pinching of the nerve endings.You can visit the bathhouse during periods when the disease does not proceed in an acute form, but in no case should you overheat;
• a course of massage cannot be done with an exacerbation of the disease, but massage itself is useful at the stage of rehabilitation and as a prophylactic agent when the acute stage has already been passed;
• should avoid prolonged static position of the body, it is necessary to periodically make safe movements. With a sedentary lifestyle, it is required to change the position of the body from time to time;
• uncontrolled weight lifting is not recommended.If the bag or backpack still needs to be lifted and carried, sudden movements should be avoided. Weight should be lifted with bent knees;
• you should not overcool the body, especially neglecting the use of seasonal clothing in the cold season. Prolonged exposure to frost or swimming in an ice hole without proper preparation should also be excluded.

The main recommendation concerns the elimination of attempts at self-treatment, which are often undertaken by patients without an accurate diagnosis of the disease and professional medical advice.The doctor will develop a treatment regimen and advise on what specifically needs to be excluded from the usual way of life in order to quickly become healthy and avoid severe pain.

Other articles

Did you like the article? Share it with your friends

90,000 What to do and what not to do if there are problems with the spine – Rossiyskaya Gazeta

A council of experts was held at the RG media center, which discussed a topic of concern, without exaggeration, to millions of Russians.These are back pain, health and spinal column diseases.

Jalal Saidbegov, professor of the Sapienza University of Rome, doctor of medicine, author of the just published book “If your back hurts”, took part in the discussion; Head of the Department of Nervous Diseases of the Moscow State University of Medicine and Dentistry, Doctor of Medicine, Professor Igor Stulin; Head of the Department of Pathophysiology, Moscow State University of Medicine and Dentistry, Doctor of Medicine, Professor Igor Malyshev; and about. Head of the Center for Manual Therapy of the Moscow Healthcare Department, Candidate of Medical Sciences Sergei Kanaev; Sergei Trukhanov, associate professor of the Department of Nervous Diseases, Moscow State University of Medicine and Dentistry.

Dear experts, why are more and more people experiencing back pain at an ever younger age?

Jalal Saidbegov: Indeed, the pathology of the spine is getting younger. My youngest patient was a 12-year-old girl who was diagnosed with two rather large intervertebral hernias. And according to statistics, after 35-40 years, up to 80 percent of the population suffers from back pain caused by a hernia or protrusion of the disc, or discopathy.What is the reason for this? With the fact that today a person is constantly sitting – at home, at work, on vacation, etc. The famous Swedish orthopedic traumatologist, Professor Nahimson measured how the pressure in the intervertebral discs changes depending on the posture. So, when a person sits leaning forward, the intradiscal pressure increases significantly, due to which the disc wears out, discopathies, protrusions, etc. are formed.

Igor Malyshev: The quality of diagnostics also contributes to the growth of morbidity.If earlier no one went to doctors with back pain and did not get into any statistics of the program, today both the rejuvenation of pathology and the increase in the number of patients are, of course, partly due to better diagnostics and people’s faith in medicine.

Sergey Kanaev: WHO regularly publishes global data on morbidity, disability, etc. In such a report for 2017, the first place among the reasons that disrupt the normal functioning of a person is pain in the lower back.Fifth place is neck pain. Despite the fact that formally these conditions do not affect life expectancy and mortality, they greatly reduce the quality of life. And the quality of life is the main goal of modern medicine. Yes, the main cause of back pain is a sedentary lifestyle, and from childhood. Before, after school, children walked, ran, played in the air.

At school they were taught how to sit properly, how to use a book holder. Now children mostly sit or even lie at home – at the computer and gadgets.Now computers have taken over office work, not only does a person sits all day, he also sits incorrectly. You need to sit so that the center of gravity of the head coincides with the center of gravity of the body, the shoulders should be relaxed. Instead, the monitor stands on the side, the person sits half-turned, in an unnatural position, the shoulders are raised, tense. Often the size of the fonts on the screen is not adjusted, so the person also pulls his neck towards the monitor. Naturally, the back muscles will be overstrained, and by the evening due to muscle hypertonicity, the shoulders, neck and head will ache.And if this is repeated from day to day, hypertonicity becomes chronic, and here we have a ready patient with chronic pain in the neck and lower back.

80 percent of the population suffers from back pain

From the school anatomy course, we remember that the nerves that extend from the spinal cord innervate all internal organs, all body systems. Does the condition of the spine affect the functioning of the brain?

Igor Stulin: The main artery that supplies blood to the brain is the carotid artery.It supplies the brain up to 70 percent of the blood from one heartbeat, the remaining 30 percent goes to the kidneys, liver and other organs. But there are also vertebral arteries that carry blood to the cerebellum, to the brain stem, where the center of balance and other important parts are located. Any vertebral artery, before it delivers blood there, makes five bends. And violations in the spine at the level of the cervical spine, of course, can prevent this. Therefore, it is very important to determine with the help of modern diagnostic methods the indications and contraindications for manual therapy in the cervical spine.Unfortunately, this selection is not always carried out carefully, and this can lead to dramatic outcomes.

Sergey Kanaev: I run the only specialized center for manual therapy in Russia. 9-10 thousand patients come to us a year. But we do not take everyone for treatment, because there are contraindications to these methods, there are quite a few of them. And if the doctor does not take into account the patient’s contraindications for manual therapy, it is dangerous. But if the selection is correct, there is no risk.I would like to remind you that the Ministry of Health and the Ministry of Education and Science have established uniform qualification requirements for all manual therapists. And the indications, as well as contraindications, are also the same everywhere. If they are not followed somewhere, this only means that either the doctor is not qualified, or the leadership that allows such a doctor to work.

Igor Yurievich, you are studying the body’s immune response to various diseases. Is there a connection between the state of immunity and the occurrence of problems with the spine?

Igor Malyshev: Spinal pathology is not a monopathology.It is associated with metabolic disorders and the immune system. Why does manual therapy have a beneficial effect on some patients, and even after spinal surgery they recover quickly and well? Others seem to have done everything right, but there is no recovery, there is even a deterioration. The idea that the immune system somehow affects the spine arose a long time ago. Scientists drew attention to the fact that some patients have spontaneous resorption of intervertebral hernias. Research has shown that two factors play a very important role.The first is which cells are present in the interdisk space. It turned out that there are many immune cells. Among them there are T cells, which are specialized in resorption, that is, the destruction of hard tissues – bone and cartilage. And there are macrophage cells that secrete substances that can lyse, that is, dissolve bone and cartilage tissue. The second factor is that there are no vessels in the cartilaginous capsule of the vertebrae. And as a result of mechanical pressure, macrophages begin to produce a factor that enhances the growth of blood vessels.And they help relieve inflammation. When we compared the histological picture of different patients, it turned out that some people have many macrophages and new vessels – and they recover well. Other macrophages and blood vessels do not have, and the result of the treatment, too. Perhaps it is the mechanical effect on the spine, which is used by the doctors of manual therapy, that activates the work of immune cells. Therefore, it seems to me that it is necessary to introduce into the practice of manual therapy doctors, and an initial assessment of the immune status.Then the success of the treatment can be much higher.

When back problems arise, residents of large cities can easily find adequate medical care. But many Russians live in small towns and villages where there is no chiropractor or immunologist. Who is there to contact for help?

Sergei Kanaev: It is most logical to consult a doctor who regularly observes him and knows all his concomitant diseases. This is a local therapist or general practitioner.They can prescribe the simplest therapy that is safe for the patient. It is often sufficient to take only non-steroidal anti-inflammatory drugs. But keep in mind that there are many of them on the market, and they all have serious side effects. Therefore, you should not take them yourself. The doctor who observes the patient and knows his concomitant diseases will prescribe drugs that are safe for him specifically.

If you have back pain, you should not postpone the visit to the doctor. While the patient is treating himself or rushing to private practitioners, precious time will be lost

Jalal Saidbegov: I recommend pain relievers very rarely.And in no case do I advise you to use warming ointments, pepper plaster. If there is a hernia, then the inflammation is already there, with warming it can only intensify.

Sergey Kanaev: The second point is that often lower back pain masks a much more serious disease. And if within some reasonable time his condition does not improve, then the doctor must decide which specialist the patient should be referred to – a rheumatologist, a neurologist, or immediately to a neurosurgeon. And in some cases, surgical treatment will be the method of choice.That is why you should not postpone the visit to the doctor if you have back pain. While the patient is being treated himself, thinking where to go or rushing about private practicing doctors, the level and qualifications of which are unknown, precious time will be lost at best. Moreover, it is a sin to be honest, people who do not have proper education often pass themselves off as manual therapy doctors or osteopaths. Even a banal massage is often taken by people who do not even have a secondary medical education.

What treatment methods are considered the most justifiable today?

Sergey Kanaev: From the point of view of evidence-based medicine, now the only approach to the treatment of back pain is an interdisciplinary multimodal approach.There is no one method that can replace all the others. Treatment methods can be roughly divided into medication and non-medication. According to international reviews, physiotherapy exercises, manual therapy show effectiveness comparable to drug methods. And there are no significant advantages of one method over another. Therefore, one must also take into account the availability of a particular method, safety, as well as the patient’s adherence to one or another treatment.

Are the manual manipulation techniques themselves standardized, clinical guidelines developed? Or is it some kind of creativity every time?

Sergey Kanaev: These methods of exposure are strictly standardized, manual therapy doctors are taught the same way.But this can be compared to the fact that all housewives know how to cook borscht, but everyone cooks differently. The manipulations themselves are clearly described. But which of them and how to apply to a specific patient – this is the subject of medical experience, if you like – medical art. It is no longer possible to prescribe this by any standards or orders.

There are many centers in Moscow that provide such services. There are also doctors who claim to have developed their own method of treatment. Jalal Gadzhievich, you are using your own method – non-invasive repositioning of the vertebrae and joints.What is its essence?

Jalal Saidbegov: This technique is based on the approaches of the doctor Nikolai Andreevich Kasyan, a hereditary chiropractor. When manipulating the cervical spine, we use the technique of the Czech doctor Karel Levit. It seems to some that this is a very easy profession – I did three, four steps – and cured the patient. I’ve been doing this for 33 years. And every day I learn from every patient, I discover something new for myself. And it’s a very stressful job if you do it seriously.As for osteopaths, chiropractors – in my opinion, this is the problem of modern medicine. In the United States, to become an osteopath, you need to study at a university for five years. In Italy, and in Russia, these “specialists” often have no medical education at all.

Igor Dmitrievich, have you ever had any patients who had complications after manual manipulations?

Igor Stulin: I know of five cases with tetraparesis, that is, paralysis of all limbs. Only an emergency operation can help such people.

There is also such a pathology as spinal instability. Human anatomy is very different, the ligamentous apparatus too. And the vertebral artery is so peculiar that it can split. I would not recommend manual exposure to such patients.

Hanging on the horizontal bar from time to time is good for the health and flexibility of the spine. Photo: Danila Shostak / TASS

Can blood pressure rise after a course of massage?

Igor Stulin: Quite.The patient may have high blood pressure, some kind of pathology of internal organs, diabetes mellitus manifests itself very badly in this regard.

Sergei Kanaev: But again, this is not a problem of manual therapy as a method of treatment, but a problem of patient selection. The second problem is the choice of a doctor. It would never occur to anyone to go to an acquaintance to some miracle doctor who will perform a knee operation with a kitchen knife at home. But for some reason, going to a person who positions himself as a chiropractor, osteopath, massage therapist, but in fact is not, is quite often.Naturally, without the necessary examination and taking into account concomitant diseases, a person will receive the whole range of complications.

Most neurologists advocate conservative methods for the treatment of intervertebral disc herniation. And in what cases is a hernia surgery inevitable?

Jalal Saidbegov: Pain syndrome is not present in all hernias. About 25 percent of hernias, even of large sizes, the person himself does not even suspect. They are found by accident, performing an MRI for some reason.Conversely, it is not just hernia that can cause pain. Sometimes it is caused by an excessive amount of intra-articular fluid. Pain receptors can also be irritated by inflammation. But these conditions do not require surgery. Therefore, the selection for surgical treatment must be very careful.

Sergey Kanaev: The cause of back pain can be not only a lesion of the disc, often it is caused by ligaments and muscles.

In practice, neurosurgeons unjustifiably expand the pool of “their” patients, or, conversely, do not notice someone?

Sergey Trukhanov: There are some small studies on this topic.We often cite not very high numbers of positive and conditionally positive outcomes in those patients who were operated on. This is most likely due to the excessive expansion of the patient pool.

Igor Stulin: Herniated discs are found in almost every healthy person. A survey was carried out of 400 young doctors who are being trained to work on submarines. All of them had MRI scans, and 80 percent of them found this notorious hernia, which never showed up and will never show up.Nothing hurts the patient, and sometimes they say to him: we will remove this silent hernia, and you will have a guarantee that pain will not occur. But there is a good principle: the best surgery is the one you don’t need to do. Therefore, before deciding on an operation, you need to listen to the opinion of three different doctors, or even four.

Jalal Saidbegov: For many years I have been a member of Eurospine, the world’s most authoritative spine pathology association. At her congresses every year they say more and more often: it is necessary to operate less.

But at every congress there is an exhibition – new equipment, artificial discs, etc. The interests of manufacturing companies are behind all this.

D Please give your recommendations to those who have back problems.

Jalal Saidbegov: We need to analyze our lifestyle, pay special attention to children, especially when they go to school. There used to be Erisman’s desks in schools, which he invented back in 1870. There was a crossbar under the desk on which you could put your feet.In this case, the lower back is not strained. And if this support is not, then the load goes to the intervertebral discs. It would be worth returning to these desks, making them adapted to the child’s growth, adjusting them in height, providing a stand for a book, a tablet, etc. There would not be as many scoliosis in children as today.

This probably also applies to office workers sitting?

Sergey Kanaev: As soon as a person feels that he is uncomfortable, begins to experience a feeling of stiffness, constriction, he just has to get up, stretch, walk for a few minutes.

Jalal Saidbegov: I recommend hanging on the horizontal bar for a minute. And if there is no horizontal bar, but there are strong doors, then on them. Finally, you can simply stand at the table, lean on it with outstretched arms and lower abdomen, and hang, relax your lower back, count to ten. This gives good relaxation to the muscles of the entire back. And, of course, to do feasible physical education: walk more, swim, move.

Important

Contraindications to the use of manual influence on the spine:

– “cauda equina syndrome”;

– displacement of the spinal cord, structural changes in it;

– deterioration after long conservative treatment;.

– increased permeability of the vascular wall,

– infectious diseases,

– high blood pressure,

– violation of blood rheology;

– oncological processes in the central nervous system and in the vertebrae;

– acute injuries;

– osteoporosis.

octeoxondrosis, protrusion, hernia? How to treat?

08.01.2019

According to statistics, half of the world’s population has back problems and each of us at least once in our life has experienced all the delights of pain in the neck or lower back.Back pain has a wide variety of origins. One of the most insidious causes of spinal pain is a herniated disc. Severe pain is the first manifestation of a hernia, which makes a person begin to worry about their health. Pain can be constant or come on unexpectedly and inexplicably, for example, when sneezing or simple and habitual movement. About how to get rid of a hernia and become a healthy person, how to prevent serious consequences of the disease, about where the boundaries of conservative treatment are and when an operation is needed, we asked Vadim Anatolyevich Zotov, a neurosurgeon at the Reaviz Multidisciplinary Clinic.

What is a herniated disc and why does it appear?

– The herd of the intervertebral disc is an illness in which part of the disc is protruding into the spinal canal with compression of the spinal structures. The main reasons for the appearance of intervertebral hernias are: overweight and a sedentary lifestyle, excessive physical exertion, poor posture and past injuries of the spine. Even ordinary osteochondrosis increases the risk of herniated discs.There are factors associated with the characteristics of the profession. At risk are athletes, truck drivers, workers in production, whose activities are associated with prolonged vibration exposure.

How to notice the signs of a hernia in time? When should a person sound the alarm?

– The most common signs of a hernia include back pain, followed by leg pain, and lower back pain may decrease or disappear. The pain is relieved by flexing the leg at the hip or knee, and worse by maintaining any other position.People suffering from this disease are forced to change their position every 10-20 minutes. The pain increases with coughing, sneezing, or straining. Alert should be pain in the neck, passing into the arm, numbness and weakness in the arm, sharp dizziness when turning the head. An urgent visit to a doctor is necessary in case of disruption of the bladder, the appearance of progressive muscle weakness in the limbs.

Can conservative treatment help and how long does the effect last?

– Conservative treatment often relieves the exacerbation of the process, eliminates pain and allows a person to return to their usual way of life.But you can get a lasting long-term effect of treatment only by eliminating the causes of disc herniation. These include weight correction, prolonged physical education aimed at strengthening the muscle corset and eliminating instability of the spinal segment, and in the presence of concomitant diseases of the musculoskeletal system, wearing corrective insoles or other external stabilization devices.

What modern methods of treatment can you suggest if conservative treatment did not give the desired result?

-Very effective methods that complement the traditional conservative treatment are therapeutic and drug blockades, facetoplasty – the introduction of a synovial fluid prosthesis into the intervertebral joints.

Are there situations when a herniated disc needs to be operated on urgently? What are the indications for surgery?

-A large disc herniation that compresses several roots of the spinal cord can lead to the development of cauda equina syndrome. This condition includes urinary retention, perineal numbness, paralysis in the feet and is an indication for emergency surgery. The indications for elective surgery are the ineffectiveness of conservative treatment with persistence of pain for 5-8 weeks, a progressive decrease in strength in the leg.All this is determined individually in each case.

When is complete spinal disc replacement necessary? What is an endoprosthesis?

-Total disc removal is performed in case of severe instability of the vertebral segment, the formation of spondylolisthesis, that is, “sliding” of one vertebra relative to the other. Such an operation is necessarily complemented by one or another stabilization method. This can be the placement of pedicle screws or interspinous stabilization.In this case, the disc is replaced with a special implant – an endoprosthesis. A disc endoprosthesis is a mechanical movable device implanted into the intervertebral space, maintaining mobility in the segment. Currently, there are a large number of endoprostheses that significantly improve the outcome of the operation. These are prostheses of the disc, annulus fibrosus, prostheses of the vertebral bodies and intervertebral joints.

Can the operation ensure that the problem does not return?

– A good result of surgical treatment can be expected only under the condition of mutual efforts of the surgeon and the patient.After the operation, it is necessary to follow the doctor’s recommendations for a long time: as a rule, these are weight loss, exercise therapy and other rehabilitation measures. When these conditions are met, there are practically no relapses of the disease and after 4-5 days the patient will be able to return home. It depends on the severity of the initial condition and the extent of the operation performed.

Tell us about the possible complications of hernias, if they were not found in time or did not begin to deal with them?

– If the hernia is not eliminated, complications will soon appear.These include impaired control of urination and defecation, persistent paralysis of the lower extremities in the case of lumbar hernias, as well as complete paralysis in cervical hernias. Also, with hernias of the spine, instability of blood pressure, headaches, dizziness, pain in the heart caused by intercostal neuralgia, or dysfunction of internal organs, including genitals, often appear.

What advice would you give to people who have just started or have had symptoms of herniated discs for some time now? What diagnostic methods are used in this case?

First of all, you need to consult a neurosurgeon.For a more precise diagnosis and determination of treatment methods, possible indications for surgical treatment, the doctor will prescribe the necessary diagnostic tests. In the multidisciplinary clinic “Reaviz” you can undergo X-ray and computed tomography using the most modern equipment.

About the operation to remove the incisional hernia of the abdomen

This guide will help you prepare for your incisional abdominal hernia surgery at Memorial Sloan Kettering (MSK).It will also help you understand what to expect as you recover.

Read this manual at least once before your surgery and use it as a reference as you prepare for the day of your surgery.

Take this guide with you to all visits to MSK, including the day of your surgery. You and your healthcare team will guide you through your treatment.

to come back to the beginning

Operation Information

About hernias of the abdominal wall

The abdominal wall, made up of muscles, protects the organs located in the abdominal cavity (belly).

A hernia is a protrusion of an organ or adipose tissue through a weak spot in the muscles or connective tissue of the abdominal wall (see Figure 1).

Figure 1. Abdominal hernia

One of the types of hernias is a postoperative hernia. Such a hernia can form around an incision (surgical cut) in scar tissue after previous surgery (see Figure 2). This can happen after any surgery performed on the abdomen, from the sternum to the groin.

Figure 2. Postoperative abdominal hernia

If you have a postoperative hernia, you may notice a swelling or bulging under the skin at the site of the surgery. In addition, you may experience abdominal discomfort by lifting weights or bending over.

About hernia surgery

You will need to have surgery to repair the hernia. Such operations are of various types, including open surgery or laparoscopic surgery.Your surgeon will explain to you which type of hernia surgery is best for you.

Operation laparoscopy

During a laparoscopic operation, your surgeon will make several small incisions in your abdominal wall. The abdominal cavity will be inflated with air, allowing the surgeon to see your organs freely. Through one of the incisions, the surgeon will insert a thin, illuminated endoscope called a laparoscope. Through other incisions, he will insert instruments to repair the hernia.

Open transaction

For open surgery, your surgeon will make an incision that is large enough to remove the scar tissue and fat from the abdominal wall near the hernia. It can also strengthen the weakened abdominal wall with a special mesh. This mesh will be secured from the inside of the abdominal wall under an opening or weakened area. Over time, the mesh grows into the inner lining of the abdominal cavity.

The operation will take about 3 hours.

to come back to the beginning

Before operation

The information in this section will help you prepare for your surgery.Read this section after you have assigned your surgery and refer to it as the date of your surgery approaches. It contains important information about what you need to do before your surgery.

Write down any questions you have and be sure to ask your healthcare provider.

Preparation for operation

You and your healthcare team will prepare for your surgery together. Help us make your transaction as safe as possible by telling us if any of the statements below match your situation, even if you’re not entirely sure.

• I am taking blood thinning medication. These drugs include aspirin, heparin, warfarin (Jantoven ^® , Coumadin ^® ), clopidogrel (Plavix ^® ), enoxaparin (Lovenox ^® ), dabigatran (Pradaxa ^{® 90aban62 (Eliquis)} ) and rivaroxaban (Xarelto ^® ). There are other similar medications, so be sure to tell your healthcare provider about any medications you are taking.
• I take prescription drugs (prescribed by a healthcare professional), including patches and ointments.
• I take over-the-counter medicines (which I buy without a prescription), including patches and ointments.
• I take nutritional supplements such as herbs, vitamins, minerals, and natural or home remedies.
• I have a pacemaker, automatic implantable cardioverter defibrillator (AICD), or other cardiac pacemaker.
• I have sleep apnea.
• I used to have problems with anesthesia (when a drug is administered that makes the patient fall asleep during the operation).
• I am allergic to some drugs or materials such as latex.
• I don’t want to have a blood transfusion.
• I drink alcohol.
• I smoke.
• I am taking soft drugs.

Alcohol use

The amount of alcohol you drink may affect your condition during and after surgery. It is very important to tell healthcare providers how much alcohol you are drinking. This will help us plan your treatment.

• If you stop drinking abruptly, it can cause seizures, alcoholic delirium and death.
  If we know that you are at risk for these complications, we can prescribe medications for you to avoid them.
• If you drink alcohol regularly, there is a risk of other complications during and after surgery. These include bleeding, infections, heart problems, and longer hospital care.

To prevent possible problems, before the operation, you can:

• Tell healthcare providers honestly how much alcohol you drink.
• After the appointment of the operation, try to stop drinking alcoholic beverages. If, after stopping alcoholic beverages, you experience headaches, nausea (vomiting sensation), increased anxiety, or have trouble sleeping, tell your healthcare provider right away.These are early signs of alcohol withdrawal that can be treated.
• Tell your healthcare provider if you are unable to stop drinking.
• Ask your healthcare provider questions about how drinking alcohol might affect your body in connection with surgery. As always, we will ensure the confidentiality of all your medical information.

About smoking

During surgery, smokers may experience breathing problems.Quitting smoking even a few days before surgery will help prevent these problems. If you smoke, your healthcare provider will refer you to our Tobacco Treatment Program. You can also contact this program by calling 212-610-0507.

Sleep Apnea Information

Sleep apnea is a common breathing disorder that causes a person to stop breathing for a short period during sleep.The most common type is obstructive sleep apnea (OSA). In OSA, the airway is completely blocked during sleep. OSA can cause serious complications during and after surgery.

Let us know if you have sleep apnea attacks, or if you suspect you may have such attacks. If you are using a breathing apparatus (such as a CPAP machine) to prevent sleep apnea, take it with you on the day of surgery.

Within 30 days prior to surgery

Preoperative study

Before your surgery, you will be assigned a presurgical testing (PST). The date, time and location of the preoperative examination will be indicated in the reminder you will receive at the surgeon’s office.

On the day of your scheduled preoperative examination, you can take your food and medication as usual.

During your visit, you will meet a highly qualified nurse who works with anesthesiologists (medical personnel with specialized training who will administer anesthesia during surgery).A senior nurse / nurse will review your medical record and your surgical history with you. You will need to undergo a number of tests, including an electrocardiogram (EKG) to check your heart rate, chest x-rays, blood tests, and other tests needed to plan your treatment. In addition, a trained nurse can refer you to other specialists.

The Nurse will also advise you on what medications you will need to take on the morning of your surgery.

You will help us a lot if you take with you to the preoperative examination:

• A list of all the medicines you take, including prescription and over-the-counter medicines, patches, and creams;
• Results of any tests you did outside of MSK, such as exercise ECG, echocardiogram, or carotid Doppler

90,043 names and phone numbers of the medical staff treating you.

Determine who will care for you

Your caregiver plays an important role in your treatment.Before your surgery, your healthcare team will tell you and your caregiver about the surgery. In addition, the person will need to take you home after your surgery and discharge from the hospital. Also, this person will help you at home.

Information for caregivers

Existing materials and support are available to help you meet the many responsibilities that come with caring for someone undergoing cancer treatment. For support resources and information, visit www.mskcc.org/caregivers or read the resource Guide for Caregivers
…

Complete the Health Care Proxy Form

If you have not yet completed the Health Care Proxy, we recommend that you do so now. If you have already completed this form, or have other advance directives, please bring them with you to your next visit.

The Power of Attorney for Health Care Decisions is a legal document that specifies the person who will represent you in the event that you are unable to do so on your own.The person listed there will be your health care agent.

Talk to your healthcare provider if you are interested in completing a Health Care Proxy. You can also read the resources Advance Care Planning and How to Be a Care Representative for information about health care proxies, other advance directives, and acting as a care agent.

Perform breathing exercises and exercises that stimulate coughing

Take deep breaths and clear your throat before surgery. Your healthcare provider will give you a stimulation spirometer to help expand your lungs. For more information, see the resource How to use your incentive spirometer. If you have any questions, ask your healthcare provider.

Stick to a healthy diet

Aim to eat a well-balanced, healthy diet prior to surgery.If you need help with diet planning, ask your healthcare provider to refer you to a dietitian nutritionist.

Buy a 4% chlorhexidine gluconate (CHG) antiseptic cleanser (such as Hibiclens®).

4% CHG solution is a skin cleanser that kills various microorganisms and prevents their appearance within 24 hours after use. Showering with this solution before surgery will reduce your risk of infection after surgery.You can purchase a 4% CHG antiseptic skin cleanser at your local pharmacy without a prescription.

7 days before surgery

Follow your healthcare provider’s instructions when taking aspirin

If you are taking aspirin and any medicines containing aspirin, you may need to change your dose or not take them for 7 days before your surgery. Aspirin can cause bleeding.

Follow your healthcare provider’s instructions. Do not stop taking aspirin unless directed to do so. Read the resource Common Medicines Containing Aspirin and Other Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) for more information.
…

Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements

Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements 7 days before surgery.These medicines can cause bleeding. For more information, read the resource Herbal Remedies and Cancer Treatments.

2 days before surgery

Stop taking nonsteroidal anti-inflammatory drugs [NSAIDs].

Stop taking NSAIDs such as ibuprofen (Advil ^® , Motrin ^® ) and naproxen (Aleve ^® ) 2 days before surgery. These medicines can cause bleeding.For more information, read the resource Common Medicines Containing Aspirin and Other Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
…

1 day before surgery

Follow a clear liquid diet

You will need to follow a clear liquid diet the day before your surgery. The clear liquid diet is all about clear liquids. Examples are shown in the Healthy Diet Table.

Following this diet:

• Do not eat any solid food.
• Aim to drink at least 1 glass (8 oz. Or 240 ml) of clear liquid every hour while you are awake.
• Drink a variety of clear liquids, not just water, coffee and tea.
• Do not drink sweetened fluids unless you have diabetes and are instructed to do so by a healthcare team member.

Diabetes

If you have diabetes, talk with your healthcare provider about what you should do when you are on a clear liquid diet.

• If you are taking insulin or other diabetes medications, please ask if you need to change the dosage.
• Ask if you should consume sugar-free clear liquids.

Check your blood sugar frequently while you are following a clear liquid diet. If you have any questions, ask your healthcare provider.

Initiate bowel preparation as needed

If your surgeon or nurse tells you that you need bowel preparation for your surgery, you need to start it 1 day before your surgery.During Bowel Preparation:

• Do not eat solid food.
• Drink plenty of liquids other than water, black coffee, and tea. Try to drink at least 1 glass (8 oz. (240 ml)) every hour while you are awake.

Drink magnesium citrate at 2:00 pm the day before your surgery.

Record the time at which the operation is scheduled

An admissions officer will call you after 2:00 pm the day before your surgery.If your surgery is scheduled for a Monday, you will receive a call the previous Friday. If no one contacts you by 19:00, please call 212-639-5014.

A staff member will tell you when you should come to the hospital for your surgery. You will also be reminded how to get to the ward.

The operation will be performed at one of the following addresses:

• Come to the Presurgical Center,
  ^{located at 1275 York Avenue (between East 67 th Street and East 68 th Street),
  New York, NY 10065
  2nd Floor , lift M.}
• Come to the Presurgical Center,
  ^{located at 1275 York Avenue (between East 67 th Street and East 68 th Street),
  New York, NY 10065
  6- th floor, lift M.}

Shower with a 4% CHG antiseptic cleanser (e.g. Hibiclens®)

The evening before the day of surgery, shower with a 4% CHG antiseptic cleanser.

1. Shampoo your hair with a regular shampoo. Rinse your hair thoroughly.
2. Wash your face and genital area with your usual soap. Rinse your body thoroughly with warm water.
3. Open the 4% CHG solution. Pour a small amount into your hand or onto a clean washcloth.
4. Move away from the water jet. Massage the 4% CHG solution lightly into the body from neck to feet. Do not apply it to your face or genital area.
5. Return under running water and rinse with 4% CHG solution.Use warm water.
6. After showering, dry yourself with a clean towel.
7. Do not apply any lotion, cream, deodorant, makeup, powder, perfume or cologne after a shower.

Sleep

Go to bed early and try to get a good night’s sleep.

Instructions for eating before surgery

Do not eat after midnight before your surgery. This also applies to candy and chewing gum.

Morning before surgery

Instructions for drinking drinks before surgery

You may drink a maximum of 12 ounces (350 ml) of water between midnight and 2 hours prior to arrival at the hospital.Don’t drink anything else.

Do not drink any liquid two hours before your scheduled arrival time at the hospital. This also applies to water.

Take medication as directed

If your healthcare provider tells you to take some medicines in the morning before your surgery, take only those medicines with a small sip of water. Depending on the medications, this may be all or some of the medications you usually take in the morning, or you may not need to take them at all.

Shower with a 4% CHG antiseptic cleanser (such as Hibiclens®)

Shower with 4% CHG antiseptic skin cleanser before leaving the hospital. Use the same product you used the night before.

Do not apply any lotion, cream, deodorant, makeup, powder, perfume or cologne after a shower.

Points to Remember

• Wear comfortable, loose clothing.
• If you wear contact lenses, remove them and put on your glasses. During surgery, contact lenses can injure your eyes.
• Do not wear metal objects. Remove all jewelry, including body piercings. The equipment used during the operation may cause burns if it comes into contact with metal.
• Do not use any lotion, cream, deodorant, makeup, powder, perfume, or cologne.
• Leave valuables at home (such as credit cards, jewelry, and a checkbook).
• If your period (period) starts, use a sanitary towel, not a tampon. You will be given disposable underwear and a pad if needed.

What to take with you

• Your own breathing apparatus for the prevention of sleep apnea (eg CPAP apparatus), if available.
• An emergency inhaler (eg albuterol for asthma), if you are using it.
• Incentive spirometer, if you have one.
• A Health Care Proxy Form, if you have completed it.
• Mobile phone and charger.
• A small amount of money that you may need for small purchases (for example, to buy a newspaper).
• A bag for storing personal items (such as glasses, hearing aids, dentures, dentures, wig, and religious items), if you have them.
• List of medicines you are taking.
• These are recommendations.Using these guidelines, your healthcare team will guide you on how to take care of yourself after your surgery.

Where to park

MSK Garage is located at East 66 ^th Street between York Avenue and First Avenue. For parking prices, call 212-639-2338.

To enter the garage, turn East 66 ^th Street from York Avenue. The garage is located approximately a quarter block from York Avenue, on the right (north) side of the street.A pedestrian tunnel leads from the garage to the hospital.

There are other garages located at East 69 ^th Street between First Avenue and Second Avenue, East 67 ^th Street between York Avenue and First Avenue, and East 65 ^th Street between First Avenue and Second Avenue.

Upon arrival at the hospital

You will be asked to state and spell your first and last name several times, as well as indicate your date of birth. This is for your safety.People with the same or similar names can be operated on on the same day.

Change for operation

When it’s time to change for your surgery, you will be given a hospital gown, gown, and non-slip socks.

Nurse meeting

You will meet with the nurse before your surgery. Tell her / him the doses of all medications you took after midnight and when you took them (including all prescription and over-the-counter medications, patches, creams, and ointments).

The nurse may place an intravenous (IV) line into one of the veins, usually in the arm or hand. If the nurse does not give you an IV, your anesthesiologist will do it when you are in the operating room.

Meeting with anesthesiologist

You will also meet with your anesthesiologist before your surgery. This specialist:

• will review the medical record with you;
• asks if you have had any problems with anesthesia in the past, including nausea or pain.
• will talk about your comfort and safety during the operation;
• will tell you about the type of anesthesia you will receive;
• will answer your questions about anesthesia.

Preparation for operation

Before surgery, you will need to remove your hearing aid, dentures, dentures, wig, and religious paraphernalia (if you have any of the above).

You will go to the operating room yourself, or you will be taken there on a gurney. A representative of the operating team will help you lie down on the operating table. Special compression boots will be worn on the bottom of your feet. They will inflate and deflate smoothly to improve blood flow in your legs.

When you are comfortable on the table, the anesthesiologist will administer anesthesia through an IV line and you will fall asleep. Your IV line will also give you fluids during and after your surgery.

During operation

When you fall asleep, a breathing tube will be inserted through your mouth into your windpipe to help you breathe. You will also have a urinary catheter (Foley) placed to drain urine from your bladder.

After surgery is complete, surgical staples or stitches will be placed on your incision.In addition, Steri-Strips ^™ (thin strips of surgical tape) will be applied to your incisions. The incision site may be covered with a bandage. The breathing tube is usually removed while you are still in the operating room.

to come back to the beginning

After operation

The information in this section will let you know what to expect after surgery, while you are in the hospital, and when you leave home. You will learn how to safely recover from surgery.

Write down any questions you have and be sure to ask your healthcare provider.

What to expect on the day of your procedure

After your surgery, you will wake up in the Post Anesthesia Care Unit (PACU).

You will receive oxygen through a thin tube under your nose called a nasal cannula. The nurse will monitor your body temperature, heart rate, blood pressure, and oxygen levels.

A Foley catheter will be inserted into your bladder to track the amount of urine you are making. In most cases, it is removed 2 days after surgery. In addition, compression boots will be worn on the shins. When you can walk, they will be removed.

You may also be fitted with a Jackson-Pratt ^® drain (JP drain). This drain is used to collect excess fluid, which helps reduce the risk of infection and promotes healing. In most cases, the drain is removed after a few days.If the drain remains with you after discharge, your nurse will teach you how to care for it.

If needed, you will be given medication for pain relief and general comfort. These drugs can be administered in a variety of ways.

• Epidural catheter. For some people, pain medication may be given through an epidural catheter in the spine. This can be a patient-controlled analgesia (PCA) machine. The analgesic machine uses a computerized pump to inject pain medication into a vein.For more information, read the resource Patient-Controlled Analgesia (PCA).
• Nerve block. Some patients may have a nerve block procedure before or during surgery.
  During this procedure, the doctor injects the medication into a specific nerve to relieve pain after surgery.
• Intravenous drugs. For some people, pain medication may be injected directly into a vein through an IV line.
• Oral medicines. In some cases, oral pain relievers (medicines taken by mouth, such as tablets) are used.

After your surgery, you may be given medication in one of these ways, or several methods may be given at once. They are all effective pain relief methods, and your doctor will discuss them with you before choosing the option or options that work best for you.

After your stay in this wake-up room, one of the staff will transfer you to the hospital room.Shortly after you are brought into the room, you will be helped out of bed and into a chair.

A nurse will tell you how to recover from surgery. Below are some guidelines to help make this process safer.

• It is very important that you walk after the operation. It would be nice to set yourself the task of walking every 2 hours. This will help prevent blood clots in your legs.
• Use an incentive spirometer.This will help expand the lungs, which will prevent pneumonia from developing. For more information, read the resource How to Use Your Incentive Spirometer.

Frequently Asked Questions

Will I have pain after surgery?

After surgery, you will experience some pain at the incision sites. The doctor and nurse will regularly ask you about your pain. If necessary, you will be given medication to relieve pain.If pain persists, tell your doctor or nurse. Pain relief is imperative so that you can cough up, breathe deeply, use an incentive spirometer, and get out of bed and walk.

Will I be able to eat?

The day after the operation, you will be able to dissolve the ice chips. After that, you can start drinking the clear liquids in small sips. As you recover, you will gradually return to your normal diet.

How long will I stay in the hospital?

In most cases, patients are hospitalized within 2 days after laparoscopic surgery and within 5 days after open surgery, but this will depend on the operation that was performed.

Will I feel pain when I get home?

The duration of the presence of pain and discomfort is different for each person. You may feel pain when you return home, and you may be taking pain medication.Follow the guidelines below:

• Take your medicine as directed and as needed.
• Call your doctor if the prescribed medication does not relieve pain.
• Do not drive or drink alcohol while you are taking prescription pain medication.
• As the incision heals, the pain will decrease and you will need less pain medication. Mild pain relievers such as acetaminophen (Tylenol) or ibuprofen (Advil) can help relieve pain and discomfort.However, taking large amounts of acetaminophen can damage the liver. Do not take more acetaminophen than what is listed on the bottle, or as directed by your doctor or nurse.
• Pain medications should help you get back to your normal routine. Take enough medication so you can exercise comfortably. Pain medications are most effective 30 to 45 minutes after you take them.Keep track of the timing of your pain medication. It is better to take the medicine when the pain first appears and not wait for it to intensify.

Pain medications may cause constipation (less frequent bowel movements than usual).

How can I prevent constipation?

• Go to the toilet at the same time every day. Your body will get used to emptying your bowels during this time.
• If you feel like using the toilet, don’t put it off.Try going to the bathroom 5-15 minutes after meals.
• We recommend emptying your bowels after breakfast. During this time, reflexes in the large intestine are strongest.
• Exercise if you can. Hiking is great exercise.
• If you can, drink 8 glasses (8 ounces (240 ml) each, 2 L total) of liquid daily. Drink water, juices, soups, milkshakes, and other decaffeinated drinks. Caffeinated beverages, such as coffee and soda, flush fluid from the body.
• Gradually increase your dietary fiber content to 25-35 grams per day. Fiber is found in fruits, vegetables, whole grains, and cereals. If you have a stoma or recently had bowel surgery, check with your doctor or nurse before making any dietary changes.
• Prescription and non-prescription drugs are used to treat constipation. Start with one of the following over-the-counter medicines:
  • Polyethylene glycol (MiraLAX ^® ) 17 grams daily.
  • Senna (Senokot ^® ), 2 tablets at bedtime. It is a stimulant laxative that can cause cramping. If you haven’t had a bowel movement in 2 days, call your doctor or nurse.

How do I care for my incision?

The location of the incision will depend on the type of surgery performed. If the skin under the incision is numb, this is normal, because some of the nerve endings were cut off during the operation. After a while, the numbness will disappear.

• By the time you are discharged from the hospital, your surgical incision will begin to heal.
• Work with your nurse / nurse to examine your incision before discharge to see what it looks like.
• If there is discharge from the incision, record the amount and color. Call your doctor’s office and talk to your nurse about incision discharge.

The nurse will talk with you about the signs of an infection.

If a bandage is applied to the incision at discharge, change it at least once a week, or more often if it gets wet from discharge.If the cut has stopped flowing, you can leave it open.

If Steri-Strips are applied to your incision at discharge, they will come off and fall off on their own. If they do not fall off after 10 days, you can take them off.

If glue is applied to the stitches during discharge, it will also come off and peel off by itself, like Steri-Strips.

Is it normal to feel tired after surgery?

Yes, feeling tired (weak) is common after surgery and can last from 6 to 8 weeks.Over time, the weakness will gradually disappear. Try to increase your activity level daily to help overcome weakness. Get out of bed, get dressed, and walk. You may need to sleep during the day, but try to stay awake for as long as possible so that you will sleep well at night.

How will my diet change after surgery?

After surgery, you may experience loss of appetite and quick satiety after eating. These phenomena are expected and should disappear over time.Try to eat your favorite foods in small portions throughout the day. It is very important to get enough calories and protein to prevent weight loss and speed up your recovery.

Can I take a shower?

Yes, you can shower after you return home. A warm shower relaxes and helps relieve muscle pain. When showering, use soap and gently wash your incision. After showering, pat dry these areas with a towel and do not bandage the incision (if there is no discharge).Call your doctor if you notice redness or discharge from your incision.

Do not take a bath until you discuss it with your doctor at your first visit after surgery.

When is it safe for me to drive?

You must not drive while taking pain medication. Talk to your doctor about when you can drive again.

What exercises can I do?

Exercise will help you gain strength and improve your well-being.Hiking is great exercise. Gradually increase the walking distance. Check with your doctor or nurse before proceeding to more vigorous exercise.

When can I lift weights?

Consult your doctor before lifting weights. In most cases, you should not lift anything heavier than 10 pounds (4.5 kg) for at least 6 weeks. Ask your doctor how long you should refrain from lifting weights.

When will my first visit to the doctor after surgery take place?

Your first postoperative visit is usually scheduled 1–2 weeks after you leave the hospital.
The nurse will give you directions on how to make an appointment, including the phone number to call.

How can I deal with my feelings?

After surgery due to a serious illness, you may experience a new feeling of depression. Many people say that at some point they felt like crying, had to experience sadness, anxiety, nervousness, irritation and anger.You may find that you are unable to contain some of these feelings. If this happens, try to find emotional support.

The first step on this journey is to share your feelings. Friends and loved ones can help you. A nurse, doctor, and social worker can give you comfort and support and advice. Be sure to tell these professionals about your emotional state and about the emotional state of your friends and loved ones. Numerous materials are available for patients and their families.Whether you are in the hospital or at home, nurses, doctors, and social workers are ready to help you, your friends, and loved ones cope with the emotional aspects of illness.

What if I have other questions?

If you have any questions or concerns, talk to your doctor or nurse. You can reach them Monday through Friday, 9:00 am to 5:00 pm.

After 5:00 pm and on weekends and holidays, call 212-639-2000 and ask the doctor who is on duty in your place.

to come back to the beginning

When to contact your healthcare provider

Tell your healthcare provider if you have:

• Temperature 101 ° F (38.3 ° C) or higher
• redness or discharge from the incision;
• pain has arisen or has increased sharply;

90,043 nausea and vomiting;

• diarrhea (loose or watery stools).
• Constipation
• have problems or issues with the use of JP drainage;
• a new or unusual symptom has appeared;
• have any questions or concerns.

to come back to the beginning

Support services

This section provides a list of support services that can help you prepare for and recover from surgery.

Write down any questions you have and be sure to ask your healthcare provider.

MSK Support Services

Admitting Office
212-639-7606
Call if you have questions about hospitalization, including requesting a single room.

Anesthesia Department
212-639-6840
Call if you have questions about anesthesia.

Blood Donor Room
212-639-7643
Call for more information if you would like to become a blood or platelet donor.

Bobst International Center
888-675-7722
MSK accepts patients from all over the world. If you are from another country, call for help arranging your treatment.

Chaplaincy Service
212-639-5982
At MSK, chaplains are ready to listen, support family members, pray, reach out to local clergy or religious groups, or simply provide comfort and a hand of spiritual help. Anyone can apply for spiritual support, regardless of their formal religious affiliation. The Interfaith Chapel is located next to Memorial Hospital’s main lobby and is open 24 hours a day.If you have an emergency, call the hospital operator and ask to speak to the duty chaplain.

Counseling Center
646-888-0200
Psychological counseling helps many people. We provide counseling for individuals, couples, families and groups of individuals, and we provide medications to help you cope with anxiety or depression. To make an appointment, ask your healthcare provider for a referral or call the phone number above.

Food Pantry Program
646-888-8055
The Food Pantry Program provides food to low-income patients during cancer treatment. For more information, contact your healthcare provider or call the phone number above.

Integrative Medicine Service
646-888-0800
The Integrative Medicine Service offers a variety of services to complement traditional health care.These services include music therapy, mind / body therapy, dance and movement therapy, yoga and tactile therapy.

MSK Library
library.mskcc.org
212-639-7439
You can visit our library website or contact library staff for more information on a particular type of cancer. Alternatively, you can check out the LibGuides section on the MSK library website at libguides.mskcc.org.

Patient and caregiver education
www.mskcc.org/pe
Visit our patient and caregiver education website to look for educational materials in our virtual library. You can find learning resources, videos, and online programs.

Patient and Caregiver Peer Support Program
212-639-5007
You may be encouraged to talk to someone who has received treatment like yours. Through our Patient and Caregiver Peer Support Program, you can talk to a former MSK patient or caregiver.Such conversations are confidential. You can communicate in person or by phone.

Patient Billing
646-227-3378
Call if you have questions about preauthorization with your insurance company. This is also called preapproval.

Patient Representative Office
212-639-7202
Call if you have questions about a health care power of attorney or concern about your care.

Perioperative Nurse Liaison
212-639-5935
Call if you have questions about who MSK will share your information with during surgery.

Private Duty Nursing Office
212-639-6892
You can request the assistance of a Private Duty Nursing Office or Companions. Call for more information.

Resources for Life After Cancer [RLAC] Program
646-888-8106
At MSK, patient care does not end after active treatment is completed. The Resources for Life After Cancer (RLAC) program is designed for patients who have completed their treatment and for their families. This program offers a variety of services such as workshops, workshops, support groups, and post-treatment counseling.She also helps with health insurance and employment issues.

Sexual Health Programs
Cancer and cancer treatments can affect your sexual health. MSK’s Sexual Health Program can help you take action and address sexual health issues before, during, and after treatment.

• Our Women’s Sexual and Reproductive Medicine Program helps women with cancer-related sexual health problems, including premature menopause and decreased fertility.For more information and to make an appointment, call 646-888-5076.
• Our Sexual and Reproductive Medicine Program for Men helps men who have cancer-related sexual health problems, including erectile dysfunction. For more information and to make an appointment, call 646-888-6024.

Social Work
212-639-7020
Social workers help patients, their families and friends cope with the challenges of cancer.They provide one-on-one counseling and support groups during your treatment and can help you connect with your children and other family members. Our social workers can also refer you to local agencies and programs, and provide information on additional financial resources, if you are eligible.

Tobacco Treatment Program
212-610-0507
If you want to quit smoking, MSK has specialists who can help.Call for more information.

Virtual Programs
www.mskcc.org/vp
MSK Virtual Programs offer online training and support for patients and their caregivers, even if you cannot come to MSK in person. Through interactive activities, you can learn more about your diagnosis and what to expect during treatment and how to prepare for the different stages of cancer treatment. Classes are held confidentially, free of charge and with the involvement of highly qualified medical professionals.If you would like to join the virtual training program, visit our website at www.mskcc.org/vp for more information.

For more information online, see the Cancer Types section of www.mskcc.org.

External support services

Access-A-Ride Organization
web.mta.info/nyct/paratran/guide.htm
877-337-2017
MTA New York offers co-op travel and escort services for people with disabilities who are not can take the bus or metro.

Air Charity Network
www.aircharitynetwork.org
877-621-7177
Provides travel to treatment centers.

American Cancer Society (ACS)
www.cancer.org
800-ACS-2345 (800-227-2345)
Offers a variety of information and services, including Hope Shelter ( Hope Lodge is a free stay for patients and their caregivers during cancer treatment.

Cancer and Careers Website
www.cancerandcareers.org
A resource for educational materials, tools and information on various activities for working people with cancer.

Cancer Organization Care
www.cancercare.org
800-813-4673
275 Seventh Avenue (between West 25 ^th Street and 26 ^th Street)
New York, NY 10001
Consulting, Groups support, educational workshops, publications and financial assistance.

Cancer Support Community
www.cancersupportcommunity.org
Provides support and educational materials for people facing cancer.

Caregiver Action Network
www.caregiveraction.org
800-896-3650
Provides educational materials and support for people caring for loved ones with a chronic illness or disability.

Organization Corporate Angel Network
www.corpangelnetwork.org
866-328-1313
Offers free travel for medical treatment around the country at the expense of seats on corporate flights.

Gilda’s Club
www.gildasclubnyc.org
212-647-9700
A place where men, women and children with cancer receive social and emotional support through communication, workshops, lectures and community events.

Good Days Organization
www.mygooddays.org
877-968-7233
Offers financial assistance to cover co-payments during treatment. Patients must have health insurance, they must meet a number of criteria, and they must be prescribed medications that are on the Good Days formulary.

Healthwell Foundation
www.healthwellfoundation.org
800-675-8416
Provides financial assistance to cover co-payments, health insurance premiums, and deductibles for certain drugs and treatments.

Joe’s House
www.joeshouse.org
877-563-7468
Provides cancer patients and their families with a list of places to stay near treatment centers.

LGBT Cancer Project
http://lgbtcancer.com/
Provides support and advocacy for the LGBT community, including online support groups and a database of LGBT tolerant clinical trials.

LIVESTRONG Fertility Organization
www.livestrong.org/we-can-help/fertility-services
855-744-7777
Provides information on fertility and support for cancer patients whose treatment involves fertility risks and cancer survivors.

Look Good Feel Better Program
www.lookgoodfeelbetter.org
800-395-LOOK (800-395-5665)
This program offers workshops to help you learn more positive perceive your appearance.For more information or to sign up for a workshop, call the above phone number or visit the program website.

National Cancer Institute
www.cancer.gov
800-4-CANCER (800-422-6237)

National Cancer Legal Services Network
www.nclsn.org
Free Cancer Legal Advocacy Program.

National LGBT Cancer Network
www.cancer-network.org
Provides educational materials, training courses, and advocacy for LGBT cancer survivors at risk.

Needy Meds Resource
www.needymeds.org
Provides a list of programs that support patients in obtaining generic and registered brand drugs.

Organization NYRx
www.nyrxplan.com
Provides prescription drug benefits to current and former NYS employees who meet certain eligibility requirements.

Partnership for Prescription Assistance
www.pparx.org
888-477-2669
Helps eligible patients who do not have prescription drug coverage get free or buy drugs them at a low cost.

Patient Access Network Foundation
www.panfoundation.org
866-316-7263
Provides co-pay assistance for insured patients.

Patient Advocate Foundation
www.patientadvocate.org
800-532-5274
Provides access to medical care, financial assistance, insurance assistance, job retention assistance and access to a national resource directory for people with insufficient health insurance.

Organization RxHope
www.rxhope.com
877-267-0517
Provides assistance with getting medicines that people may not have enough money to buy.

to come back to the beginning

Educational resources

This section provides a list of the training materials that have been referenced in this manual. These resources will help you prepare for your surgery and recover safely from it.

Write down any questions you have and be sure to ask your healthcare provider.

to come back to the beginning

90,000 Hernias – what causes them and how to treat them

Hernia – protrusion of the viscera together with the parietal leaf of the peritoneum through a defect in the muscle layer of the abdominal wall under the skin.

The disease can be classified according to its location. Hence the name of the hernia comes from: umbilical, inguinal, intervertebral, dorsal, lumbar, hernia of the white line of the abdomen, sub-umbilical.

There are also other forms of hernia, more rare – postoperative, lateral, sciatic, obturator, perineal, hernia of the xiphoid process of the sternum.

Reasons for the appearance of a hernia

There can be several reasons for this disease:

• weakening of the anterior abdominal wall that occurs during pregnancy, after childbirth in women or in people who are inactive;
• a sharp increase in pressure in the abdomen, for example, when a person lifts weights or strains while using the toilet;
• overweight;
• features in the structure of the body;
• Chronic cough or allergy accompanied by frequent cough.

Hernia can be caused by the person’s age, recent trauma or surgery that weaken the muscles. Of course, a hernia can also be hereditary, then varicose veins, scoliosis and even flat feet are the cause.

Hernia symptoms

The surest sign of the manifestation of the disease is unusual protrusions in the abdominal region. A bulge may appear in the groin, in the navel, or in the area of ​​a scar if you have recently had surgery.It all depends on the type of hernia.

But not only outwardly, one can suspect a disease, symptoms are also indicators such as pain in the abdomen and groin during prolonged standing, during physical exertion, when lifting weights. A person observes pain when sneezing, coughing, straining.

Umbilical hernia is most common in babies. Usually it passes by half a year, when the child begins to sit and actively move, thereby straining and strengthening the abdominal walls. But if it occurs in children much later, then you need to see a doctor.The disease can appear with frequent constipation, insufficient activity, or with persistent coughing. If a child complains of pain in the navel and he has protrusions in the same place in a standing position, then this is a sure sign of the appearance of an umbilical hernia. Also, the child may become lethargic, his appetite decreases and apathy occurs.

Inguinal hernia is more common in men and boys, especially in infancy. Symptoms are protrusions in the corresponding area, an increase in the scrotum, pain in the lower back, genitals, when urinating.

Herniated discs cause pain in the legs or spine after physical exertion, lifting weights, bending over or as a result of an uncomfortable position while sleeping or working. Protrusions appear in the side of the spinal cord or in the lower back.

Spinal hernia occurs in the lumbar region, neck and chest. Symptoms of this disease are pain in the corresponding area, weakness in the arms and legs, sensory disturbances.

With lumbar hernia, protrusions appear on the lateral or posterior surface of the abdomen.This type of disease can be found in a supine position on a sore side – protrusions are visible, but when a person turns over on a healthy side, it disappears.

A hernia of the white line of the abdomen is a disease in which preperitoneal fat passes through the cracks and openings. With such a hernia, a person may not complain of pain or have it in the epigastric region.

How to identify a hernia

Instrumental examination methods include a method such as diaphanoscopy, which is used to distinguish scrotal hernia from dropsy.It includes examining the scrotum area with a light element.

Physical examination methods: the doctor, after examining the protrusion, palpates it, determines its density, whether it fits into the cavity, and also notes the state of the natural canals and openings (whether they are expanded, for example, by inserting a fingertip into the inguinal canal, it is noted whether it is enlarged is he).

Another method of examination is ultrasound examination.

Treatment

Hernia is treated with two methods – conservative and operational.Conservative treatment includes:

• movement techniques, physiotherapy exercises;
• A manual technique that helps to change the tension of the muscles of the spine, is used in the case when a person has an intervertebral hernia;
• physiotherapy techniques – massage, reflexology, mechanical traction, magnetic and ultrasound treatment.

But all these methods are rarely used, very often they cannot save a person from a hernia, if only in isolated, unique cases.Conservative treatment is designed to reduce pain and reduce bulging. Most often, the surgical method of treatment is used – the removal of a hernia forever.

The operation to remove a hernia can be performed under local anesthesia, the procedure takes from 30 minutes to several hours, it all depends on the severity and type of the disease.

90,000 Osteochondrosis and hernia of the spine, treatment of osteochondrosis of the spine in Yekaterinburg, prices

Osteochondrosis is difficult to miss.If you have this not the most pleasant disease, you will surely feel all its main signs: pain that can be localized in the sacral, lumbar or cervical spine, between the shoulder blades or even in the sternum region. In some cases, unpleasant sensations can “shoot” in the limb. In this case, you should think about going to a specialist at the Spine Team medical center.

What is osteochondrosis, and why does it appear?

Our spine is made up of many vertebrae.Each of them, in turn, rests on 3 components of the inferior vertebra. One section is the intervertebral disc, the other two are the facet joints. Spinal osteochondrosis is a disease that is associated with damage to the intervertebral disc.

The causes of damage are associated with the structure of the human body and with a decrease in the physical activity of patients. A sedentary lifestyle, prolonged static loads, stressful situations and hypothermia, which cause overstrain of the muscles surrounding the spine, lead to weakness of the ligaments between the vertebrae, the elasticity of the annulus fibrosus decreases, and blood flow in the spinal structures deteriorates.These are all predisposing factors and cause disc degeneration (i.e., a decrease in the disc’s ability to retain water)

And now, when the “barrel” with the predisposing factors is overfilled, one awkward, sharp movement is enough, especially in an uncomfortable position, in a tilt, when lifting weights, and the following phenomenon occurs – the intervertebral disc begins to stretch the fibrous ring, tearing its fibers of connective tissue, trying to get out like a “cherry bone”, there is a protrusion (protrusion) of the disc.

Here the body turns on its defense mechanisms, namely, a pronounced muscle spasm occurs, which is accompanied by pain and restriction of movement in the spine, while, as a rule, it does not give pain to the limb.

For many people, the process ends at the protrusion stage, and does not develop further during life.

Possible complications

And it also happens that the disc completely breaks the annulus fibrosus, then a so-called spinal hernia is formed.In fact, this is an injury to the annulus fibrosus, its rupture. Then the situation is much more dangerous than with protrusion. Indeed, in the spinal canal, where the disc breaks through, there are many very important structures – these are nerves, and the spinal cord, and blood vessels. And then how lucky: either a herniated disc will compress one important structure, or several important structures. Sometimes a herniated disc does not harm the nervous and circulatory structures (in this case, we only randomly find it on MRI in a person who has not complained about anything).

Our body is trying to fight in this case too – it directs the mass of so-called killer cells to the hernia, trying to eliminate it, as a result a very dense edema forms around the hernia (it consists of these cells).Unfortunately, a hernia is often too tough for these cells. And inside the spinal canal there is a real “crush”, there is a hernia, and a mass of killer cells, and all this damages blood vessels, nerves, spinal cord.

This is where a person begins to experience real difficulties – this is pain, which is not only in the spine, but in the leg or arm (depending on the level at which this hernia has “crawled out”), this is also a restriction of movement, difficulty walking, a violation sleep at night due to back or leg pain. When the nerve is compressed, there may be “goosebumps”, numbness, brains in the arm or leg.All this is a manifestation of an intervertebral hernia.

Contact a specialist!

Our center has advanced experience in the treatment of intervertebral hernias. This becomes possible thanks not only to knowledge and understanding of the processes occurring in the body, but also with the presence of state-of-the-art equipment – this is a high-intensity laser (HIL-therapy), which removes edema in a hernia at a depth. It overcomes the skin barrier and muscles, therefore, eliminates muscle spasms at a depth, as well as areas of painful formations that form with a herniated disc.And much more. Only professionals using special protocols are able to achieve maximum results! We guarantee 87.4% efficiency.

There is also sequestration, hernia migration, but these are the subtleties and severity of the hernia itself. To correctly determine the level of its manifestation, you need to do an MRI. This is necessary for the doctor to determine the methodology and prognosis of treatment.

In addition to osteochondrosis in its various manifestations, we also work with various arthrosis, including uncovertebral, and other diseases.We offer medical and apparatus therapy at the best prices.

A feature of our work is a soft but high-quality impact on the problem. We try to solve your health issues as comfortably as possible for you, therefore, in the arsenal of “Spine Command” tools there are many non-surgical techniques that give excellent results! Call and sign up, we are waiting for you!

.