FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

READER'S HERNIA PROBABLY NEEDS SURGERY

Question: I developed a painful swelling in my scrotal region that my doctor diagnosed as an inguinal hernia. I don't remember doing any heavy lifting or other activity to cause it. How did I get a hernia without straining myself?

Answer: My American Heritage Dictionary defines a hernia as "the protrusion of an organ or other bodily structure through the wall that normally contains it; a rupture." The type of hernia you have is called an inguinal hernia because of its location in the "inguinal canal." This is a channel that allows the spermatic cord to pass from the testicles to inside the abdomen.

The muscles of the abdomen must have a small gap through which the spermatic cord passes. The most common type of hernia in men, and therefore the type you probably have, results from this gap being larger than it should be. This larger gap must withstand the pressures inside the abdomen produced by breathing, body movement, or straining such as occurs when trying to pass a bowel movement or lift a heavy object. When the hernia actually develops, the abdominal tissues give way and "balloon out" between the gap in the muscles. This creates the bulge or bump your doctor identified as your hernia. The extra-large gap between muscles is usually present from childhood, but it may take years as it did for you for sufficient stress to be placed on it to produce an identifiable hernia.

As the definition I used at the start of my explanation implies, hernias aren't limited to one area of the body. While men often get inguinal hernias, women more commonly have them down into the leg a condition called femoral hernia. Babies often have umbilical hernias, and elderly or very obese individuals often develop them along scars from previous abdominal surgery.

Question: My doctor wants me to see a surgeon to have my hernia fixed? Is surgery my only option?

Answer: The surgery, regardless of the type of hernia, is designed to repair the weakened wall in your case the abdominal wall. The discomfort from most hernias can be temporarily improved by providing support to the weakened area by a device called a truss. This is usually nothing more than a special belt that is used to hold a pad against the hernia. The pressure of the pad helps keep the hernia from bulging and causing pain.

The most sensible treatment for an inguinal hernia and, for that matter, any hernia, is surgery. The surgery is not particularly dangerous and is usually very effective. In cases where the muscles are very weakened or damaged, the surgeon may put a patch of synthetic material over the muscles to help reinforce the repair. More commonly though, it is only necessary to bring healthy muscles back together.

One of the most important parts of successful hernia repair is the period of recuperation. It is important to avoid putting excessive stress on the operation site until the muscles have had enough time to completely heal. This often makes it necessary to avoid heavy lifting and other strenuous work for six weeks. Six weeks is a long time, but it isn't very long compared to a lifetime without hernia pain.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.