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Monday, March 20, 2023


 Original Article

Inguinal hernia

In off-grid settings, the amount of physical exertion involved in activities of survival can be significant. Bending, lifting, and carrying heavy weights is part and parcel of the daily duties needed to stay alive. Our bodies have muscles and connective tissue to hold in internal organs in the face of pressure. When they fail, you can develop a hernia.

Hernias happen when part of an organ pushes through a defect or weakness in the wall that holds everything in place. Let’s take an analogy: imagine an old car tire with an area that has a weak wall of tread. If you put that area under enough internal pressure, the contained inner-tube will bulge out. That bulge is a hernia.

Hernias mostly occur in the torso between the chest and the hips. They can be caused by excessive lifting, obesity, aging, excessive coughing or straining on the toilet, or pregnancy. You might also just be born with a weakness in the abdominal wall.

Hernias may be broadly divided into two main groups: groin and abdominal. Each group contains multiple types:


Groin hernias include:

Blausen 0560 InguinalHerniaimage Bruce Blaus: staff (2014). “Medical gallery of Blausen Medical 2014

Inguinal Hernias: An inguinal hernia is the bulging out of a part, usually a section of bowel, through a defect in the abdomen near the groin. Inguinal hernias are, by far, the most common type; they comprise about 75-80 percent of hernias found in adults (seen more in men). We’ll discuss this type in more detail later.

Femoral Hernias: A femoral hernia occurs when part of the bowel protrudes into the groin at the top of the inner thigh. Known as the femoral area.


Abdominal hernias include:

Umbilical hernias: An umbilical hernia occurs when fatty tissues or part of the bowel protrudes through the abdomen near the belly button. This results in a pretty striking “outie” in some cases. Some people are born with this and may actually notice it improving on its own as they grow.

Epigastric hernias: This is a midline hernia that occurs when tissue protrudes out between the navel and the base of the  breastbone.

Incisional hernias: A hernia can occur as a complication of a surgical incision, known as an incisional hernia. It’s been reported that 15% of all abdominal surgeries end in an incisional hernia (honestly, I remember it happening maybe one or twice total in my entire career, maybe due to my working mostly in the pelvis.)

Hiatal hernias: Hiatal hernias are internal and not readily apparent on simple physical exam. In hiatal hernias, part of the stomach pushes into the chest cavity through a weakness in the breathing muscle known as the diaphragm. Hiatal hernias may be associated with heartburn and reflux in addition to abdominal pain, difficulty swallowing, and chest pain.


Since inguinal hernias are the most common (especially in men), it’s important for the family medic to recognize the signs and symptoms. They include:

-A bulge on either side of your pubic bone, which becomes more obvious when you’re upright, especially if you cough or strain. As part of a male’s typical physical exam for inguinal hernias, the doctor feels the area around the testicles and groin while the patient is asked to cough.

  • A burning or aching sensation at the bulge
  • Abdominal or groin pain
  • Heavy pressure sensations
  • Swelling in the area of the testicles if a part of the bowel descends into the scrotum.

Symptoms get worse when bending over, coughing, or lifting heavy objects.


Some hernias cause little discomfort, but others can become serious medical issues. A hernia that can’t be manually “reduced” by pushing in with a finger is thought to be “incarcerated.” If the incarceration is severe, it’s known as a  “strangulated hernia.”

Signs and symptoms of a strangulated hernia include:

•          Nausea and vomiting

•          Fever

•          Intense, sudden pain

•          A bulge that turns dark red or purple

•          An inability to pass gas or have bowel movements.

If a strangulated hernia isn’t dealt with, usually by surgical repair, pain worsens and an intestinal obstruction may occur.  The strangulated section of bowel may develop “gangrene,” the death of tissue due to loss of blood supply. In the past, death was a common end result.


Truss/binder for inguinal hernia support

A hernia usually doesn’t go away without surgical intervention, but non-surgical approaches do exist. Wearing a binder to  exert gentle pressure on the hernia helps keep it in place. Another item used for inguinal hernias is called a “truss.” A truss is an undergarment that keeps protruding tissue inside by applying pressure to the weakened abdominal wall.

Manual reduction (mentioned above) slowly applies pressure to the hernia to guide the portion of bowel back through the defect. Some believe that hernias may improve on their own by using cold packs, changing position, and muscle relaxation.


Surgical hernia mesh

The term “mesh” is used to describe a flat sheet Of, usually, plastic used as a patch on the hernia. If you look at it, you’d think “window screen.”

Years ago, hernia repairs were performed by simply suturing the hernia closed. This is still an option, but simple sutures can result in a recurrence of the problem later on in the 25 percent range or more. Using mesh, however, lowers the chance of hernia recurrence decreases to about 5 percent.

Having said that, complications related to the mesh do occur. It’s essentially a foreign body and has the potential to become contaminated and lead to infection. If placed inside the abdomen, mesh material can cause scar tissue called “adhesions.” Adhesions can lead to pain, and, if severe enough, bowel obstructions. Fortunately, the most problematic hernia mesh products are no longer on the market. Vaginal mesh used for incontinence issues still have a significant rate of complications, much more than when used for hernia repair.

Your chance to survive a major catastrophe isn’t good if you can’t bend, lift, or carry weight. If non-surgical interventions fail to relieve hernia symptoms, making use of high technology to resolve the problem surgically is probably the wisest move. Take advantage of it while it’s available while being aware of the risks.

Joe Alton MD

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