Hernia PDF

Hernia Definition of hernia: A hernia occurs when an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall. A hernia usually develops between your chest and hips. In many cases, it causes no or very few symptoms, although you may notice a swelling or lump in y...

Hernia Definition of hernia: A hernia occurs when an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall. A hernia usually develops between your chest and hips. In many cases, it causes no or very few symptoms, although you may notice a swelling or lump in your tummy (abdomen) or groin. The lump can often be pushed back in or disappears when you lie down. Coughing or straining may make the lump appear. Causes of hernia: Activities and medical problems that increase pressure on the abdominal wall can lead to a hernia. These include: straining on the toilet (due to long-term constipation, for example) persistent cough cystic fibrosis enlarged prostate straining to urinate being overweight or obese abdominal fluid lifting heavy items peritoneal dialysis poor nutrition smoking physical exertion undescended testicles  Types of hernia: Inguinal Hernias Sportsmans Hernias Femoral Hernias Incisional Hernias Umbilical Hernias Epigastric Hernias Spigelian Hernias Hiatal Hernias Inguinal Hernias: Inguinal hernias are located in the lower abdomen just above the leg crease, near or adjacent to the pubic area. They can sometimes occur on both sides of the pubic area, and if they do, they are called bilateral inguinal hernias. Inguinal hernias can be classified as “direct” or “indirect”: An indirect inguinal hernia occurs through the natural weakness in the internal inguinal ring. A direct inguinal hernia is a result of weakness in the floor of the inguinal canal and is more likely to develop in older men over the age of 40. Symptoms: The most common symptom to appear first is a small bulge in the groin. This bulge can be on one or both sides of the groin. It often goes away when lying down. Other symptoms may include: a swollen scrotum weakness, heaviness, or pain in the groin a burning or pinching sensation in the groin It is common for pain to improve with rest and get worse when lifting something heavy, coughing, or straining. Sportsman hernia: A Sportsmans Hernia is a condition of chronic exercise-related supra-inguinal groin pain. Symptoms are pain in the groin without any detectable swelling in the groin or any other explanation for the pain. Before chosing surgery for a sportsmans hernia, all non- operative possibilities should be attempted, including sufficient relief and rehabilitation of the most tender structures and muscles. Femoral Hernias: Femoral hernias, along with inguinal hernias are groin hernias. They are much more common in women but can occur in men. These hernias appear just below the groin crease. A weakness in the lower groin allows an intestinal sac to drop into the femoral canal, a space near the femoral vein that carries blood from the leg. These hernias are more prone than inguinal hernias to develop incarceration or strangulation as an early complication. Therefore, once these hernias are diagnosed, early repair is very strongly advised before such complications occur. Incisional Hernias A hernia that appears in the abdomen at the site of a previous surgery is known as an incisional hernia. These hernias can appear weeks, months, or even years after surgery and can vary in size from small to very large and complex. Umbilical Hernias Umbilical hernias occur near the bellybutton or navel, which has a natural weakness from the blood vessels of the umbilical cord. These hernias may occur in infants at or just after birth and may resolve by three or four years of age. However, the area of weakness can persist throughout life and can occur in men, women, and children at any time. In adults, umbilical hernias will not resolve and may progressively worsen over time. They are sometimes caused by abdominal pressure due to being overweight, excessive coughing, or pregnancy. Epigastric Hernias Epigastric hernias are more common in men than women. They occur due to a weakness, gap, or opening in the muscles or tendons of the upper abdominal wall, on a line between the breast bone and the navel or umbilicus. Spigelian Hernias A protrusion of intestine or an empty sac through a weakness between the muscle fibres of the abdominal wall, often on the right hand side of the abdomen. It develops between the muscles of the abdominal wall rather than protruding through layers of fat. This is quite a rare type of hernia which occurs in both male and females. It often develops in later life when the abdominal muscles have become weaker. Causes include sport (excessive twisting or turning), chronic coughing e.g. from smoking, being overweight or obese, straining during urination or defecation, lifting heavy objects, abdominal injury Hiatal Hernias Hiatal hernias are slightly different from other types of hernias because they are a weakness or opening in the diaphragm, which is the muscle that separates the chest cavity from the abdominal cavity. These hernias cause reflux of acid from the stomach into the oesophagus, which can lead to heartburn, pain, and erosion of the oesophagus. Surgery to repair this type of hernia is usually more complicated and may require a longer stay in hospital. Complications of hernia: Bowel Obstruction: After adhesions, abdominal wall hernias are the second leading cause of small bowel obstruction. Incarceration:Incarceration refers to an irreducible hernia and is diagnosed clinically when a hernia cannot be reduced or pushed back manually. Strangulation: Strangulation refers to ischemia caused by a compromised blood supply. How Is a Hernia Diagnosed? A physical exam by your health care provider is often enough to diagnose a hernia. Sometimes hernia swelling is visible when you stand upright; usually, the hernia can be felt if you place your hand directly over it and then bear down. Ultrasound may be used to see a femoral hernia, and abdominal X-rays may be ordered to determine if a bowel obstruction is present. Treatment of hernia: For a hernia without symptoms, the usual course of action is to watch and wait, but this can be risky for certain types of hernia, such as femoral hernias. Surgical Repair Procedures: Several different surgical procedures are used to repair abdominal wall hernias, ranging from open or laparoscopic suture repair to the use of mesh. To date, tension-free mesh repair has been accepted as the standard surgical technique for the majority of abdominal wall hernias, regardless of defect size, and is most commonly used. What can physiotherapy do to reduce symptoms and/or risk of hernia? The main goal of physiotherapy is to: Reduce pressure off the tissue (e.g. addressing poor breathing mechanics) Strengthen the supporting tissue (e.g. deep core strengthening) Apply compression support to assist Reduce aggravating activities and gradually re-introduce The rehabilitation period after an hernia surgery can include gentle stretching exercises, moving slowly to more demanding exercises if the patient feel ready and capable to do these exercises. The aim is to strengthen the core muscles located around abdominal area and lower back.