What is an Inguinal Hernia?
What is a hernia? A hernia is an outpouching of intestine from a weak abdominal wall. I explain to my patients that a piece of gut is sticking out. Some of you are born with (congenital) and some of you get later in life (acquired).
There are a few common hernias:
Umbilical hernias are at belly button.
Inguinal hernias are groin hernias. That is, with men, a piece the gut pushes down into the scrotal sac.
Quickcare or ER?
A hernia should be movable. That is, it should be able to go in and out of the abdominal wall.
When a hernia gets stuck, it means you need to go the ER.
Other Red flags include
If the hernia is movable and not bothersome, you can wait to see a doctor at a clinic for a surgery referral.
What should your doctor ask?
Your doctor will want to know your symptoms. Remember, a symptom is your description of your condition to your doctor. It is your story.
Answers to the following questions will help your doctor understand.
What makes it better?
Does it get bigger and smaller?
Are you able to push it back in?
What made it worse? Does standing up or heavy lifting make it stick out?
Why did you come in today? What changed?
Does the pain come and goes or is it constant?
Do you have anything associated with it such as fever or vomiting?
What will the doctor look for?
Your doctor will look for signs. Remember, a sign is an objective finding that a doctor finds on exam.
This is the sensitive part. Since we know the problem is “in the front”, we need to wonder if the penis or testicles are involved.
First, I just observe the mass. I want to see if I can distinguish between the mass and the genitals.
Second, a doctor will want to touch around the outside of it. The question is whether it is reducible (able to be pushed back in)
Lastly, (with a gloved hand), your doctor will want to push into the scrotum through the inguinal ring while the patient is standing. Cough! Coughing causes pressure which will push down the hernia. With the convenience and reliability of ultrasounds, it has been my experience that surgeons will ask for one before surgery.
What is the doctor thinking?
Your doctor will create a mental list of possible reasons for your signs and symptoms. This list is called a differential diagnosis.
Besides,”How can he live with that all these years?” the differential includes a hernia that is incarcerated (stuck) vs non-incarcerated (movable).
Also, it is important to know if the testicle is involved. Hence, an ultrasound is good diagnostic tool.
Sometimes a belly pain or nausea/vomiting are really pain in the genitals.
What is the connection? When a boy is developing in his mama, the testicles are in his belly. Later, they move into the scrotum via the inguinal canal. There is a natural path between the belly and the male genitals.
What is the treatment?
Hernia can be around for years. But BEWARE. When a hernia gets struck and is no longer moving in and out, then it is an EMERGENCY. This is a non-reducible hernia. Not good.
Hernia surgery repair is needed right away.
A hernia that is movable can be repaired on an elective basis.
How did your doctor treat your hernia?
How long will you be sick?
If you have a stuck hernia, you have to have a surgery. Now. This is not something that you wait on.
Then you have to have take it easy with no heavy lifting for 4-6 weeks as directed by the surgeon.
If the hernia is not stuck, then you still need surgery but it can be done electively Again, there will be period of up to 6-8 weeks of no heavy lifting or pushing/pulling.
Let me tell you a story
A truck driver named Billy Bob came to me the other day. “Doc, I got his ‘Thinga growing’ down there” Hmmm Thing growing down there. That can mean so many things. Was it a mass, a swelling or venereal disease? And when he said, “down there” is that the front (genitals) or back (anus)?
“Billy Bob, how long have you been carrying around this thing?”
“Doc, I never bothered it and it never bothered me.”
As for Billy Bob, his “thinga down there” was a constant painful, mass that gets worse with movement. No fever or vomiting.
Lo and behold, on exam, he had a large reducible right inguinal hernia like the one on the picture above. Billy Bob had an ultrasound.
After carrying the hernia around for years, he got it repaired since it was a “bother.”
He was back on the road
I hope this helps