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What is hernia?

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( Hernia Center of Southern California) : A hernia is a small sac containing tissue which protrudes through an opening in the muscles of the abdominal wall. This opening can be a result of a congenital flaw or the opening may be an acquired flaw due to sudden or even repeated stress or strain on the abdominal muscles. A hernia develops when the outer layers of the abdominal wall weaken, bulge or actually rip causing internal organs and tissue to push through the tear creating the typical "bulge" found with most hernia patients.

Any part of the abdominal wall can develop a hernia, however, the most common site is the groin area. With an inguinal hernia, the sac protrudes into the groin and sometimes the scrotum. Umbilical hernias occur through the naval, femoral hernias occur below the groin and incisional hernias occur through surgical scars. A hernia is reducible if the sac of the hernia can be pushed back into place inside the abdomen. Non-reducible, incarcerated, or imprisoned hernias cannot be replaced back in the abdomen.

Who gets hernias?

Approximately five million Americans suffer from hernias every year, according to the National Center for Health Statistics. Most adult hernias result from sudden or repeated strain or stress on the abdominal muscles. Some hernias are congenital. Types of activity typically associated with the appearance of a hernia include:

    • Lifting heavy objects
    • Sudden twists, pulls or muscle strain
    • Chronic straining with urination
    • Chronic constipation
    • Repeated coughing attacks

What are the symptoms of a hernia?

If you are afflicted by any one or more of the following symptoms, contact a doctor as soon as possible.

    • A noticeable bulge or swelling in the groin area
    • Groin pain
    • Nausea or vomiting
    • Constipation
    • Urinary difficulties

What are the different types of hernias?

Inguinal hernias occur in the groin, which is the area between your abdomen and thigh. As the most common type of hernia in adults, inguinal hernias are most common with men although they can also occur in women. With an inguinal hernia, the contents of the abdomen - namely the intestine - protrude through a weakness or tear in the abdominal wall muscle creating a visible bulge and sometimes pain. Pain caused by an inguinal hernia can be a constant, daily pain or may be sporadic, occurring once in a while. Inguinal hernias can also be bilateral, occurring on both sides of the abdomen instead of a single side.

Umbilical hernias occur in or around the naval, or umbilicus. This type of hernia may be due to congenital factors. Umbilical hernias may also result from sudden or repeated strain or stress on the abdominal muscles. In adults, as with any hernia, an umbilical hernia will not heal and go away but rather grows larger with time and often becomes problematic in that incarceration or strangulation can occur. With infants, however, an umbilical hernia may slowly close, delaying surgery until age 3 or 4 unless the hernia causes problems before then.

Incisional hernias can occur in the abdomen in the area of any prior surgical incision or scar. Hernias of this type are often accompanied by a swelling or bulge near the area of the prior incision, typically along straight incisional scars running down from the breastbone to the pubic area. Incisional hernias can be a result of 1) tension placed on the tissue from the prior surgical procedure, 2) disruption in the general area of prior suturing to the abdominal wall or 3) inadequate healing, which can be due to obesity, metabolic diseases, infection or poor nutrition. Since suturing (tension) can be the cause of some incisional hernias, it is highly advised that incisional hernias be repaired with the Tension Free Mesh technique to avoid future recurrence. Pain may be an early warning sign of an incisional hernia, as there may not be any initial presence of a bulge, though this type of hernia can develop soon after the original surgery or at any time thereafter.

Femoral hernias are almost exactly the same as inguinal hernias. The femoral hernia occurs when abdominal contents are forced through the "femoral canal". Typically, this type of hernia forms near the crease of leg in the abdominal region, but in an area relatively lower than the more common inguinal hernia. Females tend to have a slightly larger femoral canal because of the angle and shape of the pelvis, which is why they are more prone to these types of hernias as opposed to men, who tend to have slightly larger inguinal canals making them more susceptible to the inguinal hernia. The two types of hernias are often too difficult to tell apart in diagnosis, which is why a hernia specialist is often required to confirm diagnosis. Femoral hernias are more likely to become incarcerated or strangulated because of their location, which is why repair is strongly advised upon diagnosis of this type of hernia.

Epigastric hernias occur between the lower part of the breastbone and the naval and is caused by a weakness or opening in the fibrous tissue of the abdomen. This type of hernia usually consists of fatty tissue and rarely contains intestinal tissue. Although generally small in size (no bigger than a golf ball), epigastric hernias can easily become pinched in their small area, sometimes causing a great deal of pain.

Will my hernia go away?

Although a hernia may not worsen for months or even years, an untreated hernia WILL NOT get better on its own. Hernias which are reducible, are not generally an urgent danger to your health, though they can be painful. A non-reducible hernia can become life-threatening if any part of the intestine becomes trapped or strangulated in the opening or weakness and then requires emergency surgery.

What about complex hernias?

Our state-of-the-art Tension Free Mesh technique is successful at repairing large, recurrent and complex hernias, although some of these types of hernias may require general anesthesia in order to be repaired effectively. However, even if the hernia is large or complex, most inguinal, umbilical and many incisional hernias can be repaired with local anesthesia with sedation.

What is the recovery time?

Rapid recovery after surgery is dependent on the location of the hernia, the type of hernia, the repair technique used as well as your individual, physical health. With the advanced surgical techniques used at the Hernia Center of Southern California, our patients experience considerably less post-operative pain, have fewer restrictions after surgery and recover rapidly. We typically see our patients return to everyday activities within DAYS of surgery and can return to work and back to recreational and sport activities within two weeks.
NOTE: Recovery following incisional and/or more complex hernias may be slightly longer to some extent depending on the involvedness and type of the hernia and the general heath of the patient.

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When can I return to work?

After hernia repair surgery at the Hernia Center of Southern California you will be able to rapidly return to normal, daily activities as well as work and athletic activities. We use a "tension free" repair that results in minimal post operative pain.

This is a guide to assist you in determining when you can be expected to return to work after hernia surgery. At the Hernia Center of Southern California you will be examined by your surgeon after surgery to determine your individual guideline for returning to work.

Sedentary Work

This work includes secretarial work, computer work in the office or home. Work involving sitting, standing and walking with lifting less than 20 pounds.

Patients may return to unrestricted work 3 to 5 days after surgery. They will experience minimal pain which can be managed with over-the-counter pain medications such as Advil®, Motrin® or Tylenol®.

Minimal to Moderately Physical Work

This work includes electricians, plumbers, factory workers, mechanics, and workers in retail stores and laborers who lift 20 to 80 pounds. This does not include stockers who lift repetitively.

Patients can return to unrestricted work two weeks after surgery. They may return to work in one week with a light duty restriction of no lifting over 20 pounds. When you return to work you will experience minimal pain which can be managed with over-the-counter pain medications such as Advil®, Motrin® or Tylenol®.

Heavy Physical Strenuous Work

This work includes construction workers, road workers, heavy duty mechanics, and retail or wholesale stockers or order pullers who stock orders and load and unload pallet jacks throughout their work day.

Patients can return to unrestricted work four weeks after surgery. They may return to work in one week with a light duty restriction of no lifting over 20 pounds. They may return to work in two weeks with a work restriction of no lifting over 80 pounds and no repetitive lifting. When you return to work you will experience minimal pain which can be managed with over-the-counter pain medications such as Advil®, Motrin® or Tylenol®.

When can I return to recreational or athletic activities?

We typically recommend and promote patients returning to recreational or athletic activity in stages, as soon as possible, depending on the type of hernia and surgery performed. Since each patient is a unique individual with their own needs and abilities, we specifically tailor each patient's progressive return to recreational and athletic activity to your needs and abilities. We tend to follow a four week rule for most athletes. Week one consists of light or easy activities to maintain flexibility. Week two consists of minimal to moderate activities. Week three consists of moderate activities and week four consists of strenuous activities. Activities are performed four times weekly, gradually increasing in intensity.
Disclaimer: These activities are recommended by Dr. Albin for his patients who he personally examines after surgery and individually initiates an exercise program depending on the patients healing and skill level.

( Courtesy: Hernia Center of Southern California. Read full article from )





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