Inguinal Hernia

Believe it or not but I do have an inguinal hernia condition myself that will be surgically repaired this year or early next year. That being the case I thought I would explore the medical aspects of inguinal hernias, and my own experiences of living with that condition.

History

For most of my working life including when I was a child and teenager I have been involved in some form of manual lifting which I was never trained in how to lift heavy objects. It wasn’t till I commenced my aged care nursing in 2002 that I was taught manual handing skills for the first time that showed the correct procedures in how to lift objects correctly. Prior to this I just used to lift heavy objects the best I could using my body strength which no doubt has contributed to my inguinal hernia condition.  The other day I worked out that I have had three right sided inguinal hernia operations in the past so my next hernia operation will be my forth. I knew I had been operated before on my right side but couldn’t recall how many times till I did some sifting through some of my medical files.

What this means in my situation is that my previous working lifestyle prior to nursing was not favouring my health outlooks in quite a few areas. In my first job after leaving high school involved lifting heavy loads every day in fresh produce i.e., apple boxes, large bags of potatoes, beans, peas, etc. over a four year period. Then over a 14 year period on the railways I was lifting a range of objects daily from jumper couplings to hook up locomotives including various suburban electric trains. Prior to entering aged care I worked in hotel maintenance for four years which also involved lifting on a daily basis. All these working environments contributed towards my hernia condition today.

Pathophysiology of inguinal hernia

Inguinal hernias are more common with men than women, and they occur at the point of weakness in the abdominal wall where the spermatic cord in men and the round ligament in woman emerge (Brown & Edwards, 2008). Hillman (2011) describes hernias that affect males can be classified as being either “indirect or direct”.

Firstly an “indirect hernia” is referred to as “congenital hernia” as it relates back to when the male was in the womb of his mother (Sarr, 2013). Hillman (2011) states that ‘indirect hernias are caused by improper closure of the tract that develops, as the testes descend into the scrotum before birth’. This normally results in fat or the small intestine protruding through the internal inguinal ring into the inguinal canal which often descends into the scrotum (Sarr, 2013).

Secondly “direct hernia” is caused by the degeneration of connective tissue at the abdominal wall muscles which weakens the muscular strength in that area (Sarr, 2013). Hillman (2011) describes this way as being a weakness of the posterior inguinal wall which the fat of the small intestine can often descend into the scrotum. This direct hernia condition would relate to my present hernia as the constant heavy lifting over many years would have weakened my posterior inguinal wall. Sarr (2013) mentions that sudden twists, pulls, or muscle strains, lifting heavy objects, straining on the toilet because of constipation, weight gain, and chronic coughing can add pressure on the abdominal muscles overtime which would contribute to the weakening of the posterior inguinal wall.

Clinical manifestations of inguinal hernias

I think it would be fair to state that each person who has a hernia condition would have their own specific clinical manifestations as no two people are alike. That being said the general view is that a hernia may in most cases be visible when the person tenses the abdominal muscles or in the case of inguinal hernias coughing can help detect any hernia within the scrotum (Hillman, 2011). However in some cases the hernia can be quite visible due to its enlarged condition which the illustrated photo below displays.

Inguinal Hernia (Direct)

Inguinal Hernia (Direct)

The question I often get asked by doctors is how did it get to that stage? My simple answer is that I tried to have it repaired back in 2006 but was informed by my cardiologist that it would be too much of a strain on my heart condition back then so it meant I had to live with the hernia condition. Initially it was not that enlarged but since 2006 it has slowly enlarged overtime and the symptoms I have had in the last 12 months have related to being tender and aching in the groin area during prolonged physical activity. Of course the risk factor is that if you place too much stress or strain in the abdominal area such as lifting it could cause strangulation which requires emergency surgery in most cases (Hillman, 2011).

The hernia repair

Hernia operations can be either Laparoscopic or the Traditional Open surgery method.  The surgical repair of the hernia is referred to as “herniorrhaphy” (Brown & Edwards, 2008). With Laparoscopic surgery several incisions are made by the surgeon in the lower abdomen with a laparoscope which is a thin tube with a tiny video camera attached to one end (Sarr, 2013). The camera then sends a ‘magnified image from inside the body to a monitor, giving the surgeon a close-up view of the hernia and surrounding tissue. While viewing the monitor, the surgeon uses instruments to carefully repair the hernia using synthetic mesh’ (Sarr, 2013). The benefit of the Laparoscopic surgery is that it has a shorter recovery time post-op compared to the traditional open surgery method.

With the traditional open surgery means that the operation site is opened up in order for the repair to be made. In my case this will apply to me as the hernia is quite enlarged and needs better access then some of the minor hernias. If you’re not a squeamish type of person then you can look at following YouTube link of a right sided inguinal hernia operation being performed in Australia by the Melbourne Hernia Clinic. http://www.youtube.com/watch?v=Zz8-ruqMDkU&oref=http%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DZz8-ruqMDkU&has_verified=1

Recovery and education

All operations require a recovery period to which you need time to heal. As mentioned previously the Laparoscopic surgery normally has a shorter healing period as it is less invasive compared to the open surgery method. In my case I was told that it could be a good two months to recover from the traditional open surgery I will have to have. Being educated means to be mindful of what you do in the future after you fully recover. I will be ensuring I will not be lifting heavy objects any more like I did in my previous occupations prior to nursing. Exercising and a good diet is a great way to stay in shape provided the exercise is not too strenuous that it may cause any damage to the hernia site. Walking can be a great way to build up your strength again as it improves circulation aiding to recovery.

Reference

  • Brown, D., & Edwards, H. (2008). Lewis Medical-Surgical Nursing: Assessment and management of clinical problems. (2 ed.) Nursing Management: Integumentary problems, p. 1157, Elsevier Australia.
  • Hillman, E. (2011). Nursing care of clients with bowel disorders. In P. Lemone, K. Burke, T. Dwyer, T. Levett-Jones, L. Moxham, K. Read-Searl, K. Berry, K. Carville, M. Hales, N. Knox, Y Luxford, D. Raymond (Eds.) Medical-Surgical Nursing: Critical Thinking in Client Care, Vol 2. p. 828, Pearson Australia, Frenchs Forrest, New South Wales.

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