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Published On: Sun, Nov 16th, 2014

Dr Chireka: Let’s talk about hernia

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By Dr Brighton Chirekanews_bBrighton-Chireka-Columnists-250

“Ba – Ba, But eh doctor,” I protested to no avail as I was handed over a packet of antibiotics to take for a week. This happened in 1993 when I was a first year medical student at the University of Zimbabwe.

Since birth I had been aware that something was wrong with my groin and I remember being ashamed of bathing in public at school. I would try to bath when there were few students around for fear of being teased. As a kid I had been teased when I went for swimming in a river in my rural area. It was not until I started studying medicine that I realised the need to do something about my groin problem. I self-diagnosed after studying anatomy that I had Congenital Inguinal Hernia.

Having suspected that I had congenital inguinal hernia, I made a trip to see a doctor at the University Medical Centre. I saw doctor (name withheld) and I told him that I had a groin swelling and was worried that I had a hernia. The doctor did not listen to what I was saying but kept on asking me about my sexual life which was non-existent at that time. He did not even bother to examine me. I was surprised when he told me that he suspected that I had a sexually transmitted infection (this will be our next topic to discuss here on this forum). My plea that I was a virgin was not heard as I was given antibiotics to take for a week. I had and still have so much respect for doctors so I took the antibiotic as instructed as I thought maybe I got the infection from using one of the public toilets (that was silly thinking).

I finished the course of antibiotics but my groin remained the same. I then sought a second opinion and went to see Dr Ndiweni, the physician who reassured me that I had no infection but a hernia and he referred me to Mr Harrid, the surgeon who eventually carried out the operation to repair the hernia in December 1993. I would like to discuss about hernia and hopefully one person out there will benefit from reading this article.

A hernia is when there is a hole or weakness in the tummy muscles. This means that organs or tissues inside the tummy can poke through the hole or weakness in the muscle and cause the skin to bulge. An inguinal hernia is a hernia that occurs in the groin region. “Congenital” meaning that the defect is present from the time one is born. During development in the womb, all babies normally have a tunnel that connects the tummy to the groin. In boys, this connects the tummy with the scrotum. The testicles initially grow inside the tummy and descend through this tunnel to end up in the scrotum. This tunnel is supposed to seal off prior to the baby being born. If it fails to close before birth, then the child is at risk of having an inguinal hernia.

Types of hernia

Hernias can occur throughout the body, but they most often develop around the abdomen. Some of the more common types of hernia are described below.

Inguinal hernias

This is the type of hernia that I had and is fully described above. It is the most common type of hernia and it mainly affects men. It is often associated with ageing and repeated strain on the abdomen. In my case it was a defect which I was born with and not infection as wrongly suggested by one health professional.

Femoral hernias

These occur when fatty tissue or a part of one’s bowel pokes through into groin at the top of the inner thigh. They tend to affect more women than men and inguinal hernias, femoral hernias are also associated with ageing and repeated strain on the abdomen.

Umbilical hernias (Guvhu-dende)

Umbilical hernias occur when fatty tissue or a part of one’s bowel pokes through the abdomen near the belly button (navel). This type of hernia can occur in babies if the opening in the abdomen through which the umbilical cord passes doesn’t seal properly after birth. Adults can also be affected, possibly as a result of repeated strain on the abdomen.

Hiatus hernias

Hiatus hernias occur when part of the stomach pushes up into the chest by squeezing through an opening in the diaphragm (the thin sheet of muscle that separates the chest from the abdomen). This type of hernia may not have any noticeable symptoms, although it can cause heartburn (chirungurira) in some people. Its cause is not clear, but it may be the result of the diaphragm becoming weak with age or pressure on the abdomen.

Other less common types of hernia

Other types of hernia that can affect the abdomen include:
Incisional hernias – these occur when tissue pokes through a surgical wound in your abdomen that has not fully healed.

Epigastric hernias – these occur when fatty tissue pokes through your abdomen, between your navel and the lower part of your breastbone (sternum).

Spigelian hernias – these occur when part of your bowel pokes through your abdomen at the side of your abdominal muscle, below your navel.

Diaphragmatic hernias – these occur when organs in your abdomen move into your chest through an opening in the diaphragm. This can affect babies if their diaphragm does not develop properly in the womb, but can also affect adults.

Muscle hernias – these occur when part of a muscle pokes through your abdomen. They can also occur in leg muscles as the result of a sports injury.

What are the symptoms of a hernia?

In many cases, hernias cause 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 will disappear when you lie down. Coughing or straining may make the lump appear.

When should one seek medical advice?

You should see your GP if you think you have a hernia, so they can determine whether you need to be referred for surgical treatment.

You should go to the accident and emergency (A&E) department of your nearest hospital immediately if you have a hernia and you develop any of the following symptoms:

  • sudden, severe pain
  • vomiting
  • difficulty passing stools (constipation) or wind
  • the hernia becomes firm or tender, or cannot be pushed back in

These symptoms could mean that the blood supply to a section of organ or tissue trapped in the hernia has become cut off (strangulation), or that a piece of bowel has entered the hernia and become blocked (obstruction).A strangulated hernia and obstructed bowel are medical emergencies and need to be treated as soon as possible.

There is another condition which I need to discuss as it is an emergency and must be treated as soon as possible without any delay. This condition is testicular torsion.

Testicular torsion

Testicular torsion is a benign but serious condition caused by the spermatic cord (the cord that supplies the testicles with blood) becoming severely twisted.

Unlike the other types of benign testicular lumps and swellings, testicular torsion is a medical emergency. You should contact your doctor immediately or visit your nearest accident and emergency (A&E) department as soon as possible if you suspect you have testicular torsion.

Signs and symptoms of testicular torsion include:

  • a sudden, severe pain in one of your testicles
  • swelling of the scrotum
  • nausea (kuda kurutsa)
  • vomiting
  • abdominal (tummy) pain

If the spermatic cord becomes severely twisted, the blood supply for the affected testicle can be interrupted. If this is not treated quickly with surgery, there is a risk of losing the affected testicle. You should aim to present at the hospital within 3hrs as the testicle can “die” if not repaired within a period of 6 hours. If the blood supply to the testis is cut off for more than about six hours, then permanent damage is likely to occur.

Testicular torsion can occur at any age, but is most common in boys aged 13-17 and is rare in men over 30. It can also affect newly-born babies and even unborn babies in the womb. Most cases happen for no apparent reason, although the problem can occur in boys who are born with an unusually loose spermatic cord and it can develop after an injury to the testicles. You may also be at a higher risk of developing testicular torsion if you have a history of undescended testicles (where a boy is born without both testicles in their scrotum).

Visit your doctor for assessment of your lump or hernia

If after reading this article and you notice a swelling or a lump, please do not ignore it. Visit your doctor or emergency centre if you have severe pain or you have some of the symptoms mentioned above. Your doctor will usually be able to identify a hernia by examining the affected area. In some cases, they may decide to refer you to a nearby hospital to have an ultrasound scan (USS) to confirm the diagnosis or assess the extent of the problem. This is a painless scan where high-frequency sound waves are used to create an image of part of the inside of the body. Once a diagnosis has been confirmed, your GP or hospital doctor will determine whether surgery to repair the hernia is necessary.

Treatment of hernias

There are two main ways surgery for hernias can be carried out:

Open surgery – where one cut is made to allow the surgeon to push the lump back into the abdomen.

Keyhole (laparoscopy) surgery – this is a less invasive, but more difficult, technique where several smaller cuts are made, allowing the surgeon to use various special instruments to repair the hernia.

Most people are able to go home the same day or the day after surgery and make a full recovery within a few weeks. If your doctor recommends having surgery, it is important to be aware of the potential risks, as well as the possibility of the hernia recurring. Make sure to discuss the benefits and risks of the procedure with your surgeon in detail before having the operation. I had an informed discussion with my surgeon Mr Harrid and he performed open surgery on me to repair my inguinal hernia and it’s now 21 years since the operation and I have had no problems with the repair. I hope you will see your doctor about your lumps and have them sorted.

This article was compiled by Dr. Brighton Chireka who is a GP and a Patient Engagement Advocate (PEA) in Folkestone Kent, UK. He is also an NHS Certificated Change Agent (CCA). You can contact him at: brightonchireka@yahoo.com

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr. Chireka has used all reasonable care in compiling the information, but makes no warranty as to its accuracy. Consult a doctor or other health care professionals for diagnosis and treatment of medical conditions.

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