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Inguinal hernia in men, it can be congenital or acquired. A congenital inguinal hernia is usually operated on at an early age because, unlike an umbilical hernia, which is common in infants, an inguinal hernia does not go away on its own.
Most patients with inguinal hernia (90-95%) are men, due to the anatomical structure of the inguinal canal. If the connective tissues are not strong enough, they cannot withstand the constant pressure of the abdominal organs, which increases with heavy lifting, digestive problems (chronic constipation, intestinal disorders) and coughing. There is an expansion of the inguinal canal and a protrusion of part of the internal organs into the hernial sac.
If the internal organs exit through the inguinal canal without affecting the spermatic cord, then such a hernia is called direct. A protrusion through the spermatic cord occurs with an oblique hernia. Combined hernia is a disease in which the organs go into the inguinal canal and spermatic cords, but there is no communication between such protrusions.
What does inguinal hernia mean?
Inguinal hernia – protrusion of internal organs through the inguinal canal, while the integrity of the membranes is not violated. The peritoneum forms an inner sheet that covers the organs, and outwardly the hernia looks like a rounded protrusion in the inguinal region. If the contents of the hernial sac descend into the scrotum, then the hernia has an oval shape. At the initial stages of the disease, a hernia does not bring discomfort to the patient – there are no painful sensations and symptoms of inflammation, it is easily reduced to a supine position, and it becomes visible as soon as the patient gets up.
Despite the fact that the disease for many years can manifest itself only as a visible swelling in the area of the hernia, its outcome in the absence of treatment can be very unfavorable. Whatever size the hernia reaches, the real danger threatens the patient when it is infringed. And if a person did not feel discomfort for many years and refused a surgical operation, then one day, under the influence of one of the provoking factors, the hernia is squeezed or incarcerated, which not only causes severe pain, but also threatens life. If the internal organs that have fallen into the hernial sac are infringed, their necrosis and inflammation of the peritoneum may develop, as a result of which a person can die in a few hours or days.
Causes of inguinal hernia
The cause of an inguinal hernia may be a congenital weakness of the walls of the inguinal canal or acquired pathologies. Hereditary weakness of the ligaments, lack of collagen of the first and third type are the main causes of inguinal hernia. In addition, abdominal injuries, weakness of the abdominal muscles, and weak abdominal muscles contribute to the onset of the disease in adulthood. Postoperative hernia is a fairly common occurrence if the operation was completed with complications or the patient did not follow the rules of the rehabilitation period.
Factors provoking the disease:
Excessive physical activity – while inguinal hernia is more common among athletes than among loaders, the severity of the loads, although high, but their regularity allows the body to get used to and adapt. Athletes often have a Gilmore’s hernia in the groin as a result of the overload they are exposed to during training.
Violations of the gastrointestinal tract, frequent constipation increase intra-abdominal pressure, creating prerequisites for the formation of a hernia.
Severe coughing and vomiting can also increase intra-abdominal pressure, so chronic diseases of the respiratory tract and digestive tract can provoke a hernia.
Inflammatory diseases of the genital organs, prostate gland. Genitourinary infections also act as provoking factors.
Symptoms of an inguinal hernia in men
The main symptom of an inguinal hernia is a noticeable round-shaped protrusion in the groin area or an oval-shaped swelling in the scrotum, which makes it asymmetrical. To the touch, the formation has an elastic consistency, in a calm position of the body (lying, sitting in a relaxed position) disappears, but protrudes again during physical exertion and stress. Pain in the area of the hernia appears when the internal organs that fall into the hernial sac are squeezed, before this the disease may not manifest itself in any way.
Other symptoms of inguinal hernia in men:
The inguinal ring is expanded, which is felt on palpation;
Even if the hernia is in a reduced state, it is easy to feel for it, since it differs in consistency from the adjacent tissues;
Nausea, digestive disorders, bloating – are observed if part of the intestine falls into the hernial sac;
Violation of urination – if part of the bladder got into the hernia;
Cough push – when coughing, the hernia becomes tense, rhythmic movements are felt during palpation;
Chronic pain in the lower back, at the location of the hernia, in the hip joints;
An increase in temperature, a sign of an inflammatory process, vomiting and acute pain in the abdomen – if there is an infringement of the caecum in the hernial sac, these symptoms are often confused with appendicitis. (See also: How to determine if you have appendicitis at home?)
Symptoms of strangulated inguinal hernia
If a part of the organ gets into the hernial sac, then when the hernia is pinched, severe pain often appears.
Symptoms of a pinched hernia in young children are more difficult to recognize than in adults, as adults and older children can determine the localization of pain and report it to the doctor on their own. If a small child behaves restlessly, cries continuously, and his stomach is very tense, then we can assume an incarcerated hernia. There may be vivid symptoms that are rarely found in adults – nausea, vomiting, fever. In infants, blood circulation in the intestines is more intense, and the inguinal ring during a hernia does not squeeze the organs too much, which leaves its mark on the symptoms of the disease.
Other symptoms of strangulated inguinal hernia:
When pressing on the place of the hernia, it does not go back into place, painful sensations appear;
The absence of a cough push when pressing on the inguinal ring;
General weakness and fatigue;
Nausea, vomiting, indigestion, lack of stool.
Diagnosis of inguinal hernia
During a visual examination, the doctor determines the size of the hernia, its location, classifies it as straight, oblique or combined.
The presence of a rounded or oblong (with localization in the scrotum) protrusion in the inguinal region is determined. In a calm state, the protrusion disappears, but appears again during physical exertion or tension, if there is no pinching, it is easily set with a finger.
On palpation, the consistency of the contents is determined – elastic is characteristic of a hernia, harder – for lymphadenitis. Preliminary conclusions can be drawn about the contents of the protrusion; this may be fluid or intestinal loops, which makes it possible to differentiate an inguinal hernia from a varicocele in men. The presence of a “cough push” is checked – the reaction of a hernia when coughing and tension of the diaphragm, while its contents growl.
In men, an inguinal hernia is differentiated from a cyst of the spermatic cord.
Further diagnostic studies are aimed at determining the contents of the hernia and part of the organs that fall into the hernial sac.
To do this, use the following methods:
Ultrasound of the groin – allows you to determine the size and type of hernia, examine its contents in detail, the spermatic cords, testicles, scrotum and inguinal canal are clearly visible in the picture.
Ultrasound of the peritoneum – allows you to more accurately determine which organs have shifted into the hernial sac.
Cystography – this study is prescribed if during ultrasound of the peritoneum it was determined that a part of the bladder entered the hernial sac. A contrast agent is delivered into the bladder through a catheter, which allows you to see in detail on an x-ray that part of the organ that has been displaced.
Herniography – X-ray method for examining the organs of the peritoneum with the introduction of a contrast agent. It is prescribed if there are no visible signs of a hernia, but all symptoms indicate its presence, if the patient complains of pain in the groin and hip joints. The study is carried out as follows: after local anesthesia, a needle is inserted into the patient’s abdomen, through which a contrast agent enters. Further, from the position lying on the stomach, X-rays are taken in a tense state, for which the doctor asks the patient to cough. If there is a hernia, then when a contrast agent enters it, it becomes clearly visible in the picture. (Does not apply if the patient has poor blood clotting, weak peritoneal walls after surgery, or adhesions).
Irrigoscopy – a study in which x-rays of the large intestine are taken, where a contrast agent is first injected with an enema. It is prescribed if the symptoms indicate that part of the colon has entered the hernial sac.
Diaphanoscopy – determination of the contents of the hernial sac using a lamp. A simple method of primary diagnosis, which allows you to determine whether internal organs fall into the hernial sac, is less informative than ultrasound. When a formation filled with liquid is translucent, most of the light passes, and if there are parts of the internal organs in the hernial sac, the rays are scattered.
Before a surgical operation, it is necessary to pass urine and blood tests, determine the parameters of blood clotting and identify possible contraindications – cardiovascular diseases, diabetes mellitus, intolerance to drugs for anesthesia.
Answers to popular questions:
Can an inguinal hernia go away on its own? Only an umbilical hernia, which occurs in infants with a weak umbilical ring, can pass on its own. In such cases, by the age of three, the ligaments are strengthened and the protrusion disappears. Other types of hernia, including congenital inguinal hernia, do not disappear without treatment. Inguinal hernia occurs due to the fact that the vaginal process of the peritoneum does not overgrow, creating prerequisites for the protrusion of internal organs into the inguinal canal. The same applies to an inguinal hernia acquired in adulthood – it does not go away without surgical treatment.
Can an inguinal hernia hurt? Pain in the area of the hernia appears when squeezing or infringing on the internal organs that have fallen into the hernial sac. This situation is very dangerous and requires immediate surgical intervention. However, in most cases, the hernia does not hurt, and even when the organs are squeezed, there may not be pain, but there are violations in their work. This is dangerous because the patient seeks medical help too late, when the adhesive process has already begun or pathologies of the strangulated organ have arisen. Pain in the area of the hernia can also be the result of her injury.
Can an inguinal hernia reappear after surgery? Relapses of the disease are quite common, the reason for this may be a poorly performed operation, physical activity during the rehabilitation period. If the hernia recurs, it is necessary to perform the operation again, because due to the weakness of the connective tissue, it can increase in size, respectively, the likelihood of possible complications also increases, pathologies and malfunctions of the internal organs occur.
Can an inguinal hernia affect potency? Internal organs get into the hernial sac, which can cause disruption of their work. If a hernia is incarcerated, compression of the intestines, bladder, organ necrosis and peritonitis can occur (See also: Types, causes and symptoms of necrosis). Often observed pathologies when squeezing the contents of the hernial sac are intestinal disorders, constipation, bloating, problems with urination, impaired potency and decreased sexual desire. In addition, an inguinal hernia can disrupt the process of spermatogenesis in the testicles, leading to male infertility (Read also: Causes, symptoms and treatment of male infertility).
Can an inguinal hernia burst? A hernia injury can occur when it is incorrectly repositioned or from a sharp blow to the hernial sac or a fall on the stomach. When a hernia is injured, there is a rupture of the internal organs that fall into the hernial sac, which is accompanied by a hematoma, severe pain and requires surgical intervention in order to prevent peritonitis and remove the danger to the patient’s life.
When can I have sex after inguinal hernia removal? If sexual relations do not involve serious physical exertion and do not create increased intra-abdominal pressure, then you can have sex a few days after the operation. So, you can have oral sex already 3-5 days after the hernia is reduced, it is better to wait with classic sex until 14 days after the operation. Physical activity on the inguinal region before the expiration of the rehabilitation period can provoke a recurrence of the disease, displacement of the graft-mesh and suture divergence.
Surgery to remove an inguinal hernia in men
Conservative treatment of an inguinal hernia is ineffective and can lead to a number of complications – the onset of an adhesive process, in which the organs grow together, incomplete reduction of the hernia. However, wearing bandages, special diets and exercises, and traditional recipes for hernia treatment can help you recover faster after surgery and prevent recurrence of an inguinal hernia.
Thus, surgical treatment of a hernia is the only way to get rid of this pathology and avoid serious complications.
Any operation to remove an inguinal hernia consists of three stages:
The surgeon has access to the hernia area – an incision is made during an open operation, and punctures are made during laparoscopy
The hernial sac is removed
The inguinal ring is sutured to normal size
Plastic surgery is being performed.
Hernia surgery is performed in one of two ways – open or endoscopic. In open surgery, the surgeon needs to make one or two incisions. Two incisions are needed for bilateral inguinal hernia, which is rare, one is usually sufficient. With laparoscopy, three punctures are made – through an eight-millimeter puncture above the navel, a laparoscope and a mesh implant are inserted, and endoscopic instruments are inserted through two five-millimeter punctures in the inguinal region.
Both methods have their advantages and disadvantages. Thus, during open operations, the risk of suture divergence increases and the rehabilitation period is extended, while after laparoscopy, punctures quickly and without a trace disappear. However, this may give the false impression that there has been a full recovery after the operation, which is why the patient forgets about the ban on heavy physical activity and puts himself at risk. In addition, endoscopic surgery is contraindicated in people who cannot tolerate general anesthesia, while open surgery can be performed under local anesthesia.
Tension repair of inguinal hernia
Tension hernioplasty in the treatment of inguinal hernia was used long before the advent of mesh implants and is still used in small clinics that do not install implants due to their cost or insufficient qualifications of the surgeon. The reduction of the hernia and the closure of the hernia ring is performed using the patient’s own tissues. The contents of the hernial sac are pushed into place in the hernial cavity, and the surrounding tissues are stretched and sutured to close the hernial orifice.
This method is not perfect because a hernia usually develops in patients with weak connective tissue that cannot withstand the load. With additional tension, these tissues can be injured, which increases the risk of bleeding, inflammation, their necrosis and adhesive processes. After tension plasty, there is often a divergence of the seams, the rehabilitation period becomes more complicated, the likelihood of recurrence increases, postoperative hernia occurs in about 30% of patients. Another disadvantage of this technique is the pain after the operation, which can last all the time while the tissues are healing – from a couple of weeks to several months.
Modern method of treatment of inguinal hernia – tension-free hernioplasty
This technique involves the use of a metal mesh implant, which additionally strengthens the walls of the inguinal canal, making them more resistant to pressure from the internal organs. At the same time, the risk of recurrence is reduced, since the tissues are less injured and do not stretch, according to the Lichtenstein plastic technique.
Implants used in tension-free hernioplasty are made of non-toxic materials and can be placed even in people prone to allergic reactions. The composition and type of implant can be different, it is selected by the surgeon depending on the individual characteristics of the patient. To accelerate the processes of regeneration and overgrowth of the hernial ring with the patient’s own tissues, self-absorbable polymeric materials are used, which eventually dissolve without a trace.
The implant-coil is used to additionally strengthen the hernial orifice, fills them in, closes them from the outside and inside. The use of a coil implant reduces the risk of displacement, which is often the case with mesh implants. The number of sutures required to secure the implants is much less than with tension hernioplasty, so the risk of their divergence is minimal, and pain after the operation is mild or absent.
The mesh implant on a nitinol frame allows the operation to be performed without sutures, which facilitates its installation and completely eliminates pain in the postoperative period.
Implants do not cause allergic reactions and inflammatory processes, quickly take root and become overgrown with connective tissue, forming a framework that supports the walls of the inguinal canal and prevents displacement of the abdominal organs.
The percentage of recurrence of inguinal hernia after tension-free hernioplasty is reduced to 1-3%, which is an excellent result compared to 30% of repeated hernias after tension hernia repair.
The use of implants has few contraindications, but they cannot be used to treat inguinal hernia in children.
Modern surgery without incisions – laparoscopic hernioplasty
To provide access to the hernial orifice during the reduction of the hernia and the installation of the implant during open operations, one oblique incision is made (or two in the case of a bilateral hernia). Incisions involve suturing, tissue trauma, and most often leave a scar for life. Laparoscopic techniques make it possible to do without incisions; three punctures are enough for access, through which a laparoscope with a camera is inserted (the surgeon controls the operation and sees it on the screen) and endoscopic instruments.
In addition to the reduction of a hernia during endoscopic surgery, surgical intervention on other organs is possible – removal of the gallbladder in case of cholelithiasis. During the operation, the wall of the peritoneum is removed, the implant is inserted and installed, the hernial sac is removed, and the hernial orifice is closed.
Pain after endoscopic surgery to remove a hernia is short, tissue healing is faster, as they are less traumatized. The disadvantage of this technique is its duration in comparison with open operations, the need for specially trained surgeons, which are not available in every clinic.
Contraindications for laparoscopy:
Laparoscopy is contraindicated in patients with intolerance to general anesthesia, while open hernioplasty can be performed with local anesthesia;
It is not used for the correction of large inguinal hernias;
It is not used for adhesive disease, when it is necessary to separate parts of organs that have grown together.
Recovery after inguinal hernia surgery
The patient is discharged after the operation in one or two days, and a second visit to the doctor is necessary in a week to remove the suture material. A month after the operation, physical exertion should be avoided, especially those associated with a sharp simultaneous stress. Two weeks after the operation, the patient can have sex and lead a normal life.
For the first time after the operation, the hernia site may hurt, after 8-12 hours the doctor changes the bandage, it may show discharge. Suppuration of postoperative sutures is a fairly common phenomenon, to avoid this, the bandage should be changed more often. A special bandage helps to reduce pain, accelerate the healing of a postoperative wound and engraftment of a mesh-graft; only a specialist should apply it.
For complete engraftment of the mesh implant, its fouling with connective tissue, it takes at least two months, after six months the hernia completely heals and the risk of recurrence is significantly reduced. After the rehabilitation period (1 month), you can perform therapeutic exercises that strengthen the abdominal wall. To do this, pump the press (from a position with bent legs to reduce the load) or push up from the floor. Push-ups strengthen the muscular corset and give a load to almost all muscle groups, so it is advisable to use them to prevent the recurrence of the disease. However, it is best to engage in swimming – while the load on the muscles is quite intense, but does not cause excessive stress and is distributed evenly.
Diet after surgical treatment of inguinal hernia
The diet after removal of the hernia excludes foods that can provoke indigestion. To exclude an increase in intra-abdominal pressure and reduce the load on the operated area, the patient should have a normal stool, without constipation or diarrhea.
To do this, food is taken in small portions, the frequency of meals increases up to six times a day. Food should be liquid and rich in protein (fish, cottage cheese, eggs, boiled beef).
Foods that cause intestinal irritation are excluded from the diet. These include smoked meats, sweet, spicy and sour foods, fatty meats, coffee and carbonated drinks.
Scrotal edema after inguinal hernia surgery – what to do?
Edema of the inguinal region after surgery is a normal phenomenon caused by a violation of the outflow of lymph. The intervention of a doctor is required only if the swelling and redness does not subside 10-14 days after the operation. To reduce pain, the doctor may prescribe analgesics, calcium preparations, antihistamines and vitamin supplements, in particular vitamin D, help relieve swelling.
Also, for the prevention of postoperative complications, it is recommended to wear swimming trunks made of thick cotton material, without removing them even at night. Special bandages that can be used within a month after the operation help to reduce the load on the operated area.