. Tuesday, September 30, 2008
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The battle of the bulge doesn’t necessarily end at the waistline. Sometimes the soft tissue of an inner organ, such as the intestine, will start to bulge through a defect in the muscle wall. This protrusion doesn’t exactly announce itself by saying “peekaboo,” but most often, it will create bulging and sometimes tenderness in the groin area.

At the very least, this protrusion, called a hernia, is an uncomfortable nuisance. But it may also become painful and, in rare cases, lead to complication that, if untreated, can even cause death, says Alex G. Shulman, M. D., director of the Litchtenstein Hernia Center in Los Angeles.

A hernia is something like a tear in a piece of fabric. It most often results when the abdominal muscles are strained by doing things such as heavy listing, having a difficult bowel movement or even coughing or laughing. Those that appear in the lower abdomen are by far the most common, and nearly nine of ten people who get them are men. That’s probably because of a potential physical weakness the spermatic cord passes through muscle in the groin.

Stopping the Bulge

The beast way to deal with hernias is to never get one in the first place. There are several things you can do to prevent one.

Lift properly. Any type of heavy lifting increases pressure on the abdominal muscles and can cause a hernia, says Timothy Pohlman, M. D., assistant professor of surgery at the University of Washington School of Medicine. Try to use your leg muscles and distribute the weight of the object over you entire torso. Better yet, hire a professional mover or find a friend to help you with heavy object!

Avoid constipation or straining during bowel movements. “There are people who get fixated on the idea that they have to have a bowel movement at a certain time of the day, even if they have to strain, “Says Arthur Gilbert, M. D., director of the Hernia Institute of Florida in South Miami. “Those people predispose themselves to hernias. “Eat lost of fiber and drink plenty of fluids––at least six to eight glasses a day––to keep your stool soft and prevent constipation, he says.

Firm your abdomen. Exercises such as sit-ups strengthen the abdomen and are particularly useful in helping to ward off hernias, says Dr. Pohlman. Work up slowly to two to there sets of 10 to 15 sit-ups, keeping your legs bent to avoid back strain.

Quit smoking. Yes, here is yet another reason to give up tobacco. If you’re a smoker, you’re more likely to have a chronic cough that may strain your likelihood of getting a hernia, Dr. Pohlman says.

Hernia Relief

If you thing you have a hernia, see your doctor. Several other conditions, including an abscess, muscle strain, an aneurysm, an undescended testicle and arthritis, can cause groin tenderness. Only your doctor can determine the specific cause.

If you do have a hernia, you can wear a truss, an elastic or canvas pad that may keep a small hernia from protruding. A truss can be cumbersome, however, and cause skin irritation. And if the hernia enlarges, a truss may cut off blood to the herniated area.

“Trusses are generally a stopgap measure,” Dr. Pohlman says. “Most people will eventually opt for surgery.”

That’s because hernias almost always get larger and more uncomfortable over time. “Usually, when a hernia first becomes obvious, it’s about the size of a golf ball. Then it gets bigger and bigger until it’s the size of a tennis ball or soft ball. They can get as big as a watermelon in some rare cases“, Dr. Shulman says.

The Surgical Options

Surgical corrections of hernias are common: About 600,000 such procedures are performed every year in the United States.

If you do have surgery, you and your doctor will have a choice of three basic procedures. The first is the traditional operation, performed since the 1880s. The surgeon makes an incision in the groin and pushes the hernia back into the abdomen. Then the edges of the tear in the abdominal wall are sewn together to prevent the hernia from bulging out again. When the tear is sewn up in this fashion, however, there is tension on the sutures whenever you move your muscles. Should the edges of the tear rip open, the hernia can recur. The procedure may also require several days in the hospital and weeks of limited activity. On the up side, this is a natural reconstruction of the way things were before the hernia developed, Dr. Pohlman says.

A more common option in recent years fixes hernias in something of the way you would fix a tire. The surgeon covers the tear with a patch made from a synthetic material called Marlex. Because the edges of the tear aren’t being pulled back together, there is no tension on the repair, and the chances of the hernia recurring are significantly reduced. The operation itself shouldn’t have you in the hospital for more than a few hours. Generally you can resume most of your normal activities within three or four days, says Dr. Shulman.

The latest advance in hernia repair is laparoscopic surgery. The surgeon makes an incision near the belly button, then inserts a scope into the abdomen and guides it to the site of the hernia. Mesh is inserted through the scope to repair the tear. By eliminating the need for an incision in the groin, recovery comes fast––you should be back to your normal self in a day or two. The pain is minimal, similar to that of a finger cut. But doctors are still evaluating the effectiveness of this procedure.


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