Hernia

A few days ago I got a call to evaluate someone’s “new belly lump,” so here’s a short bit on hernias. First off, many people live with these for years. They don’t always have to be a straight shot to the ER or operating room. However, they are a drag and can be life threatening as well, so the buzz words are important.

Red Flags:

• Pain (above and beyond usual discomfort)
• Fevers
• Vomiting
• Constipation
• Abdominal distension
• Redness and swelling over the lump
• Diabetes, obesity or other chronic illness/frailty
• Multiple past bowel obstructions and surgeries
• “I’ve stopped passing gas.”
• “I can’t eat anything.”
• “I can’t push my hernia back in and it’s killing me.”

Happy Words

• “It goes away when I lie down.”
• “I’ve had this thing for years.”
• “I can push it back in no problem, but it keeps jumping back out.”

Most of us think about heavy lifting related inguinal hernias. But they can appear wherever the abdominal wall may be weak. Your abdomen is essentially a guts-filled sac, where internal pressure may push the contents out through any areas of weakness. Examples include congenital (Bochdalek, Morgagni), inguinal, ventral, umbilical, Spigelian, femoral, obturator, hiatal… inguinal and umbilical being most common, visible and palpable.

You may be able to postpone surgery by dropping some internal pressure with weight reduction. Or give your belly wall some support with a “truss,” a support belt, or neoprene abdominal wrap. However, most hernias eventually do find a surgeon. My father, being a scientist, had one inguinal hernia repair with the “open” technique and another laparascopically. Choice B won for him hands down. (Does HIPPA apply here? Sorry Dad.)

Two other terms to consider are “incarcerated” and “strangulated.” The former means that the abdominal contents are stuck in the hole. The latter means that blood supply to those abdominal contents are being cut off. Both are concerning, but a strangulated hernia is much worse and a definite trip to the ER.
Call Pre-R if you’d like help “reducing” your hernia or for advisement. If you think red flags apply, then head to the hospital.

P.S. Opiates don’t make these better. If anything, they slow the bowels and can mask serious pathology. So steer clear.

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