And whether you know...
Inguinal hernia is an often met disease at which there is a noticeable protrusion of a peritoneum in a cavity of the inguinal channel. This illness most often occurs at men: among total quantity of patients with inguinal hernias men contain from 90 to 97 percent. So frequent display of an illness at men is connected with anatomic characteristics of inguinal area.
The first references of this illness came from ancient times: Hippocrates, Galen wrote about hernia, and Tsels in the first century of our era gave definition of hernia as protrusion of interiors through the inborn and acquired gate.
Types of inguinal hernia
Inguinal hernias at men are fixed much more often, than other types of hernias of a stomach. At women of hernia appear much less often as the pakhovy channel at them is much better strengthened by sinews and muscles, besides it narrower and long, than at men.
By origin a hernial bag distinguish the inborn and acquired hernias from slanting inguinal hernias. Inborn inguinal hernias develop owing to incomplete mending of vulval part of a peritoneum. In that case the cavity of this part is reported with a peritoneal cavity. There is a formation of inborn inguinal hernia, at the same time the vulval shoot becomes a hernial bag. In most cases inborn inguinal hernias are diagnosed at children's age, however quite often their symptoms are shown also at adults. At inborn inguinal hernia at patients the hydrocele and a seed cord is often shown.
Among a disease of the acquired form from the anatomic point of view it is accepted to distinguish two kinds of hernias: slanting and direct. Also the combined types of hernias meet. In that case the person on the one hand has several hernial bags which are not combined among themselves and are direct, slanting hernias or their combinations. Today allocate also special type of hernias — difficult forms of inguinal hernias. These are the hernias of the big sizes sliding, which are difficult set and subject to recurrence.
Slanting inguinal hernia passes through an external inguinal pole. At the same time, direct hernia leaves already through a medial inguinal pole. At the first stages of slanting inguinal hernia of people can not notice protrusions. However if the patient strongly strains or coughs, then he designates a swelling which has the oval form. After the person relaxes, the swelling disappears. Slanting hernia only at the first stage the direction has slanting. Hernia increases, and there is a medial expansion of an internal opening of the inguinal channel.
Distinguish a channel form of slanting inguinal hernia (in this case the bottom of a hernial bag can reach an opening outside of the inguinal channel); a funicular form of hernia (a bottom, passing through an outside opening in the inguinal channel, is located at the different height of a seed cord); an inguinoscrotal form (the bottom falls to a scrotum, in turn it increases).
Distinguish also reducible hernias (in this case the patient can set them independently) and unreducible hernias (reposition of hernias is impossible in view of existence of commissures of a hernial bag with the dropped-out internals).
Symptoms of inguinal hernia
At patients with uncomplicated inguinal hernias typical symptoms are shown. First of all, the person finds protrusion in inguinal area which reminds a tumor. Pain at the same time can be different intensity. They are accurately shown in the course of physical tension. As a rule, similar signs are characteristic of inguinal hernia.
If the size of inguinal hernia small, then it can not cause a long time to the person of discomfort and painful feelings at all. But if hernia exists a long time, and at the same time has the big size, then the patient can feel constant pain. Also patients with a recurrent form of a disease complain of pain.
The place of localization of pain – lower parts of a stomach, a groin, pain gives to a sacrum and a waist. At big protrusion hernia can worsen considerably quality of life and ability to work. Locks of chronic character become quite often accompanying symptom of inguinal hernia. If in hernial gate the caecum slides off, then at the person abdominal distention, pain, a lock is shown.
If at hernia the worm-shaped shoot inflames, then severe pains, vomiting, nausea, a chair delay, pulse increase, temperature increase will be symptoms of a similar state. If inguinal hernia is shown at women, then internal generative organs can be involved in hernial gate owing to what there is an abdominal pain giving to a waist.
Diagnosis of inguinal hernia
Difficulties with diagnosis of inguinal hernia at men can arise at rather small protrusion which takes place at channel hernia or at the first stages of a disease. It is sometimes difficult to define existence of an illness in case of atypically located protrusion (in case of mezhstenochny hernia). With similar features studying of the anamnesis of the patient, carrying out a palpation of area of a groin and careful survey is important for diagnosis.
Examining the patient, the surgeon pays special attention to size, and also a protrusion form, watching it in vertical and horizontal provisions of the patient. If the patient has available a slanting hernia, then protrusion will have the long form. It is on the course of the inguinal channel, falls to a scrotum quite often later. At patients with direct hernia protrusion has rounded shape and is located near medial part of an inguinal sheaf. Depending on an arrangement and the size of protrusion the specialist defines a form of inguinal hernia.
Quite often survey of inguinal area includes a careful palpation of hernial protrusion that allows to define whether it is possible to set it. It is also important to define whether there is available a varicosity of a seed cord. In the course of statement of the diagnosis it is important to differentiate direct, slanting and femoral hernia.
At women diagnosis has features. The most informative way of research – survey and a palpation of protrusion. At direct hernia protrusion at women is over an inguinal sheaf, and at slanting hernia there is its lowering in outside vulvar lips.
If the specialist assumes existence at the patient of the sliding hernia, he can apply also other ways of inspection: tsistografiya, irrigoskopiya, tsistoskopiya, etc.
Treatment of inguinal hernia
Most often an operative measure at patients with free inguinal hernia is carried out with use of a local anesthesia. The general anesthesia is carried out to children in the first years of life, by patients who do not transfer novocaine, and wishes of the patient concerning the general anesthesia.
When carrying out operations at inguinal hernia initially the specialist needs to make access to the inguinal channel. After that the hernial bag is removed and the inguinal opening in case of its destruction or expansion is taken in. The plastics of the inguinal channel is considered the last stage of operation.
To prevent further manifestation of recurrence of a disease, the specialist when carrying out operation without fail pays attention to features of topography of the inguinal channel, a type of the hernia which is available for the patient, age, the sizes of hernial gate.
However even recurrence of inguinal hernia takes place in rather large number of cases. This results from the fact that at use of usual methods of strengthening of a front wall of the inguinal channel not in each case it is possible to eliminate weakness of a back wall. Therefore, hernia can arise again. Therefore the surgeon pays especially close attention to reliability of strengthening of a back wall of the inguinal channel. The last especially concerns patients with irregular shapes of hernias (slanting with the direct channel, combined, sliding, recurrent). Sometimes at extensive inguinal hernias, and also in case of repeated palindromias there is a need of creation of the new inguinal channel. Autoplastichesky reconstruction of walls of the channel is for this purpose carried out or additional plastic materials are applied. After the main stages of such operation the plastics of the inguinal channel is carried out. Today specialists use many methods of plastics.
At similar operation preservation of a physiological role and anatomic position of the inguinal channel is considered a main goal. Performance of all stages of operation with special care and scrupulousness guarantees the high level of the general vital quality for the patient further.
In some quite exceptional cases at people of advanced age it is carried out the inguinal channel. Before that to the person completely delete a small egg and a seed cord, and hernial gate are taken in.
Prevention of inguinal hernia
For prevention of inguinal hernia first of all it is important to strengthen an abdominal wall. For this purpose it is necessary to conduct correct and active lifestyle, constantly to carry out complexes of the physical exercises directed to improvement of the general condition of an organism, and also to training of muscles of a stomach. Also in the course of prevention of a disease the hardening is important. It is necessary to avoid too strong muscular exercises: it is very important to watch to lifting sharply strong weights, to try to avoid injuries. The special attention needs to be paid to healthy nutrition, to refuse completely smoking. The last point is important from the point of view of the prevention of cough which is characteristic of heavy smokers. Often during a severe cough hernias are formed and develop, causing complications further.
Women during pregnancy have to watch a body weight, eat healthy food for avoiding of locks. It is also desirable to carry a special bandage to prevent weakness of belly muscles, and after the delivery to do specially picked up gymnastics.
Good results bring regular jobs by swimming, fitness. Sharp obesity or weight loss also is the factor provoking developing of hernias. Therefore in the course of weight loss it is necessary to approach the matter elaborately, previously having consulted with the specialist.
One more important point in a question of prevention of developing of inguinal hernia – timely treatment of those diseases which consequence increase of intra belly pressure is. These are pulmonary diseases and colds which are accompanied by cough, a lock, urological illnesses leading to disturbances of an urination.