Tag Archives: Inguinal hernia

Inguinal hernia

Description:
An inguinal hernia is a protrusion of abdominal-cavity contents through the inguinal canal. Symptoms are present in about 66% of affected people.
It occurs when tissue, such as part of the intestine, protrudes through a weak spot in the abdominal muscles. The resulting protrusion can be painful, especially when you cough, bend over or lift a heavy object, exercise, or bowel movements. Often it gets worse throughout the day and improves when lying down. A bulging area may occur that becomes larger when bearing down. Inguinal hernias occur more often on the right than left side. The main concern is strangulation, where the blood supply to part of the intestine is blocked. This usually produces severe pain and tenderness of the area.

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An inguinal hernia isn’t necessarily dangerous. It doesn’t improve on its own, however, and can lead to life-threatening complications. Your doctor is likely to recommend surgery to fix an inguinal hernia that’s painful or enlarging. Inguinal hernia repair is a common surgical procedure.

Sign & symptoms:
Hernias present as bulges in the groin area that can become more prominent when coughing, straining, or standing up. They are rarely painful, and the bulge commonly disappears on lying down. Mild discomfort can develop over time. The inability to “reduce”, or place the bulge back into the abdomen usually means the hernia is ‘incarcerated’ which requires emergency surgery.

Causes & Risk Factors:
There isn’t one cause for this type of hernia, but weak spots within the abdominal and groin muscles are thought to be a major contributor. Extra pressure on this area of the body can eventually cause a hernia.

*heredity
*personal history of hernias
*premature birth
*being overweight or obese
*pregnancy
*cystic fibrosis
*chronic cough
*frequent constipation
*frequently standing for long periods of time

Significant pain is suggestive of strangulated bowel (an incarcerated indirect inguinal hernia).

As the hernia progresses, contents of the abdominal cavity, such as the intestines, liver, can descend into the hernia and run the risk of being pinched within the hernia, causing an intestinal obstruction. If the blood supply of the portion of the intestine caught in the hernia is compromised, the hernia is deemed “strangulated” and gut ischemia and gangrene can result, with potentially fatal consequences. The timing of complications is not predictable. Emergency surgery for incarceration and strangulation carry much higher risk than planned, “elective” procedures. However, the risk of incarceration is low, evaluated at 0.2% per year. On the other hand, surgical intervention has a significant risk of causing inguinodynia, and this is why minimally symptomatic patients are advised to watchful waiting.

Diagnosis:
There are two types of inguinal hernia, direct and indirect, which are defined by their relationship to the inferior epigastric vessels. Direct inguinal hernias occur medial to the inferior epigastric vessels when abdominal contents herniate through a weak spot in the fascia of the posterior wall of the inguinal canal, which is formed by the transversalis fascia. Indirect inguinal hernias occur when abdominal contents protrude through the deep inguinal ring, lateral to the inferior epigastric vessels; this may be caused by failure of embryonic closure of the processus vaginalis.

Direct inguinal hernia: Enters through a weak point in the fascia of the abdominal wall (Hesselbach triangle)

Indirect inguinal hernia: Protrudes through the inguinal ring and is ultimately the result of the failure of embryonic closure of the processus vaginalis after the testicle passes through it.

In the case of the female, the opening of the superficial inguinal ring is smaller than that of the male. As a result, the possibility for hernias through the inguinal canal in males is much greater because they have a larger opening and therefore a much weaker wall through which the intestines may protrude.

A physical exam is usually all that’s needed to diagnose an inguinal hernia. Your doctor will check for a bulge in the groin area. Because standing and coughing can make a hernia more prominent, you’ll likely be asked to stand and cough or strain.

If the diagnosis isn’t readily apparent, your doctor might order an imaging test, such as an abdominal ultrasound, CT scan or MRI.

Treatment:

If your hernia is small and isn’t bothering you, your doctor might recommend watchful waiting. In children, the doctor might try applying manual pressure to reduce the bulge before considering surgery.

Enlarging or painful hernias usually require surgery to relieve discomfort and prevent serious complications.

There are two general types of hernia operations — open hernia repair and laparoscopic repair.

Open hernia repair:
In this procedure, which might be done with local anesthesia and sedation or general anesthesia, the surgeon makes an incision in your groin and pushes the protruding tissue back into your abdomen. The surgeon then sews the weakened area, often reinforcing it with a synthetic mesh (hernioplasty). The opening is then closed with stitches, staples or surgical glue.

After the surgery, you’ll be encouraged to move about as soon as possible, but it might be several weeks before you’re able to resume normal activities.

Laparoscopy:
In this minimally invasive procedure, which requires general anesthesia, the surgeon operates through several small incisions in your abdomen. Gas is used to inflate your abdomen to make the internal organs easier to see.

A small tube equipped with a tiny camera (laparoscope) is inserted into one incision. Guided by the camera, the surgeon inserts tiny instruments through other incisions to repair the hernia using synthetic mesh.

People who have laparoscopic repair might have less discomfort and scarring after surgery and a quicker return to normal activities. However, some studies indicate that hernia recurrence is more likely with laparoscopic repair than with open surgery.

Laparoscopy allows the surgeon to avoid scar tissue from an earlier hernia repair, so it might be a good choice for people whose hernias recur after traditional hernia surgery. It also might be a good choice for people with hernias on both sides of the body (bilateral).

Some studies indicate that a laparoscopic repair can increase the risk of complications and of recurrence. Having the procedure performed by a surgeon with extensive experience in laparoscopic hernia repairs can reduce the risks.

Prevention and Outlook of Inguinal Hernias:
Although you can’t prevent genetic defects that may cause hernias, it’s possible to lessen the severity of hernias by:

*Maintaining a healthy weight
*Eating a high-fiber diet
*Not smoking
*Avoiding heavy lifting

Early treatment can help cure inguinal hernias. However, there’s always the slight risk of recurrence and complications, such as infection after surgery, scars.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
https://en.wikipedia.org/wiki/Inguinal_hernia
http://www.mayoclinic.org/diseases-conditions/inguinal-hernia/home/ovc-20206354
http://www.healthline.com/health/inguinal-hernia?isLazyLoad=false#causes3

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Some Health Quaries & Answers

Q: I have male pattern baldness and want to correct it by some cosmetic procedure. I am in my twenties and not married yet. The baldness makes me look older.

A: There have been rapid strides in the treatment of baldness. Tired of applying minoxidil daily — which is often unsuccessful — people are increasingly turning to surgical solutions. Hair can be transplanted from the sides and back of the head to the front by micro hair transplantation. This is only an outpatient procedure, with local anesthesia. Otherwise a procedure called scalp reduction is used where strips of bald skin are surgically removed.

Phantom swelling :-

Q: I have a swelling in one scrotum which appears when I stand up and disappears when I lie down. This phantom swelling is not painful.

A: It looks like you have a “reducible inguinal hernia”. A part of the contents of the abdomen is sliding into an area called the inguinal canal. As long as the to and fro movement is free, there will be no pain. However, the contents can suddenly get stuck. And this is painful and dangerous. Before this occurs, consult a general surgeon who will surgically repair the hernia.

Jock itch:-     

Q: I have uncontrollable itching and redness in my groin area. I sometimes have to leave the room in the middle of a meeting to scratch.

A: It sounds like you have “Jock itch” or Tinea cruris, a fungal infection of the skin in the groin. This is more common in men and aggravated by diabetes and obesity. It can be treated by bathing twice a day using a soap such as Neko, drying the area well and then applying anti-fungal creams like terbafine or clotrimazole (which contain no steroid). Clotrimazole powder can be applied after using the cream. The infection takes around two weeks to heal, but the application should be continued for about a week after that to prevent a recurrence. Avoid wearing many layers of clothing, change sweaty clothes immediately and dry yourself thoroughly after a bath. Steroids either applied or ingested aggravate the infection.

Irritating cough :-    

Q: I am on Enalapril for the treatment of my hypertension. Ever since I started this, I have had an irritating cough. No matter how many different antibiotics I take, nothing works.

A: Antibiotics will not help in a cough unless it is caused by a bacterial infection. A constant cough without fever is more likely to be due to an allergen. Avoid mosquito repellents (mats, coils and liquids), room fresheners, agarbattis and camphor. Sometimes Eenalapril too can cause a cough. Try having vitamin C (500mg), half a tablet in the morning and evening. This often cures the cough.

Fair baby……..

Q: I am getting married soon and I would like to have a fair baby. What can I do?

A: Instead of concentrating on skin colour, it makes more sense to think “how can I have a healthy baby?” All girls should be immunised against hepatitis B (three doses) and rubella (German measles) before marriage. They need to take folic acid (5mg) every day to prevent defects in the baby’s brain and spinal cord. Walking or jogging for 40 minutes a day will build up stamina and strength in the legs, both of which are required for normal childbirth.

Painful periods :-

Q: I have severe pain during periods. What can I do?

A: Dysmenorrhoea is the medical name for painful periods. Some women suffer more than others. The tendency to develop pain runs in families. To tackle this, have an ultrasound examination of the pelvis to make sure there is no correctable cause for the pain. If everything is normal, taking medication like Mefenemic acid (500mg) three times a day for the first two or three days brings relief.

Regular diarrhoea :-

Q: My daughter has bloody diarrhoea all the time. Her paediatrician has given her a seven-day course of metronidazole, an antibiotic, and a single dose of albendazole.

A: The diarrhoea may be because of milk allergy. This is common and often undiagnosed. Check her stool for reducing substances. If this is positive, you have hit the nail on the head. Then try stopping milk completely for 48 hours and see if there is an improvement.

You may click to see:->Understanding and Managing Acute Diarrhoea in Infants and Young Children………..

Itchy skin :-

Q: I itch and scratch all over my body after a bath. What can I do?

A: You can :—………

• Purchase a “water treatment softening device” and fit it to your bath water supply. Fitting it for the whole house is expensive.

• Add a tablespoon of coconut oil to the bath water.

• Apply a mixture of five parts of coconut oil, five parts of sesame oil and one part of olive oil to your body. Wait for 10 minutes and then bathe.

• Use a mild soap like Dove

• Apply baby oil to the whole body after your bath.

Source: The Telegraph (Kolkata, India)

Hydrocele

A hydrocele is an accumulation of clear fluid in the tunica vaginalis, the most internal of
membranes containing a testicle. A primary hydrocele causes a painless enlargement in the scrotum on the affected side and is thought to be due to the defective absorption of fluid secreted between the two layers of the tunica vaginalis (investing membrane). A secondary hydrocele is secondary to either inflammation or a neoplasm in the testis.

Click to see the picture

A hydrocele usually occurs on one side. The accumulation can be a marker of physical trauma, infection or tumor, but the cause is generally unknown.

.Click to see the picture.

A hydrocele is a fluid-filled sac surrounding a testicle that results in swelling of the
scrotum, the loose bag of skin underneath the penis. About one in 10 male infants has a
hydrocele at birth, but most hydroceles disappear without treatment within the first year of life. Additionally, men  usually older than 40 can develop a hydrocele due to
inflammation or injury within the scrotum.

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Hydroceles usually aren’t painful. Typically not harmful, hydroceles may require no
treatment. However, if you have scrotal swelling, see your doctor to rule out other causes, such as testicular cancer or other conditions

Symptoms
A hydrocele feels like a small fluid filled balloon inside the scrotum. It is smooth, and is
mainly in front of one of the testes. Hydroceles vary greatly in size. Hydroceles are
normally painless and harmless. Large hydroceles cause discomfort because of their size. As the fluid of a hydrocele is transparent, light shone through a hydrocelic region will be
visible from the other side.

Symptoms of a hydrocele can easily be distinguished from testicular cancer, as a hydrocele is soft and fluidy, where a testicular cancer feels hard and rough.
Through diagnostic ultrasound the accumulation of fluids can be diagnosed correctly.

Causes:
For baby boys, a hydrocele can develop in the womb. At about 28 weeks of gestation, the
testicles descend from the developing baby’s abdominal cavity into the scrotum. A sac
(processus vaginalis) accompanies each testicle, allowing fluid to surround them.

In most cases, the sac closes and the fluid is absorbed. However, if the fluid remains after
the sac closes, the condition is known as a noncommunicating hydrocele. Because the sac is closed, fluid can’t flow back into the abdomen. Usually the fluid gets absorbed within a
year.

In some cases, however, the sac remains open. With this condition, known as communicating hydrocele, the sac can change size or, if the scrotal sac is compressed, fluid can flow back into the abdomen.

In older males, a hydrocele can develop as a result of inflammation or injury within the
scrotum. Inflammation may be the result of infection of the small coiled tube at the back of each testicle (epididymitis) or of the testicle (orchitis).

Risk factors
Most hydroceles are present at birth (congenital). Otherwise, the condition generally
affects men 40 or older. Risk factors include:

*Scrotal injury
*Infection
*Radiation therapy

Possible Complications

Complications may occur from hydrocele treatment.

Risks related to hydrocele surgery may include:

  • Blood clots
  • Infection
  • Injury to the scrotal tissue or structures

Risks related to aspiration and sclerosing may include:

  • Infection
  • Fibrosis
  • Mild-to-moderate pain in the scrotal area
  • Return of the hydrocele

When to seek medical advice
For yourself
See your doctor if you experience scrotal swelling. It’s important to rule out other
possible causes for the swelling, such as a tumor. Sometimes a hydrocele is associated with an inguinal hernia, in which a weak point in the abdominal wall allows a loop of intestine to extend into the scrotum and which may require treatment.

For your child
In infants, a hydrocele typically disappears on its own. However, if your baby’s hydrocele
doesn’t disappear after a year or if it enlarges, you may need to have it evaluated.

Diagnosis
Screening and diagnosis entails a physical exam, which may reveal an enlarged scrotum that isn’t tender to the touch. Pressure to the abdomen or scrotum may enlarge or shrink the
fluid-filled sac, which may indicate an associated inguinal hernia.

Because the fluid in a hydrocele usually is clear, your doctor may shine a light through the scrotum (transillumination). With a hydrocele, the light will outline the testicle,
indicating that clear fluid surrounds it. If your doctor suspects your hydrocele is caused by inflammation, blood and urine tests may help determine whether you have an infection, such as epididymitis.

The fluid surrounding the testicle may keep the testicle from being felt. In that case,
further study may be needed. Possible tests include:

Ultrasound imaging. This test, which uses high-frequency sound waves to create images of structures inside your body, may be used to rule out a testicular tumor or other cause of
scrotal swelling.
Abdominal X-ray. A basic X-ray uses electromagnetic radiation to make images of your bones, teeth and internal organs. An X-ray may distinguish a hydrocele from an inguinal hernia.

Other Complications
A hydrocele typically isn’t dangerous and usually doesn’t affect fertility. However, it may be associated with an underlying testicular condition that may cause serious complications:

*Infection or tumor. Either may impair sperm production or function.

*Inguinal hernia. A loop of intestine could become trapped in the weak point in the

abdominal wall (strangulated), a life-threatening condition.

Treatment
For baby boys, hydroceles typically disappear on their own within a year. If a hydrocele
doesn’t disappear after a year or if it continues to enlarge, it may need to be surgically
removed.

For adult males as well, hydroceles often go away on their own. A hydrocele requires
treatment only if it gets large enough to cause discomfort or disfigurement. Then it may
need to be removed.

Surgical excision (hydrocelectomy). . The procedure is called hydrocelectomy, the tunica vaginalis is excised, the fluid drained, and the edges of the tunica are sutured to prevent the reaccumulation of fluid.

If the hydrocele is not surgically removed, it may continue to grow. The hydrocele fluid can be aspirated, the procedure is less invasive but recurrence rates are high. Sclerotherapy, the injection of a solution following aspiration of the hydrocele fluid may increase success rates. In many patients, the procedure of aspiration and sclerotherapy is repeated as the hydrocele recurrs.

Needle aspiration. Another option is to remove the fluid in the scrotum with a needle. This treatment isn’t widely used because it’s common for the fluid to return. The injection of a
thickening or hardening (sclerosing) drug after the aspiration may help prevent the fluid
from reaccumulating. Aspiration and injection may be an option for men who have risk factors that make surgery more dangerous. Risks of this procedure include infection and scrotal pain.

Sometimes, a hydrocele may recur after treatment.

Outlook (Prognosis)

Generally, a simple hydrocele goes away without surgery. If surgery is necessary, it is a simple procedure for a skilled surgeon, and usually has an excellent outcome.

 

Homeopathic Treatment & Medicines of Hydrocoele –
Following homeopathic medicines are known to help in cases of hydrocoele – Apis, Aurum-met, Calc-c, Con, Flour-acid, Graph, Iod, Kali-iod, Puls, Rhod, Selen, Sil, Spong.

Hydrocele treatment: alternative therapy

Herbal Remedies of Hydrocele

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.mayoclinic.com/health/hydrocele/DS00617/DSECTION=1
http://en.wikipedia.org/wiki/Hydrocele_testis
http://health.nytimes.com/health/guides/disease/hydrocele/overview.html

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