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Taking the Strain away from hernia treatments

16 February 2018

“You’ll be giving yourself a hernia” – it is a common warning to someone seen to be lifting too much or overstraining themselves. 

But how do you really get a hernia, what are they and how are they treated? 

Mr David McArthur, a Consultant General Surgeon at Spire Parkway Hospital, who specialises in laparoscopic (keyhole) surgery to treat hernias, answers some often-asked questions about the condition and the treatments available. 

What is a hernia? 

A hernia usually refers to a defect in the abdominal wall muscle arrangement that allows structures normally contained within the abdomen, such as the bowel, to protrude through the abdominal wall. 

There are a number of different types of hernia, depending on where they occur, with the most common site being the groin (inguinal hernia), followed by the umbilical region. 

People might notice a lump or swelling at the site, which usually becomes more pronounced on standing and often disappears when they lie down. It can give symptoms of an ache or pain. 

How do you get them? 

They often occur due to situations that cause an increase in the intra-abdominal pressure, such as heavy lifting, prolonged coughing, straining due to constipation, or pregnancy. 

They are more common as people become older due to the abdominal muscles becoming weaker, and they are more likely to occur in people who are overweight.

Previous surgical incisions in the abdominal wall can also lead onto hernias, known as incisional hernias, and they can be associated with stomas (colostomy and ileostomy).  They are relatively common and can occur for no obvious underlying reason. 

Can they be avoided? 

To an extent they can be prevented from occurring by avoiding the situations that lead to their development. However, a lot of people will develop a hernia when there was nothing they could have done to prevent it from arising. 

Are they always painful? 

No, a large proportion of hernias cause no symptoms at all whilst some might result in an aching-type discomfort that is more noticeable throughout the day whilst people are standing.

Some, however, may cause significant pain, and this usually occurs either early in their development due to the “splitting” of the muscle, or thereafter due to something being stuck out through the hernia defect. 

Are people of a certain age more susceptible to getting hernias? 

Hernias are more common as people get older due to the muscles of the abdomen getting weaker.  However, they are commonly seen in young, fit people as well, including professional sportsmen and women. 

Another group of people who develop hernias are young children. These are usually “congenital” hernias, which arise due to the closure of the abdominal wall that normally occurs during development not completely happening. 

What are the treatment options? 

The first step is to get checked out by a doctor or a surgeon. If the hernia does not cause any symptoms, then one option is to manage it conservatively and do nothing. 

An alternative is to wear a support garment to keep things pushed back in, although these don’t tend to work particularly well. 

Traditionally, however, people with a hernia who are fit enough to have an operation have been advised to have that done to prevent the risk of developing a strangulated hernia (see below), which is a surgical emergency. 

Hernia operations can either be done using “traditional” open surgery, or through newer keyhole laparoscopic techniques. 

Not all hernias are suitable for keyhole repairs, but keyhole surgery has the advantage of less pain, reduced wound infections and quicker return to normal activity.  Most hernia repairs involve the placement of a synthetic mesh in the abdominal wall to reinforce it, a process that occurs due to the scar tissue the patient’s body generates in response to the mesh. 

How long does a typical operation take?

A typical groin hernia operation usually takes 30 to 45 minutes, depending on how big the hernia is and a number of other patient-related factors. 

Depending on the patient, what sort of results can be expected?

Hernia repairs are the most commonly performed general surgical operation, and the majority of people make a very good recovery. 

Depending on whether a hernia is repaired open or keyhole, most patients have their surgery performed under a general anaesthetic as a day case and are able to walk and get up and down stairs immediately after the operation.

Driving is usually possible a week to ten days post-op, once patients are able to get in and out of the car comfortably and perform an emergency stop. 

Return to heavier activities, such as gym work and heavy lifting is usually discouraged for about 5 to 6 weeks to allow the scar tissue to develop around the mesh and give the strength to the repair.

Although the majority of people have a good outcome, as with all operations there are risks. These include the risk of bleeding or bruising in the groin, a risk of infection, a chance of developing either numbness in the groin or long-standing pain (usually due to the effect of the repair on nerves that run through the area), or the risk of recurrence, which for a groin hernia repair is less than 1%. 

Is it likely that after surgery a hernia may occur in a different part of the body?

It is recognised that people who develop a hernia in one groin are more likely to subsequently develop one on the other side.  People who have ongoing predisposing factors, such as a long-standing cough or a job involving heavy lifting, are also more likely to develop one elsewhere. 

Are people ‘suffering in silence’?  Should they report to their GP quicker if they think they have a hernia? 

People are often concerned when they notice a lump that it could be something more sinister - such as cancer.  Usually, from a simple clinical examination, it is possible to diagnose a hernia and at the very least allay someone’s anxiety. Even if people are aware that they’ve developed a hernia, it is worth consulting their GP to discuss options for its treatment and consider referral to a surgeon to have it repaired. 

Can ignoring the fact for any length of time actually have unforeseen consequences?

Ignoring a hernia can lead onto a number of things:

  1. They can become bigger and give more symptoms. They are often more difficult to repair when they are bigger.
  2. They may cause more symptoms of pain and discomfort. 
  3. There is a risk, with any hernia, of something coming out through the hernia defect, usually a bit of small bowel, which becomes stuck in the hernia (known as incarceration). This can lead to a restriction to the blood supply to the piece of bowel (strangulation), which is a surgical emergency and often requires a bigger operation than just a hernia repair to resolve.  Therefore, most people with a hernia should consider having it repaired as a planned operation. 

How quickly could I have a consultation, and how much would it cost? 

It depends on the availability of the consultant you wanted to see, but we pride ourselves on getting you fast access to diagnosis and you can often get a consultation within 24 to 48 hours. Initial consultation fees vary by consultant, but between £175-£250 is a reasonable guide. 

If I need surgery, how quickly could I have it? 

We have no waiting lists at Spire Parkway, but again it depends on the availability of the consultant you wanted, but as a guide, and subject to your pre-operation assessment, between one and two weeks. 

I don’t have health insurance, can I self-pay? 

Yes, you can. Our self-pay team can talk you through this and explain the finance options that are available, should you wish to explore them. Call 0121 704 5530, or email info@spirepakway.com.

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