Last updated 11 Jan 2011
Inguinal hernias are quite common in men. They occur in the groin area and are well-known to be associated with improper lifting technique. A hernia of this type is when a piece of small intestines moves through a weakness in the muscular wall of the body. Most do not cause any symptoms like pain or discomfort, and most others cause only mild symptoms.
If a hernia is causing severe pain, or has visibly moved into the scrotum or canal between the abdomen and scrotum (known as the inguinal canal), then surgery may be essential. If sudden, sharp, unrelenting pain occurs in the groin area then emergency care should be sought, as the hernia is said to have incarcerated or gotten blocked. This can be life threatening in very rare cases and should NOT be ignored in hopes it will “go away on its own.”
Hernia Surgery and Its Problems
Many times a hernia is only detected during that annoying exam at the doctor’s office, or because of mild pain or bulging that goes away by just pushing. Though for many years it was believed surgery corrected all minor hernias without lasting bad effects, large studies say otherwise. In the biggest to date, over 700 men with very mild hernias were randomly either treated with either surgery or no treatment. After 2-4.5 years, there was no difference in pain levels or number of men who had acute blockages!
Rates of chronic pain after hernia repair surgery are often said to be as low as 5% by surgeons. The actual rates turn out to be more like 30-40% in studies in which thousands of men are sent questionnaires 1-3 years after surgery. Furthermore, most surgeons do not ask about sexual side effects of the procedure. One study found that of 1,015 Danish men who underwent hernia surgery, 22% had pain during sex for years afterward.
Once mesh is placed to keep intestines from herniating, it is also very difficult to remove later if there is a problem. There is also the nagging question of whether having a piece of plastic mesh in your body for several decades is a good idea, but no one seems to have assessed the long-term hazards.
Alternatives to Surgery
The main alternative to hernia surgery is to watch and wait. As noted in the large trial above, such watchful waiting was just as effective as surgery. The goal is simply to make sure pain isn’t progressing or that the hernia doesn’t get stuck and blocked.
Everyone should be careful how they lift. Breathe out, and lift using the knees and not the back. This prevents a build-up of pressure in the abdomen during lifting, which squeezes the intestines and can contribute to herniation. It’s a hard habit to get into but it pays major dividends, particularly since it is free.
Simply applying pressure with the hand over the weakened are when standing up or sitting down can also potentially help prevent herniation. It may occasionally be embarrassing to do but in private is a good habit to get into.
Hernia trusses, belts or supports are devices specially made to apply continuous pressure to the herniation area. These used to be very uncomfortable and not very effective, but now at least one company has developed a much better product (I have no connection with them). The Support Company in England (www.thesupportcompany-uk.com) can provide a custom-fitted, comfortable device known as the Flat Pad to prevent the need for surgery.
For herbal, hydrotherapy, and other suggestions that may help prevent a hernia from worsening or relieve minor pain, make an appointment with Dr. Yarnell today. He can also help you determine if you have a sufficiently severe problem that surgery is actually necessary.
References
Aasvang EK, Bay-Nielsen M, Kehlet H (2006a) “Pain and functional impairment 6 years after inguinal herniorrhaphy” Hernia 10(4):316-21.
Aasvang EK, Møhl B, Bay-Nielsen M, Kehlet H (2006) “Pain related sexual dysfunction after inguinal herniorrhaphy” Pain 122(3):258-63.
Fitzgibbons RJ Jr, Giobbie-Hurder A, Gibbs JO, et al. (2006) “Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial” JAMA 295(3):285–92.
Fränneby U, Sandblom G, Nordin P, et al. (2006) “Risk factors for long-term pain after hernia surgery” Ann Surg 244(2):212-9.