“The pain was intense”

Posted on 2 December 2021

A hernia occurs when an organ pushes through an opening in the muscle or tissue that holds it in place.

“It was a very sharp pain. I felt a strain in my abdomen and groin that made me wince and buckle over,” says Jason Brown, a 47-year-old editor. While renovating his house, Jason had stretched over to pick up a bag of cement. “It wasn’t too heavy, but I put all my weight on my right leg and my body was in an awkward position,” he recalls. Jason thought he’d simply strained a muscle. “It felt tender that night, but I thought it would subside after a few days.”

About a week later, he noticed a bulge on his lower abdomen when he stood up. “I also experienced discomfort when I bent over or picked up things. It was only when someone mentioned it could be a hernia that I went to my local GP. By this stage, I had started feeling increasingly uncomfortable and had stopped going to gym.” Although an ultrasound scan was inconclusive, Jason made an appointment with his urologist, who immediately made the diagnosis. It was an inguinal hernia on the right side of his groin.

Dr Ignatius Botha is a surgeon with a special interest in gastroenterology who is affiliated to Mediclinic Panorama. He explains that a hernia is a sac formed by the lining of the abdominal cavity (peritoneum). “The sac comes through a hole or weak area in the fascia, the strong layer of the abdominal wall that surrounds the muscle.”

Types of hernia

These are based on where they occur:

• Inguinal – appears as a bulge in the groin and is more common in men.
• Femoral – appears as a bulge in the upper thigh and is more common in women.
• Hiatal – occurs in the upper part of the stomach.
• Incisional – can occur through a scar if you’ve had abdominal surgery in the past .
• Umbilical – appears as a bulge around the belly button. It occurs when the muscle around the navel doesn’t close completely.

 

Hernias may be present at birth, Dr Botha adds, but the bulging may not be noticeable until later in life. This can happen when the lining around the abdominal organs does not close properly before birth. About five out of 100 children have inguinal hernias (more boys than girls). “Sometimes hernias occur with heavy lifting and some patients may have a family history of hernias.”

Your doctor should be able to confirm the presence of a hernia during a physical exam, although Dr Botha explains that in some cases an ultrasound might be required. “The mass may increase in size when coughing, bending, lifting, or straining. Surgery is the only treatment that can permanently fix a hernia. However, smaller hernias with no symptoms can sometimes be watched.”

 

Open surgery

Jason underwent open repair surgery to “mesh” the hernia tear. “It was a lot more intense than I’d expected,” he admits. I was limited to bed rest for two weeks, and when I began walking around, I felt very uncomfortable and tender. The wound itself healed quickly, but the bruising and tissue took way longer.”

Instead of open surgery, some hernias can be repaired using a laparoscope (camera). The advantages of using a camera include small surgical cuts, faster recovery, and less pain after the procedure.

Surgery secures the weakened abdominal wall tissue (fascia) and will close any holes, Dr Botha says. “Today, most hernias are closed with cloth patches to seal the holes. Although a hernia may only cause mild discomfort, it may get bigger and strangulate. This means the tissue is stuck inside the hole and its blood supply has been cut off. If this occurs, you will need urgent surgery.”

The good news is that the outcome is usually good with surgery and the likelihood of the hernia recurring is only 1-3 %. “In rare cases, inguinal hernia repair can damage structures involved in the function of a man’s testicles,” Dr Botha cautions. “Another risk of hernia surgery is nerve damage, which can lead to numbness in the groin area.”

Fortunately Jason suffered no complications and was back at work within three weeks. “Note to self: never rush to lift something heavy,” he quips.