Among the various abdominal hernias, inguinal hernia (IG) is the most common.

It is characterized by protrusion of various organs located in the abdominal cavity into a slit-like gap as a result of separation of muscle tissue in the groin area.

The structure of the hernial sac consists of the mouth, neck, body and bottom. Formed from parietal thin sheets of peritoneum. Can be filled with various intraperitoneal organs:

• large seal;
• part of the small, cecum, or sigmoid colon;
• vermiform appendix;
• bladder;
• female genital organs.

In this material we will look at an inguinal hernia: we will look at the photo, and also find out the symptoms and methods of treating this problem in men.

Provoking factors

There are many reasons for the formation of a hernial protrusion in the groin:

• the influence of heavy physical work;
• prolonged, reflex cough;
• a consequence of gastrointestinal dysfunction;
• acute urinary retention;
• anomalies in the anatomical structure of the posterior wall of the canal;
• closed abdominal injuries;
• weak muscular aponeurotic layers of the abdominal wall.

Types of GHGs

According to anatomical characteristics, they are:

• oblique;
• straight;
• combined.

1. 1) In the initial stage, the protrusion can be easily felt when the patient coughs or has abdominal tension.
2. 2) In the second stage, a canal protrusion develops, located at the very opening of the inguinal gap.
3. 3) The third stage is characterized by the formation of an oblique hernia located along the canal through the lateral fossa;
4. 4) The fourth stage is characterized by the descent of the hernial contents into the scrotum.

Oblique type PG

In the process of enlarging the hernial sac, the gap in the transverse muscle expands towards the epigastric vessels, pushing them inward. The expansion of the hernial opening more medially than usual causes weakening and good expression of the vascular and muscular lacunae in the posterior wall of the canal.

1) Congenital types of PG in men are caused by the gradual descent of the fetal testicle into the musculocutaneous scrotum. Before birth, the testicle must reach the bottom of the scrotum, and the exit behind it closes. If this does not happen, fragments of the abdominal organs can penetrate into the open passage of the musculocutaneous scrotum, forming a congenital form of inguinal hernia.

Neglected processes cause an enlargement of the hernial sacs, as a result of which the musculocutaneous scrotum stretches and increases in size, hiding the genital organ under the skin. Independent correction of such a formation is impossible. When trying to reduce it, rumbling sounds are heard in the intestines.

2) Purchased types of PG are caused by the formation of protrusion of organs located in the abdominal cavity, in a closed peritoneum, passing from the internal to the external opening of the canal.

Inguinal hernia in men photo:

Variety

1. 1) The location of the hernial sacs in the posterior inguinal space is classified as inguinal-intermediate types of hernial formations;
2. 2) Two-chamber formations that communicate with each other and lie in different places - located in the canal itself and in the parietal tissue - belong to the inguinal-preperitoneal type.
3. 3) Inguinal-superficial appearance - has two capsules, is located in different places and lies in different directions - in the canal itself and under the skin of the fascial sheath, in the bundle of the external oblique muscle.
4. 4) Ensacculated PGs are two hernial sacs enclosed within each other.
5. 5) Peri-inguinal - characterized by penetration into the subcutaneous fatty tissue.

Direct PG

The combined type of PG includes anatomically different hernial sacs in its classification.

Another type of hernia, up to 2% of formation, is a sliding type of hernia, one wall of which is adjacent to a nearby organ that is not covered by the peritoneum.

Types of localization of PG in men

1. 1) With bilateral localization - characterized by the same or different size protrusion in the peritoneum on both sides of the inguinal or scrotal areas.
2. 2) Left-sided localization of PG - manifests itself due to the anatomical features of the peritoneum. A protrusion on the left side can be from the internal organs - the intestines or bladder, the greater omentum or the ovaries.
3. 3) Right-sided protrusions are a consequence of a pressure imbalance between the surrounding muscles and internal organs. First, depressions are formed in the abdominal cavity, followed by the introduction of intestinal loops, omentum or bladder into it, increasing local pressure.

Symptoms of inguinal hernia in men

• tumor-like protrusion;
• pain;
• belching and nausea;
• constipation or frequent urination;
• feeling of discomfort and burning in the groin.

Probability of consequences

In addition, infringement is fraught with various complications such as:

• acute urinary retention;
• dysfunctions of the gastrointestinal tract;
• constipation and;
• potency disorder;
• disruption of spermatogenesis, which leads to.

Treatment of inguinal hernia in men

The only effective treatment for inguinal hernia in men is surgical intervention. Now the operation is performed mainly by the laparoscopic method, using 3-4 punctures in the lower abdomen the size of a pencil in diameter, or the old-fashioned way, through a regular incision in the groin. It all depends on the desire of the man, the presence of contraindications and financial capabilities.

A regular operation can be performed under local anesthesia, but during laparoscopy only general or combined anesthesia is used. In any case, the person remains unconscious during the entire operation. Because of this, some people prefer a standard incision under local anesthesia, as they are afraid of the “come-off” from a stronger anesthesia.

1. 1) Surgical intervention is carried out using the necessary techniques for a given case, created by various authors;
2. 2) The most effective method is to surgically create supporting folds or plastic the posterior wall of the canal using a special mesh;
3. 3) Herniotomy operation using abdominal wall plastic surgery;
4. 4) Congenital types of PG are treated using intraperitoneal and extraperitoneal approaches of laparoscopic hernioplasty.

In addition, it is possible to use a special bandage that will support the PG and prevent it from falling out. However, this is a temporary measure, because the hernial orifice cannot be closed in this way, and as soon as you remove the bandage, the inguinal hernia will come back out. Therefore, it is impossible to do without surgery.

Operations performed for inguinal hernia

1. 1) Operation using the Lichtenstein method. The idea is to strengthen the posterior wall of the inguinal canal with a specialized mesh. Strengthening is done behind the spermatic cord. This technique has its undeniable advantages among other methods of treatment and is “classical”. The main advantages of the Lichtenstein operation include: an extremely low relapse rate (close to zero), a short rehabilitation period, minimal risk of traumatic injury to the urinary tract, as well as minimal possibility of developing postoperative complications from the cardiovascular and respiratory systems, mild pain syndrome, the ability to perform surgery under local anesthesia;
2. 2) Operation Trabucco. It is one of the modifications of the Lichtenstein method. More often, it uses a one-component flat prosthesis, which is not fixed with sutures (there is no need for suturing due to the high rigidity of the mesh material);
3. 3) Endoscopic hernioplasty. This technique is performed under the mandatory supervision of specialized endoscopic equipment. The reinforcing mesh can be installed using abdominal preperitoneal or extraperitoneal methods. In the first case, the mesh is located between the muscular aponeurotic layer and the peritoneum itself. In the second case, the intervention is performed without penetrating the abdominal cavity: a mesh is installed between the peritoneum itself and other layers of the anterior abdominal wall. The main advantages of such an intervention are: the ability to simultaneously assess the situation from both sides, a low percentage of possible relapse, mild pain, minimal size of surgical incisions (punctures) and postoperative scars, fast rehabilitation, the ability to perform physical activity a short time after the operation;
4. 4) Obstructive hernioplasty. A feature of this type of treatment is the obturation of the hernial orifice with a mesh prosthesis. Stitching is not used to strengthen the inguinal canal. This operation, like the previous one, allows you to control the progress of the manipulations performed on both sides. In addition, it has a short postoperative period, the ability to perform physical exercises several days after the treatment, a low rate of relapse, and minimal pain;
5. 5) Application of UHS, PHS systems. Obturation of the hernial orifice is performed using implants made of semi-absorbable or polypropylene materials. For the purpose of obturation, a monoblock implant is used. It has 2 parts: one of them is attached to the preperitoneal space, and the second is somewhat lateral (between the layers of the anterior abdominal wall).

Which doctor should I contact for treatment?

In order to understand what an inguinal hernia is, you need to understand the very concept of “hernia”. A hernia is a protrusion of an organ or part of it under the skin, into the intermuscular space or some cavity through various openings. Abdominal hernias are the most common type of hernia, in which abdominal organs emerge under the skin through openings called hernial orifices. The peritoneum, which is the membrane for the abdominal organs, forms the so-called hernial sac.

An inguinal hernia is a fairly common disease in which a portion of the peritoneum protrudes into the inguinal canal. According to statistics, inguinal hernia occurs 10 times more often in men than in women, which is due to the peculiarities of the anatomical structure of the groin area in men. However, cases of inguinal hernia in women are not so rare. The disease usually occurs in women who have given birth several times. The appearance of a hernia can be caused by obesity, chronic cough, constipation, pregnancy, and excessive sudden physical activity.

Symptoms of inguinal hernia

The clinical symptoms of the disease depend on the size of the hernia and which organ is located in it.

A typical sign of an inguinal hernia is the appearance of a rounded protrusion in the groin area, which resembles a tumor. This formation increases slightly with straining or coughing. It often happens that the protrusion does not cause the patient practically any inconvenience, and therefore he does not pay any attention to the hernia.

Pain in the lower abdomen and groin, radiating to the lumbar region and sacrum, clearly manifested during physical activity, is a sign characteristic of this type of hernia. With a long-standing inguinal hernia or its large size, the pain is constant. In women, when the ovary and fallopian tube are in the hernial sac, the pain may intensify during menstruation. In addition, a hernia can cause discomfort when walking.

Another symptom that often accompanies this disease is chronic, sometimes accompanied by bloating. This occurs when it enters the hernial sac of the cecum.

Inguinal hernia strangulation

This condition develops as a result of sudden compression of the contents of the hernial sac in the hernial orifice. There are two mechanisms of infringement:

The elastic mechanism is the sudden entry of a large number of abdominal viscera into the hernial sac through a narrow hernial orifice. This can occur with a sharp increase in intra-abdominal pressure (for example, with sudden physical stress).

Fecal strangulation occurs as a result of overflow of the intestinal loop, which is located in the hernial sac, with contents.

A strangulated inguinal hernia is manifested by sharp, severe pain in the abdomen. The protrusion, which previously could be straightened without effort, becomes irreducible and tense. Often this condition is accompanied by fever, nausea, vomiting and stool retention.

If an inguinal hernia is strangulated, emergency surgery is necessary.

Treatment of inguinal hernia

Treatment of this disease can only be surgical. No medications or other conservative treatment methods can eliminate hernial protrusion and hernial orifices. If you suspect an inguinal hernia, you should consult a doctor who, if the diagnosis is confirmed, will most likely recommend elective surgery. Strangulation of the hernia should not be allowed, since severe complications may develop as a result.

During the operation, the surgeon opens the hernial sac, inserts the internal organs into the abdominal cavity and sutures the hernial orifice. In most cases, for small hernias, the operation is performed using local anesthesia. If the hernial protrusion is large or a strangulated hernia has developed, conduction anesthesia (epidural, spinal) or general anesthesia is used.

Usually this operation is well tolerated by patients, and the very next day after it they are allowed to get up and walk. If there are no complications in the postoperative period, discharge from the hospital is made 3–4 days after surgery. However, patients who have undergone surgery for an inguinal hernia must remember that physical activity must be avoided for at least 2 months after the operation.

Prevention of inguinal hernia

The occurrence of an inguinal hernia can be prevented. To do this, it is necessary to strengthen the abdominal wall and avoid extreme physical activity.

You need to regularly perform physical exercises aimed at training your abdominal muscles. It is necessary to avoid conditions that can lead to a sharp increase in intra-abdominal pressure (constipation, cough). Pregnant women are recommended to wear a special bandage and do gymnastics after childbirth. The fight against obesity also plays a big role in the prevention of inguinal hernias.

Which doctor should I contact?

If an inguinal hernia occurs, it is necessary to be observed and treated by a surgeon.

An inguinal hernia is a disease in which a tumor-like protrusion of internal organs occurs into a kind of pocket formed as a result of separation of the layers of the peritoneum in the groin area. Most often it is unilateral in nature and is manifested by pain of varying intensity, a feeling of discomfort, heaviness, and burning in the groin area.

The pathology is one of the most common of all hernias of the anterior abdominal wall. Most often, men suffer from the disease (5 times more often than women). This is due to the fact that the inguinal canal is one of the weakest anatomical formations of the anterior abdominal wall.

The main elements of a hernia: the inguinal canal (hernial orifice), the parietal peritoneum (hernial sac) and the abdominal organs, most often the omentum and intestines (hernial contents). Inguinal hernias account for 75 to 80% of all external abdominal hernias, of which 90–95% are inguinal hernias in men. In 85% of cases, indirect inguinal hernias are acquired, in 15% they are congenital.

Based on their origin, inguinal hernias are divided into:

• Congenital. The disease develops as a consequence of non-fusion of the peritoneal intussusception after intrauterine descent of the testicle into the scrotum. With complete nonunion, the testicle will be located in the hernial sac. With this type of inguinal hernia, men may experience undescended testicles into the scrotum (cryptorchidism).
• Purchased. Appears as a result of the influence of a number of factors.

The main difference is the location of the testicle. If it is close (outside) to the hernial sac, then it is an acquired hernia; with the congenital nature of the disease, the testicle is located in the hernial sac.

Based on anatomical characteristics and depending on the location and nature of formation, the following types of inguinal hernias are distinguished:

• Direct - is acquired in nature and most often occurs in older people. A characteristic feature of this type of hernia is that the internal organs enter the inguinal canal through the medial inguinal fossa outside the spermatic cord. The main reason for the formation of pathology is the presence of a wide inguinal gap and weakness of the posterior wall of the inguinal canal. The hernia can be incomplete or complete (the protrusion remains within/extends the inguinal canal). The protrusion is round, often bilateral, reaching large sizes in rare cases.
• Oblique - characterized by unilateral localization and most often is congenital, although it can appear at any age. The protrusion is located either from the elements of the spermatic cord outward, or its elements can fit the hernial sac on all sides.
• Combined - characterized by anatomically different multiple hernial sacs (quite rare).
• Sliding - the walls of the hernia adjoin the adjacent organ (this is one of the most dangerous types of the disease).

Causes of inguinal hernia in men

There is no single cause of inguinal hernia; it can occur in different age categories at any time.

Discomfort appears when the inguinal hernia increases significantly in size. An important role is played by the size of the hernial protrusion and the organ located in it.

Factors that can provoke the appearance of inguinal protrusion in men include:

• prostate pathology;
• hereditary factor (presence of this disease in close relatives);
• congenital disorders of connective tissue, consisting in its weakness;
• excess body weight (contributes to increased intra-abdominal pressure);
• dysfunction of the gastrointestinal tract (lead to increased load on the anterior abdominal wall);
• abdominal wall muscle injuries;
• hard physical work;
• chronic cough (provokes increased intrauterine pressure).

The risk group also includes premature babies, who are more likely to develop an inguinal hernia in adulthood.

There are 4 stages in the development of pathology.

1. Initial – a tumor-like protrusion forms in the groin area as a result of overexertion.
2. Canal - characterized by protrusion of the hernial sac at the very opening of the inguinal canal, acting as a hernial orifice.
3. Actually inguinal hernia - the hernial contents extend beyond the inguinal canal.
4. Inguinal-scrotal hernia - the contents descend through the spermatic cord into the scrotum.

Clinical symptoms of inguinal hernia in men, depending on the stage of the disease, may appear gradually or suddenly sharply worsen. The main sign of the initial stage of the disease is a small protrusion in the groin area, which disappears in a supine position and becomes practically invisible in appearance. This pathology proceeds relatively favorably, pain is insignificant. It can be detected during a visual examination of the patient.

Discomfort appears when the inguinal hernia increases significantly in size. An important role is played by the size of the hernial protrusion and the organ located in it. A man may experience painful sensations that increase with loads and tension, pain in the lumbar region, and dysuric disorders. Possible disruption of the digestive system. In addition, a strangulated inguinal hernia can cause hyperthermia, weakness, malaise, vomiting, and acute pain.

Diagnostics

Diagnosis of the pathology is not particularly difficult and includes examination by a surgeon, instrumental and laboratory research methods.

Timely detection of pathology and early surgical treatment of an inguinal hernia is the prevention of its strangulation.

Instrumental methods

• Ultrasound (ultrasound examination) of the inguinal canals: will allow you to determine some features of the hernial sac, its contents, size and position, especially if the formation is small.
• X-ray with contrast agent: the method involves injecting a radiopaque solution into the hernial sac to determine the hernial contents, the size of the gate and the inguinal canal.
• Laparoscopy: allows a definitive diagnosis to be made in difficult cases.

Laboratory methods

• general blood test (clinical);
• general urine analysis;
• blood chemistry.

It is necessary to differentiate inguinal hernias from hydrocele, lymphadenitis, hydrocele of the testicle and spermatic cord, femoral hernia and other similar conditions.

Treatment

Treatment of inguinal hernia in men is carried out using surgery. There is no alternative to surgical treatment of hernias. Bandages, special gymnastics and other conservative methods of therapy in the treatment of hernia are ineffective. They are usually prescribed for serious contraindications to surgery or are indicated for men in the form of prevention of organ prolapse into the hernial sac.

Inguinal hernia surgery in men (hernioplasty) is performed in several options, the selection of which takes into account the specific topography of the inguinal canal, the location of the hernia, and the size of the hernial orifice.

Basic methods:

• endoscopic hernioplasty - performed through small punctures. The doctor excises the hernial sac and installs a mesh to strengthen the surface of the abdominal wall. After the operation, small scars remain;
• obstructive hernioplasty (according to Linchenstein) – has a very low probability of relapse. The essence of the method is to remove the hernial sac through small incisions in the skin, followed by implantation of a composite surgical mesh.

Removal of an inguinal hernia in men reduces the likelihood of relapse of the disease (less than 1%).

Complications

Complications of a hernia include strangulation. A strangulated inguinal hernia restricts blood flow to the small intestine, causing necrosis. Compressed or strangulated hernias are life-threatening and require emergency medical attention.

The following symptoms indicate infringement of internal organs:

• nausea;
• lack of bowel movements and gases, bloating;
• blood in stool;
• sharp pain;
• inability to reduce the hernia into the abdominal cavity even with a horizontal body position.

After surgical treatment, postoperative complications may occur, which depend on many factors, including the physiological characteristics of the body and compliance with medical recommendations.

Possible early consequences of the operation include:

• swelling and pain;
• inflammation of the postoperative wound due to infection;
• the appearance of a hematoma in the groin area and scrotum;
• divergence of seams.

At a later period, you may experience:

• thromboembolic complications;
• postoperative dropsy of the testicles due to damage to their membranes;
• repeated bulging of a hernia in the groin, as a result of violation of bed rest during the rehabilitation period;
• development of infertility.

Features of inguinal hernia in children

The disease is often observed in children, especially premature ones, and is predominantly congenital in nature. In childhood, hernias are usually oblique, and the frequent contents of the hernial sac in boys are the cecum or bladder. Adolescents are diagnosed with congenital and acquired hernias.

The clinical picture of an inguinal hernia in children is not much different from adult symptoms and requires immediate medical attention if there is a risk of strangulation of internal organs.

Features of inguinal hernia in older people

Treatment of inguinal hernia in patients of this age category has its own characteristics. In chronic diseases of the respiratory and circulatory organs, urinary, endocrine, and digestive systems, a periodic increase in intra-abdominal pressure is observed, which contributes to hernia formation. Severe postoperative complications occur much more often in older people than in young people, which is also a risk factor.

Clinical symptoms of inguinal hernia in men, depending on the stage of the disease, may appear gradually or suddenly sharply worsen.

Contraindications for elective surgery are:

• heart attack;
• acute form of ischemic disease;
• Stage III hypertension;
• heart failure;
• severe diabetes;
• oncological diseases.

Forecast

The prognosis for surgical treatment is favorable.

Preventive measures

Timely detection of pathology and early surgical treatment of an inguinal hernia is the prevention of its strangulation.

• healthy eating;
• active lifestyle;
• weight normalization;
• rational approach to lifting weights.

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An inguinal hernia is a common pathology, which is accompanied by protrusion of organs through the inguinal canal. The disease causes discomfort and pain in patients. Complications of an inguinal hernia in men can have irreversible consequences. The disease must be prevented, as well as promptly detected and treated.

Complications are accompanied by specific symptoms and are divided into several types. The doctor’s main task is to determine the type of pathology and select the correct method of therapy. There are general and postoperative complications. Each of them has a complex mechanism and can lead to permanent disorders in the male body.

Inflammation

The inflammatory process is accompanied by a sharp rise in body temperature, pain and tension in the groin area, and symptoms of intoxication. In most cases, the source of inflammation is hernial appendicitis, but there are other ways of damaging the contents of the hernial sac:

1. Trauma leading to the accumulation of exudate and the formation of adhesions.
2. Transition from the skin to inflammation that has developed due to long-term wearing of the bandage.
3. Tuberculous lesion.

Infringement

One of the most common complications of an inguinal hernia is strangulation; it is characterized by various symptoms depending on the contents of the hernial cavity. Most often, compression of the intestines occurs; in rare cases, a greater omentum is found in the sac. Symptoms of the pathology include pain, the presence of a defect and tension. Infringement leads to compression of the sac and disruption of blood flow to its contents, resulting in tissue necrosis.

The causes of complications are:

1. Increased intra-abdominal pressure associated with exercise, constipation, prolonged cough and difficulty urinating.
2. Weakness of the abdominal muscles.
3. Intestinal atony.
4. Injuries and operations.

Peritonitis is a life-threatening condition for the patient. It occurs when the inflammatory process spreads to the peritoneum or perforation of a section of the intestine. Pathology can lead to the development of shock and intestinal paresis. Acute appendicitis in patients with strangulation is observed in rare cases. To preserve human health, the operation is performed on an emergency basis.

Damage

Trauma to the contents of the hernial cavity is possible. Closed injuries are detected late and lead to deterioration of the patient's condition. Open injuries are detected immediately, and the patient is given the necessary assistance. Untimely treatment leads to thrombosis, the spread of the inflammatory process and the development of peritonitis.

Irreversibility

Loops of intestine enter the inguinal canal due to the weakness of its walls. In many cases, organs can be reset on their own. However, when parts of the intestine and the hernial sac grow together, irreducible hernias occur. One of the reasons is long-term use of the bandage. The condition does not bother the patient at first, and the disease progresses slowly. Then signs of strangulation, intestinal obstruction and impaired blood circulation appear.

Intestinal obstruction

Intestinal obstruction is accompanied by nausea, bloating and cramping pain. It occurs due to compression of the intestinal loops in the cavity of the hernial sac, which leads to disruption of the movement of feces. The cause of the condition is an increase in intra-abdominal pressure, provoked by various factors. If left untreated, peritonitis, necrosis and coprostasis occur.

Coprostasis

Coprostasis is accompanied by blockage of a section of the intestine in the hernial cavity with feces, which disrupts intestinal patency and leads to the development of constipation. The progression of this condition causes strangulation of the hernia and poor circulation. The patient in such cases complains of general malaise, nausea, dry mucous membranes and disturbances in the activity of the heart. He is indicated for urgent surgery. Removing the hernial sac and releasing its contents normalizes intestinal motility.

Hypogonadism

Long-term progression of an inguinal hernia may be accompanied by impaired reproductive function, since the contents of the hernial cavity descend into the scrotum and can compress the testicles. As a result, tissue nutrition necessary for the production of male sex hormones and spermatogenesis is disrupted. Lack of therapy threatens the development of infertility, so the patient in such cases is indicated for surgical intervention.

If left untreated, a man may lose the opportunity to have children. The defect can only be eliminated through repeated surgery.

Hernia recurrence

A common cause of relapse is non-compliance with doctor's recommendations after surgery. If the regime and diet are violated, repeated protrusion of organs is possible due to the weakness of the walls of the inguinal canal.

The lack of professionalism of doctors can also play a negative role; relapse occurs when the walls of the inguinal canal are unreliably strengthened during surgery.

Repeated surgery results in a longer recovery period and more often leads to complications.

Infectious complication

Infection can occur when a large area of ​​tissue is injured during surgery. This contributes to the accumulation of fluid, the formation of cavities and fistulas. When operating on a recurrent hernia, foci of infection may go unnoticed. The spread of pathogenic agents can cause septic shock. The patient is prescribed antibacterial therapy using broad-spectrum drugs.

Diagnostics

The most informative method is ultrasound, which helps determine the size and position of the hernia. Depending on the nature of the contents of the hernial sac, additional visualization methods are prescribed.

To perform herniography, local anesthesia is used. A contrast agent is injected into the abdominal wall, which enters the hernia cavity and is visualized on x-rays. Using herniography, not only the size of the hernia is determined, but also the level of risk of possible complications.

Treatment of inguinal hernia

Conservative therapy does not bring the desired result. In this case, the hernia progresses, adhesions develop, and the contents of the hernial sac grow together with its walls. That's why patients undergo surgery.

Bandage

In the period before surgery, patients wear a bandage, which prevents the hernia from enlarging and causing complications. The bandage consists of a rigid plate; it can be either one-sided or two-sided. To be effective, it must be worn constantly, so it will keep the internal organs from protruding.

Operation

The main treatment method is surgery. Hernia repair is carried out using various methods; its goal is to radically eliminate the hernial sac and close the hernial orifice. The surgeon chooses a technique depending on the location of the hernia, its structure and size.

During open surgery, one large incision is made. Access to the inguinal canal can be extraperitoneal, intraperitoneal or combined. The operations are performed under local anesthesia and have a longer recovery period.

Endosurgery opens up new possibilities in the treatment of inguinal hernias. After operations, small scars remain instead of extensive cosmetic defects. During laparoscopy, 3 incisions are made to insert the laparoscope and manipulators. The laparoscope displays an image on a monitor, which is monitored by a doctor.

For plastic surgery of the walls of the inguinal canal, tendon plates of the patient's oblique abdominal muscle or artificial meshes are used. The graft used can be absorbable or non-absorbable.

The effectiveness of treatment depends on the professionalism of the surgeon and the correct behavior of the patient in the postoperative period.

How to avoid complications

In the first days of the postoperative period, the patient is prescribed bed rest. The first month it is forbidden to perform physical exercises, since during this time the implant is overgrown with connective tissue and the wound heals completely.

Wearing a bandage speeds up the recovery process and allows you to quickly return to a normal lifestyle.

The patient is recommended physical therapy and special exercises to strengthen the muscles of the groin area. The complex is selected individually for each patient, the classes become more complex gradually. To prevent complications, you must follow all recommendations of your doctor.

Diet

One of the causes of complications in the postoperative period is disruption of the intestines. Proper dietary therapy prevents constipation and facilitates bowel movements. It is recommended to exclude soda, smoked foods, cabbage, and dishes with excess spices. The most beneficial is liquid food, rich in microelements and vitamins. The patient needs to eat often, but in small portions.

Disease prevention

To prevent the disease, it is necessary first of all to prevent an increase in intra-abdominal pressure:

1. Strengthen your abdominal muscles. It is recommended to engage in physical therapy and gymnastics.
2. Prevent constipation with diet therapy and laxatives.
3. Take antitussive medications for severe paroxysmal cough.
4. Avoid excessive physical activity.

It is easier to prevent any pathology than to treat it. A healthy lifestyle allows you to maintain the normal functioning of your internal organs.

Content

Already the first symptoms of an inguinal hernia in men indicate that the disease must be urgently treated with conservative therapy or surgery, otherwise it can lead to serious consequences. The disease is the emergence of various abdominal organs into a slit-like gap due to muscle separation in the groin area. A hernia can be an acquired or congenital pathology. In the groin area it is one of the most common.

What is an inguinal hernia in men

With this disease, the walls of the abdominal cavity weaken, due to which they can no longer hold the internal organs in place. One of the weak parts in this area is the inguinal canal. It is a gap through which the spermatic cord passes. It lasts from the deep inguinal ring to the superficial one, from where, under certain conditions, the abdominal organs protrude.

What does it look like

The first sign of this pathology is the appearance of a swelling in the groin area, which changes in size. It may disappear when lying down. When changing position, the swelling appears again. The same happens when coughing, going to the toilet and during physical activity. The size of the protrusion can be very small, about the size of a nut, as shown in the photo, or reach larger dimensions.

Symptoms

In addition to a protrusion in the lower abdomen, in the pubic area, a hernia in the groin can manifest itself as a number of other symptoms. The patient is bothered by minor pains that quickly pass, so the person simply does not pay attention to them. Inguinal hernial protrusion is accompanied by other symptoms:

• flatulence;
• belching;
• constipation;
• frequent urination;
• burning in the groin area;
• swelling and pain in the scrotum;
• heaviness and squeezing sensation in the groin.

Pain

In the first stages, the pathology does not cause pain. For this reason, many patients consult a doctor already at an advanced stage. The presence or absence of pain is determined by the complexity of the developed pathology. Some patients complain of a burning sensation that gets worse after exercise. Others experience tingling and dull pain. With a significant increase, protrusions can increase

First signs

A small swelling in the groin area is the first sign. Over time, it gradually increases. Against this background, the following symptoms may occur:

• change in size and shape of swelling during physical activity;
• burning in the groin area;
• It's a dull pain;
• discomfort when walking;
• feeling of fullness in the lower abdomen.

Causes

A hernia in men can be congenital or acquired. In the first case, the pathology is formed inside the womb. Acquired ones develop as a result of weakening of the peritoneal muscles. The causes of this pathology are:

• changes in connective tissue with age;
• consequences of surgical interventions on the abdominal cavity;
• muscle weakness as a result of systemic diseases;
• a state of prolonged increased intra-abdominal pressure due to work associated with heavy lifting, obesity, constipation or prolonged cough;
• sedentary lifestyle.

Forms of the disease

Depending on the location, hernias in the groin in men can be right- or left-sided or bilateral. They are also reducible and irreducible. In the first case, the protrusion may disappear due to slipping back into the abdominal cavity. When the hernial sac is already fused with the contents, it becomes irreducible. Taking into account the peculiarities of the anatomical structure, the pathology can be:

1. Oblique. It can be acquired or congenital inguinal hernia. Its contents are located along the inguinal canal inside the spermatic cord. Canal, cord and inguinal-scrotal hernia in men are types of oblique inguinal hernia.
2. Straight. Such a hernia can only be acquired. The protrusion of the peritoneum in this case is located outside the spermatic cord and passes through the inguinal space.
3. Direct interstitial, or subcutaneous. Here the hernial sac does not descend into the scrotal cavity, but is located in the subcutaneous tissue of the aponeurosis of the external oblique muscle.
4. Combined. This type of hernia is very complex in terms of anatomy. It consists of several hernial sacs.

Why is an inguinal hernia dangerous in men?

The most dangerous thing happens when a hernia in a man’s groin becomes pinched. Then the contents of the hernial sac are compressed. This condition is dangerous, because strangulation reduces the flow of blood into the intestines or stops the movement of contents through it. There is no talk of hernia reduction here. Due to poor circulation, it becomes red-violet or blue-purple in appearance. This is a reason for immediate surgical intervention. A pinched hernia threatens men with dangerous complications, such as:

• complete cessation of blood flow in the strangulated loops, their necrosis;
• intestinal obstruction;
• self-poisoning of the body;
• peritonitis.

Diagnostics

The pathology is always visible to the naked eye, because the first sign is the appearance of a hernial protrusion in the groin area. To confirm the diagnosis and obtain additional data, in addition to the examination, the patient is prescribed the following procedures:

• cystography - x-ray of a bladder filled with a contrast-colored solution;
• herniography – x-ray of the hernial sac;
• irrigoscopy - an X-ray examination of the colon after filling it with a contrast agent to identify the contents of the hernia and the size of its gate;
• Ultrasound of the groin area, abdominal cavity and bladder;
• cystoscopy – endoscopic examination using a cystoscope of the inner surface of the bladder.

If there is a suspicion of a strangulated hernia, then a differential diagnosis is carried out with a non-strangulated hernia. It is necessary to distinguish it from the following diseases:

• varicocele;
• femoral hernia;
• lymphadenitis;
• hydrocele.

Treatment

In men, inguinal hernia is treated in two ways - conservative and surgical. Only surgical intervention can correct an organ at any stage of the disease:

• open hernia removal;
• laparoscopy, i.e. removal of protrusion through the external opening.

If the disease is not too advanced, conservative treatment sometimes helps to get rid of it. It is important to follow all recommendations regularly and correctly. Conservative treatment of inguinal hernia includes:

• wearing a bandage;
• compresses made from oak bark, sauerkraut brine or acetic acid;
• following a special diet;
• regular physical activity to strengthen the abdominal muscles;
• taking non-steroidal anti-inflammatory drugs and analgesics to relieve inflammation and pain.

Treatment without surgery

Conservative treatment is indicated only in exceptional cases when the patient cannot undergo surgery. This applies to older people or those with cardiovascular disease. The doctor prescribes them to wear a special bandage. Treatment of inguinal hernia in men without surgery includes taking certain medications, doing therapeutic exercises, and following a diet.

Exercise treatment

Exercises for a hernia are aimed at strengthening the muscles of the peritoneal wall, but this can only prevent the progression of the disease for a while. It will not be possible to completely reduce the protrusion with the help of sports. Although doctors still recommend swimming, slow running and walking. You need to train in a bandage. Specific exercises that treat a hernia are aimed at strengthening the ligaments and muscles of the abdominal cavity:

1. "Scissors". Lie on your back, raise your legs 30-40 cm. Cross them like scissors. Do 3 sets of 8-10 times.
2. "Bike". Lying on your back, bend your legs at the knees, then perform movements with them as if pedaling a bicycle. Repeat for 30-60 seconds.
3. Squeezing the ball. Remain in the same position on your back, bend your legs, keep your feet on the floor. Place a small ball between your knees and squeeze and unclench it for a minute.

Diet

The main goal of the diet is to prevent constipation and flatulence, saturate the body with minerals, and lose weight. To treat hernial protrusion, you need to eat little and often, up to 4-5 times throughout the day. The following foods should be avoided:

• fatty, salty, fried and spicy;
• flour and sweet products;
• alcoholic drinks;
• strong tea and coffee;
• cabbage, peas, fresh cucumbers and other foods that cause constipation.

This food needs to be replaced with something more healthy, from which you can make up your diet for the week or month ahead. The list of such products includes:

• porridge;
• fruit juices;
• broths;
• fresh fruits and vegetables;
• lean varieties of meat and fish;
• jelly and jelly;
• rosehip decoction;
• omelette.

Surgery

The only treatment for a hernia is surgery. Conservative methods do not bring positive results. Only a surgeon can remove the protrusion. The operation is performed open or laparoscopically, i.e. through a small hole. The first method is more common. The operation goes like this:

• local anesthesia using spinal anesthesia;
• opening the soft tissues of the anterior abdominal wall to access the organs;
• isolating the hernial sac from the surrounding tissues, opening it through incisions parallel to the inguinal ligament;
• repositioning the contents of the sac into the abdominal cavity;
• suturing and tying the neck of the hernial sac in the hilum area;
• cutting off excess peritoneum that extends beyond the abdominal cavity;
• elimination of hernial orifices and strengthening of the abdominal wall.

Consequences

In addition to strangulation, a hernia can lead to other dangerous complications. The most common among them are the following:

• inflammation of the testicles;
• penetration of infection into the abdominal cavity;
• dysfunction of the male reproductive system;
• intestinal obstruction.

After surgical treatment of a hernia, some negative consequences are also possible. In most cases, they arise due to the fault of the patient who does not follow the recommendations regarding the recovery period. Although there may be consequences due to a doctor’s mistake. In general, postoperative complications are:

• hematoma (to exclude them, ice is applied immediately after surgery);
• dropsy of the testicles due to damage to their membrane;
• damage to the hip joint due to rough sutures;
• infection and suppuration of the wound;
• damage to the spermatic cord due to the fault of the doctor;
• seam divergence;
• relapse of the disease;
• damage to blood vessels, leading to testicular atrophy.

Forecast

If the patient undergoes a timely operation to remove an inguinal hernia, this guarantees a complete recovery and restoration of working capacity in a short time. Self-treatment with folk remedies can lead to serious consequences. In such cases, the hernia becomes irreducible. In addition, its infringement and possible complications further worsen the prognosis.

Prevention

To prevent the development of such a pathology, it is important to follow a few simple rules, recommended even by doctors. Such tips include the following:

• regular physical activity aimed at strengthening the abdominal muscles;
• quitting smoking, which leads to chronic cough;
• avoiding excessive physical activity and lifting too much weight;
• wearing a bandage after surgery on the abdominal organs;
• distribution of the load when carrying large items on both hands;
• proper nutrition to avoid obesity;
• gradual weight loss, which excludes sudden weight loss.

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