Inguinal hernia in men

Pathology in the form of a circular convexity localized near the groin under the skin, formed due to protrusion beyond the abdominal wall of a part of the contents of the abdominal cavity, is diagnosed as inguinal hernia inguinal hernia in men. And this anomaly arises quite often and is more typical of men. She was given the code for ICD 10 - K40, class XI (diseases of the digestive system).

[1], [2], [3], [4]

Causes of the inguinal hernia in men

The pathogenesis of this disease has an anatomical and in some way a physiological character. And according to the anatomical classification, inguinal hernia in men is a hernia external.

The protrusion of the hernial sac with the intestinal loops that enter it and the parts of the abdominal omentum occurs through the inguinal canal (canalis inguinalis), which is a triangular slit and an average length of about 50 mm located in the thickness of the anterior abdominal wall between the inner muscle layers of the abdomen, oblique and transverse.

Anatomical prerequisites or causes of inguinal hernia in men in the adult state are associated with the features of embryogenesis of male genital organs, which begin to form in the fetus at the end of the first trimester of pregnancy (as is known, in the first seven weeks the fetus does not differ in gender). The external genitalia of the male fetus are already formed by the 20th week, but the testes from the abdominal cavity are lowered into the scrotum (scrotum) only at the end of the gestation period. The lowering occurs by protruding part of the serous membrane of the vaginal process and moving down directly through the layers of the abdominal muscles. This is how the inguinal canal is formed, which almost completely closes in boys only during the newborn period. But for the passage of the spermatic cord, blood vessels and nerves, the upper (external) opening and the lower (or internal) hole remain. Through them, and hernia protrusion occurs in most adult men, because during their intrauterine development, weakened zones can occur in both the inguinal canal and the fibers of the abdominal muscles themselves.

We brought these anatomical details not only to explain the cause of inguinal hernia in men, but also to ensure that patients understand the essence of the disease and did not expect that they could be helped by medications, alternative herbal treatments or homeopathy.

And now about the second component of the cause of inguinal hernia in men - an increase in internal abdominal pressure. Why does it increase? Physicians explain the reasons for increasing internal pressure on the abdominal wall:

• heavy lifting;
• jumps from a great height;
• peritoneal injuries (blows to the abdomen);
• long stay in standing position;
• chronic constipation (i.e., associated with this strain of abdominal muscles during defecation);
• chronic strong cough;
• overweight for obesity;
• sharp weight loss with weight loss;
• ascites (abdominal dropsy).

Inguinal hernia in elderly men appears due to age-related changes in muscle tissue, including the abdominal press. With age, they become shorter and thinner than the fascia of oblique and straight abdominal muscles, and the muscular tissues are partially replaced by fibrous tissues. This increases the risk of a hernia after 60.

[5]

Symptoms of the inguinal hernia in men

Many do not seek medical help when the first signs of this pathology are present: the appearance in the inguinal region of a varying swelling, disappearing in a recumbent position and increasing with a change in body position, with physical exertion, after coughing or visiting the toilet.

It should be borne in mind that the inguinal hernia symptoms in men manifest themselves either over a long period, or they can rapidly progress - due to the impact of excessive intra-abdominal pressure (as discussed above). If the size of the hernia is small, complaints are reduced to a burning sensation in the groin, gravity in the lower abdomen.

Periodically, there are pains in inguinal hernia in men - after lifting the weights or tension of the abdominal press, due to other factors. If the protruding intestine descends into the scrotum, there is pain and swelling around the external genitalia, there are problems with urination.

With significant dimensions of the hernia, not only discomfort in walking is associated, but also more severe pains, often of permanent character - in the groin and lower abdomen, with irradiation into the sacral or lumbar region.

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Forms

Although the localization of this type of hernia is one, but in surgery it is customary to distinguish between types of inguinal hernia in men.

First, inguinal hernia can be congenital or acquired. Congenital - the consequence of the formation of a hernial sac (in which enter the loop of the intestine) from the finally not overgrown part of the serous membrane of the vaginal process after the testicles are lowered into the scrotum. All other clinical cases represent acquired inguinal hernia.

Secondly, inguinal hernias can be guided and not guided. The guided inguinal hernia in men is different in that in a lying position the doctor or the patient himself can gently return the hernial sac into the abdominal cavity.

Direct inguinal hernia in men is diagnosed if its formation occurs through the upper opening of the inguinal canal (hernial gates) with an extension of the inguinal canal in the area of its posterior wall - with an exit at the base of the scrotum. A direct inguinal hernia can also go through a weak spot in the fascia of the abdominal wall. Direct hernias account for approximately 25-30% of all inguinal hernias and, as a rule, occur in men after 40 years.

The inguinal inguinal hernia in men is noted when the hernial sac enters the upper opening of the inguinal canal and exits through the lower one. Since part of the hernial sac remains in the canal, mechanical compression of the spermatic cord often occurs. Actually, this explains why the inguinal hernia in men and infertility can have one etiology.

In addition, with this type of hernia her bag often descends into the scrotum, and then the doctors say that it is an inguinal and scrotal hernia in men.

There is also a channel or internal inguinal hernia in men, and it is determined when, entering from above into the inguinal canal, it does not come out of it and only when the cough or tension of the abdominal muscles under the skin appears a bulge for a short time. Intraoral inguinal hernias are sometimes referred to as cases of localization of hernial formation within the muscles of the abdominal wall between oblique and transverse layers.

Depending on which side of the pubic region the hernial sac comes out, the right-sided inguinal hernia in men or the left-sided inguinal hernia in men are determined; also there is a hernia on both sides, that is, a bilateral inguinal hernia in men.

[7], [8]

Complications and consequences

The main complications of a hernia occur when the contents of the hernial sac are squeezed in the area of the hernia's exit into the inguinal canal. And then the affected inguinal hernia or pinching of the inguinal hernia in men is diagnosed. This is a potentially dangerous condition, since infringement prevents the flow of blood into the intestine or stops the flow of intestinal contents.

Correction of the injured hernia is impossible, and patients, in addition to severe pain in the groin and lower abdominal cavity, note nausea and severe vomiting, constipation and flatulence; subfebrile temperature and pronounced tachycardia. Indisputable evidence of infringement of a hernia is a change in its color to a red-violet or blue-purple blood circulation disorder. These signs - the most convincing argument for the need for urgent intervention of the surgeon. Otherwise, pinching the inguinal hernia in men threatens intestinal obstruction, complete cessation of blood flow in its hindered loops and their necrosis. Consequences can be lethal, since intestinal obstruction develops total self-poisoning of the body, and tissue necrosis can lead to peritonitis.

Also, surgeons note other complications of this pathology:

• inflammation of the inguinal hernia in men (with infection of the hernial sac);
• inflammation of the testicles;
• disturbance of intestinal peristalsis and accumulation of stool (occurs when a part of the large intestine enters the hernial sac);
• trauma to the hernia with a violation of the integrity of the intestines that have entered her cavity.

[9], [10], [11], [12]

Diagnostics of the inguinal hernia in men

In all cases, the diagnosis of inguinal hernia in men begins with examination of the patient in a supine position and standing with a cough (to increase internal abdominal pressure). A palpation examination of the protrusion is also performed (this is how the hernia can be adjusted).

Instrumental diagnostics includes hernography of the x-ray of the hernia with the introduction of a contrast medium into the abdominal cavity (through the puncture of the abdominal wall).

To clarify the type of hernia, ultrasound may be necessary for inguinal hernia in men with visualization of the inguinal canal and sroctum.

Differential diagnosis of inguinal hernia is designed to exclude possible inflammation of inguinal lymphonoduses, femoral hernia, vascular aneurysm, testicular edema (hydrocele), epididymis (epididymitis), veins of the spermatic cord and testicles (varicocele), congenital undescension of the testicles in scrotum (cryptorchidism), twisting testicle and spermatic cord, as well as lipoma of the spermatic cord.

[13], [14], [15], [16], [17], [18]

Treatment of the inguinal hernia in men

Alternative treatment of inguinal hernia compresses from decoction of plantain, calligraphy (golden mustache) or pickle brine - no results. And, as already noted at the beginning of the article, there is no cure for this disease.

Of course, the use of symptomatic drugs is necessary: analgesics and NSAIDs - to relieve pain or inflammation. But the cause of pathology in inguinal hernias is not one pharmacological remedy.

Therefore for today the way is one surgical treatment. It can be either planned (to avoid infringement), or - in case of pinching of the hernia - urgent.

Surgical treatment, which suggested simple hernia repair - herniaoraphy, after which chronic pain and high risk of recurrence arise, was not a thing of the past, but it was improved to hernia repair with abdominal wall plasty (performed in a hospital, the standard tenure is 7-10 days). Preparations for a routine operation include standard general blood and urine tests, blood coagulation studies, ECG, ultrasound, or pelvic x-ray.

After the cut, the surgeon gets to the hernial sac from the inside and after it is opened and the content revision moves the guts to their "legitimate" place. The operation requires great accuracy, since the spermatic cord passing through the inguinal canal is affected. Also, the abdominal wall is strengthened at the point of protrusion of the hernia. If the open operation is carried out according to the method of Shoydals, then autoplasty is used.

But most often surgical treatment of hernia is carried out according to the technique of California surgeon Irving Liechtenstein "Tension-Free Mesh". Annually, only in the United States, about 750,000 operations on inguinal hernia are performed with this technology. This type of gernoplasty with minor hernia size is done under local (epidural) anesthesia, and the patient (after examination of the doctor) on the same or the next day can go home.

After a 50-70 mm incision in the groin, the surgeon reaches the hernia gates, a small hernial sac returns to the inside of the abdominal cavity, or binds and completely removes it, and, with larger dimensions of the hernia, performs a partial excision of the anterior wall of the hernial sac followed by standard actions. The dissected muscles are laminated together layer by layer without strong contraction of the edges and for between their muscular layers of the abdominal wall, for their greater strength, they are superimposed with a special "patch" of polymeric mesh material. Surgical nets are used as a reinforcing material for the ingrowth of new tissue.

But laparoscopy of inguinal hernia in men loses its popularity among patients, and among doctors. Despite the minimal external traumatic effect (there are three punctures in the abdominal wall, and scarring practically does not remain), the negative consequences after the endoscopic operation force Western surgeons to resort to it only in cases when the operated hernia recurs in the same place. First, it should be borne in mind that laparoscopy is performed under general (endotracheal) anesthesia. Secondly, carbon dioxide is pumped into the abdominal cavity to create a wider operating space (which is what it leads to - see below).

It should be borne in mind that, according to statistics, after surgery, a recurrence of inguinal hernia in men occurs in about 10% of cases.

Implications after surgery and rehabilitation after inguinal hernia in men

First, consider the main consequences after the operation - depending on its variety.

After open hernia repair with plastic or hernioplasty Tension-Free Mesh, long pain after surgery occurs in the groin (in 45-60% of cases). Experts call a number of reasons for postgernioriaphic pain syndrome (PHPS), including: nerve damage directly during the operation; infringement of a nerve in a cicatrical tissue, a grid or a seam; narrowing of the inner inguinal ring around the spermatic cord; postoperative benign neural tumors (neurinomas), etc.

Pain after the operation is pursued to 96% of patients who underwent laparoscopy of inguinal hernia in men. This is a well-known in the professional environment post-laparoscopic pain syndrome (pain syndrome after laparoscopy). Pain occurs in puncture sites and in the introduction of trocars (40-45% of cases), as well as due to intra-abdominal trauma and rapid stretching of the peritoneum with traumatic stretching of blood vessels and nerves. Doctors associate the occurrence of this pain syndrome in the upper right side of the abdomen and the projection of pain in the shoulders with irritation of the diaphragmatic nerve due to the pressure of the sub-diaphragmatic gas bubble, which does not resolve immediately after surgery in more than 90% of patients.

In addition to pain, there are such consequences after hernioplasty and laparoscopy, such as:

• the sense of presence in the inguinal region of a foreign body,
• rather rigid compaction after surgery,
• damage affecting the regional nerves,
• inflammation of the testicle and its atrophy,
• formation in the scrotal area of hematomas and congestion of serous fluid,
• anejaculation or painful ejaculation due to damage to the spermatic cord or nerve (about 12% of cases),
• the formation of thrombi in the deep veins of the tibia (especially in patients of older age), etc.

To rehabilitate after inguinal hernia in men was without complications, it is necessary:

• do not lie down, but start walking no later than 3-4 hours after the operation;
• monitor the condition of the seam and prevent it from becoming infected;
• stop lifting weights (max weight 5 kg);
• when the chronic cough of a smoker abandons this harmful habit;
• to achieve normalization of the intestine and to fight with constipation.

By the way, the prevention of this pathology consists of practical ones from the same points. To perform the last item, food after the operation of inguinal hernia in men should be complete, but with a decrease in the proportion of fats and carbohydrates. What should be the diet after inguinal hernia in men - see Diet after a hernia; also specific recommendations for proper nutrition after surgery - see Diet after surgery.

As clinical practice shows, in 40-45 days after the operation, the life of most patients enters the usual course. Approximately in the same terms, sex is possible after surgery for inguinal hernia, but everything is individual here. In the presence of problems in this area, you need to contact your doctor, as after such a surgical intervention, they can be quite serious: erectile dysfunction occurs with damage to the spermatic cord and the expansion of its veins (varicocele), dropsy testes, etc.

Treatment without surgery

Taking into account the pathogenesis of the disease, it is believed that with inguinal hernia treatment without surgery is impossible.

It should be borne in mind that the bandage for inguinal hernia in men also does not heal, but only contributes to the fact that the inguinal inguinal hernia in men is kept in the abdominal cavity.

But also this auxiliary tool can bring not only greater comfort to patients: it was found out, that long to wear a bandage at inguinal hernia in men is harmful. Firstly, the size of the hernial gates and the hernia itself may increase, and secondly, the funiculus spermaticus (the seminal cord) passing through the inguinal canal contains the vas deferens, vessels and nerves, under constant pressure, the bandage can atrophy and cease to perform its functions.

According to some doctors, treatment of inguinal hernia in men with physical exercises has no therapeutic effect. However, many experts advise using exercises to increase the strength of the muscles of the abdominal wall, but only lying on your back or sitting. For example, exercises such as:

• breathing belly with a load (1-2 kg) on the abdominal wall;
• lifting straight legs by 30 ° with respect to the horizontal position of the body;
• lifting of the shoulder belt and shoulder blades from the horizontal position (with hands on their heads);
• squeezing the ball between the knees (in the supine position on the back, with knees bent at the knees), etc.

The most suitable for inguinal hernia asanas are yoga exercises: uddiyana, pavamuktasana, sarvangasana, etc. Asanu udidiyana should be performed sitting: with a force to exhale the air, "squeezing" it from the lungs, pulling the belly as much as possible, hold it for three seconds, and then take a deep breath through the nose. Repeat 5-6 times.

To perform pavanmuktasana, you need to lie on your back, bend the right leg in the knee (your left leg lies flat on the floor) and, wrap your shin with both hands, pull the bent leg to the chest and stomach. Then lift the head and shoulder blades from the floor, and touch the forehead or nose with the knee of the bent leg. On exhalation take the original position. A similar action is performed by the other leg. And sarvangasana is a "birch" on the shoulder blade with back support with both hands.

Of course, moderate exercise - without increasing intra-abdominal pressure - is useful, especially for obese men. So force exercises, for example, with the bar, with inguinal hernias are contraindicated. For the same reason, inguinal hernia in men and bodybuilding are considered incompatible, as well as weightlifting.

Forecast

Despite the fact that the specialists of the European Hernia Society determine the prognosis of this pathology as conditionally favorable, inguinal hernia in men - after timely surgical treatment - allows to lead a normal life to the majority of patients.

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