Investigations & Treatment

*Investigations-
If you have an obvious hernia, the doctor will not require any other tests (if you are healthy otherwise). If you have symptoms of a hernia (dull ache in groin or other body area with lifting or straining but without an obvious lump), the doctor may feel the area while increasing abdominal pressure (having you stand or cough). This action may make the hernia able to be felt. If you may have an indirect inguinal hernia, the doctor will feel for the potential pathway and look for a hernia by inverting the skin of the scrotum with his or her finger.

*Hernia Treatment-

Self care at home-
In general, all hernias should be repaired unless severe pre-existing medical conditions make surgery unsafe. The possible exception to this is a hernia with a large opening and a relatively small sac. Trusses and surgical belts or bindings may be helpful in holding back the protrusion of selected hernias when surgery is not possible or delayed. However, they should never be used in the case of femoral hernias.
Avoid activities that increase intra-abdominal pressure (lifting, coughing, or straining) that may cause the hernia to increase in size.

Medical Treatment

Treatment of a hernia depends on whether it is reducible or irreducible and possibly strangulated.

• Reducible

• In general, all hernias should be repaired to avoid the possibility of future intestinal strangulation.
• If you have pre-existing medical conditions that would make surgery unsafe, your doctor may not repair your hernia but will watch it closely.
• Rarely, your doctor may advise against surgery because of the special condition of your hernia.
  
  • Some hernias have or develop very large openings in the abdominal wall, and closing the opening is not possible because of its large size.
  • These kinds of hernias may be treated without surgery, perhaps using abdominal binders.
  • Some doctors feel that the hernias with large openings have a very low risk of strangulation and that surgery is not needed if you are relatively symptom free.
  
  
  
• The treatment of every hernia is individualized, and a discussion of the risks and benefits of surgical versus nonsurgical management needs to take place.

• Irreducible

• All acutely irreducible hernias need emergency treatment because of the risk of strangulation.
• An attempt to reduce (push back) the hernia will generally be made, often with medicine for pain and muscle relaxation.
• If unsuccessful, emergency surgery is needed.

• If successful, however, treatment depends on the length of the time that the hernia was irreducible.
  
  • If the intestinal contents of the hernia had the blood supply cut off, dead (gangrenous) bowel is possible in as little as 6 hours.
  • In cases where the hernia has been strangulated for an extended time, surgery is performed to check whether the intestine has died and repair the hernia.
  • In cases where the length of time that the hernia was irreducible was short and gangrenous bowel is not suspected, you may be discharged.
  
  

• Because a hernia that becomes irreducible has a dramatically increased risk of doing so again, if you have had an irreducible hernia, you should have surgery sooner rather than later.

• Occasionally, the long-term irreducible hernia is not a surgical emergency. These hernias, having passed the test of time without signs of strangulation, may be repaired electively.

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