Surgery the only way to treat hernia

By Maria Endah Hulupi

JAKARTA (JP): Heru, a 30-year-old executive, carried on with his routine activities although he was aware of a bulge in his groin. He thought the bulge was normal since it did not hurt and disappeared in the morning.

He did not consult a doctor on the bulge, which he noticed two months ago, until he realized it had enlarged and become painful.

The doctor's examination confirmed the lump was hernia and that it should be operated on immediately to prevent it from worsening.

Gastroenterologist Unggul Budihusodo identified the painless bulge that would slowly disappear when a person lay down as an indication of hernia.

The Cipto Mangunkusumo General Hospital specialist explained that hernia was a weak gap in the peritoneum (a thin layer lining the abdominal cavity), which enabled part of intestine to slide down, creating a bulge. If in the early stages, the lump can glide back to its proper position.

"It's true the bulge might disappear when the person lies down but it will get bigger as the gap widens, enabling a bigger part of intestine to slide out of the peritoneum," Unggul said.

Hernia, he said, was not inherited but a defect as the gaps which exist at birth should naturally close as the person grew older.

Hernia is distinguished by its location -- inguinal hernia (in the groin) affects both men and women; scrotal hernia (in the scrotum) affects only men and makes one testes look bigger than the other; umbilical hernia affects both men and women, but those with liver problems are more vulnerable to it; and incisional hernia which affects both men and women and stems from the failure to properly stitch surgical incisions.

Another type of hernia, hiatal hernia, is not tangible from the outside. It is the result of the upper part of the stomach protruding through a weak esophageal hiatus or passage in the upper part of the diaphragm. In this case, the person might suffer heartburn, which is a painful burning sensation in the chest.

Unggul said the most common hernia was inguinal hernia, scrotal hernia and umbilical hernia.

"If the problem is left untreated, the weak gap in the peritoneum can strangulate the protrusion, making it difficult for that particular part of the intestine to slide back to its proper position. This can create discomfort or even severe pain," he cautioned.

Surgery

Lack of knowledge of the symptoms and hope that the come-and- go lump will go away for good is the reason why some people only consult doctors when they are already in the advanced stages of the hernia. The advanced stage is accompanied by a dark colored lump accompanied with flatulence, vomiting, nausea and severe pain.

"The affected area will become darker as the strangulated intestine can no longer function and slowly dies," Unggul said. In such conditions, he added, doctors would immediately operate to save the patient's life.

"Advanced hernia can be fatal. But, most people with less serious hernia see a doctor because they can't stand the terrible pain from the strangulated area."

According to Unggul, hernia, whichever stage it may be in, can only be treated by surgery. In less serious cases, surgery is performed to close the gap in the peritoneum to ensure the intestine remains in the abdomen. In serious cases, doctors will have to remove the damaged part of the intestine before stitching up the gap.

Apart from having a lump in the mentioned parts of the body, people who frequently carry heavy objects, or those with poor nutrition -- since lack of nutrition weakens muscles and other body tissue -- are also vulnerable to hernia.

"We can't tell if a person is prone to hernia unless he or she develops the symptoms," Unggul said.

He advised people with early hernia symptoms to have the gap in the peritoneum stitched through surgery.

He also urged the elderly to avoid activities that forced them to strain their muscles.

Tight underwear

Wearing tight briefs, widely thought to be able to solve the problem, is not entirely true.

"Temporarily, yes, tight briefs can prevent the intestine from slipping down. But it is not comfortable and surely not healthy. As long as the gap exists, a person is at risk of developing hernia," Unggul said.

In order to relieve hernia pain, the expert advised sufferers to lie down, lift their legs and cool the lump with ice.

People with hiatal hernia are urged to use extra pillows to prop up their head to prevent acid reflux at night and avoid heartburn.

People with chronic liver disease are prone to developing umbilical hernia because the accumulation of body fluid in the abdominal cavity may cause the intestine to protrude through the weak gap of the umbilicus.

"People with chronic liver disease should have their problem treated properly. While controlling body fluids, doctors will give them diuretic drugs to absorb excess fluid in the abdomen and legs before discharging it through urination. But the weak gap in the umbilicus needs to be stitched up too," Unggul said.