What is a hernia?
Depending on whether they develop in the upper abdomen or groin, hernias may be broadly divided into two main groups, and each group contains multiple types:
- Inguinal hernia: It is the bulging out of fatty tissues or a part of the bowel through a defect in the abdomen (tummy) near the groin. An inguinal hernia is the most common type of hernia.
- Femoral hernia: It occurs when fatty tissues or part of the bowel protrudes into the groin at the top of the inner thigh.
- Umbilical hernia: It occurs when fatty tissues or part of the bowel protrudes through the abdomen near the navel (belly button).
- Epigastric hernia: This type is a midline hernia that occurs when fatty tissues protrude through the abdominal area between the navel and sternum (lower part of the breastbone).
- Spigelian hernia: This rare type of hernia occurs when the bowel pushes through the abdomen at the outer side of the abdominal muscle, below the navel.
Can you heal a hernia without surgery?
A hernia usually does not go away without surgery. Non-surgical approaches such as wearing a corset, binder, or truss may exert gentle pressure on the hernia and keep it in place.
These methods may ease the pain or discomfort and may be used if you are not fit for the surgery or awaiting surgery. They can provide temporary relief, but surgery is the only definitive treatment for a hernia.
Conservative or non-surgical management should strictly be done under a doctor’s supervision because they may lead to complications such as bowel obstruction and strangulation (part of the bowel is trapped in a way that cuts off its blood supply).
How do you manually reduce an inguinal hernia?
An uncomplicated hernia (that has not been strangulated or obstructed) can be reduced manually to send its contents back to their compartment. Although manual reduction may provide relief from symptoms, surgery is essential for long-term management.
For manual reduction, hernias can be classified into three groups:
- Easily reducible hernia: They are easily reducible because the hernia contents can easily be returned to their original compartment providing symptom relief and may prevent future complications to some extent.
- Incarcerated hernia: This cannot be reduced easily because its contents are trapped (incarcerated) in the abdominal wall.
- Strangulated hernia: This is an absolute contraindication for manual reduction. A strangulated hernia is a surgical emergency in which the blood supply to the herniated tissue is compromised.
During a manual reduction of a hernia
- The patient lies on the bed in the Trendelenburg position with the legs and body slightly inclined up to reduce an inguinal hernia. Gravity pulls the hernia contents inward and facilitates reduction.
- The supine position (lying with face upward) is appropriate for an upper abdominal hernia.
- Anesthesia is generally not required for most reductions. Local anesthesia or a nerve block may be provided to reduce pain.
- Sedation may be given to a young child or an adult if a difficult reduction is expected or if initial attempts without sedation are unsuccessful. Epidural anesthesia may be given to infants.
- The doctor applies ice or a cold compress to the hernia for several minutes to reduce the swelling.
- Some hernias reduce on their own because of cold compress application, gravitational force, and muscle relaxation around the hernia from sedation and painkillers.
- The doctor slowly applies pressure to the lower part of the hernia while guiding the upper portion into the abdomen through the defect.
- Once the procedure is completed, an ultrasound may be performed to confirm whether the manual reduction was successful.
What are the complications of the manual reduction of a hernia?
The complications of manual reduction may include:
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