When 35-year-old Devika (name changed) felt a sharp pain in her abdomen after a bout of coughing one morning, she initially dismissed it as a muscle pull. But the pain only kept increasing over the next couple of hours.
Unable to bear it, Devika finally went into the hospital to receive a shock from her doctor. The hernia she developed after her pregnancy and had dismissed as a minor inconvenience, had become strangulated. She needed major surgery on her intestine. And if she had delayed by a few more hours, she might not have survived at all.
“When the bulge first developed after my delivery, I never thought about it much. It didn’t hurt and I was very uneasy about surgery, so I put off worrying about it till later. By the time I decided to fix it, it was almost too late,” says Devika.
Unfortunately, cases such as Devika’s are all too common, says Dr Magnus Jayaraj Mansard, Senior Consultant for Gastrointestinal and Minimally Invasive Surgery at Gleneagles Global Health City, Chennai. “There are two ways we meet patients: in our OPD where the hernia is easily treatable, or in the emergency room or operating theatre where it has become life threatening,” he says.
A hernia refers to a defect in the abdominal wall through which internal organs or body parts protrude. Dr Magnus Jayaraj explains that these areas of weakened muscle typically exist from birth and become more prominent due to aging or repeated strain on the abdomen due to physical exertion (lifting heavy weights), pregnancy and the pressure exerted by the foetus, obesity, frequent coughing, or repeatedly straining on the toilet due to constipation.
“One common factor we see among women and older patients is disregarding the weight of lifting and carrying their children or grandchildren. They don’t realise that their kids are heavy weight that they are frequently lifting,” observes Dr Magnus Jayaraj.
Based on the location of the weak point, hernias are classified into various types. Among men, for instance, weak points are common in the inguinal canals, which are narrow slits connecting the abdomen with the scrotum. Such hernias are called inguinal hernias. The region around the navel is another common area where weaknesses in the tissue wall can develop, particularly during pregnancy. Such hernias are called umbilical hernias. Sometimes, hernias can also occur at the site of a surgical scar, which is called an incisional hernia.
Hernias can typically be recognised by a bulge in the abdomen that may protrude while standing and disappear while lying down. While there can be pain at the site of the bulge, says Dr Magnus Jayaraj, this is not always the case. Over time the bulge may grow larger if not repaired.
Dr Magnus Jayaraj says that once a hernia develops, the only solution for it is surgical. “The hernia will not go away on its own and we can’t close it medically. We have to close the gap surgically and put in a mesh to provide additional support to the weakened area of tissue,” he explains.
This can be done through either open or laparoscopic surgeries. “Laparoscopic surgeries offer the advantage of being able to cover a larger area through small incisions. So patients experience less pain, have a faster recovery. Also, because imaging technologies are improving rapidly, we get much better visibility and more accurate surgery through laparoscopic methods.”
Though the procedure for repairing a hernia is a routine and fairly minor procedure, says Dr Magnus Jayaraj, many patients shy away from treatment because it is surgical. “If patients don’t experience pain, then they feel that the bulge is hidden away and they are not experiencing any inconvenience.” In such cases, patients often opt to postpone surgery.
However, Dr Magnus Jayaraj warns such delays can be potentially disastrous because hernias can lead to complications involving internal organs. “It is like having an open manhole on the street and worrying about when you are going to fall in,” says Dr Magnus Jayaraj.
One of the major complications is when the portion of tissue pushing through the abdominal wall gets strangulated or loses blood supply because of being forced through a small opening. Such strangulated tissue can release toxins or infection that can lead to sepsis, organ failure and even death, says Dr Magnus Jayaraj. “So that becomes an emergency situation where a relatively minor surgery with fast recovery becomes a major operation where we may need to remove significant amounts of tissue and repair organs,” he explains.
What’s more, it’s hard to predict when such complications can occur. “Such complications can occur at any point of time. That’s why it’s always important to undergo treatment to close the defect as soon as possible,” says Dr Magnus Jayaraj.
This article was published in partnership with Gleneagles Global Health City, Chennai.
For Appointments: 044 -4477 7000
Dr Magnus Jayaraj Mansard,
Institute of Gastro Sciences,
Senior Consultant – Gastrointestinal & Minimally invasive surgery,
MBBS (JIPMER), MS (JIPMER), MNAMS (GI Surgery), MRCS (Edin.), FACS, GCSRT (Harvard)