What Is an Inguinal Hernia?

Symptoms of Inguinal Hernia

What Is a Hernia?

A hernia occurs when an organ or fatty tissue squeezes through a weak spot in a surrounding muscle or connective tissue called fascia. The most common types of hernia are inguinal (inner groin), incisional (resulting from an incision), femoral (outer groin), umbilical (belly button), and hiatal (upper stomach).

In an inguinal hernia, the intestine or the bladder protrudes through the abdominal wall or into the inguinal canal in the groin. About 96% of all groin hernias are inguinal, and most occur in men because of a natural weakness in this area.

In an incisional hernia, the intestine pushes through the abdominal wall at the site of previous abdominal surgery. This type is most common in elderly or overweight people who are inactive after abdominal surgery.

A femoral hernia occurs when the intestine enters the canal carrying the femoral artery into the upper thigh. Femoral hernias are most common in women, especially those who are pregnant or obese.

In an umbilical hernia, part of the small intestine passes through the abdominal wall near the navel. Common in newborns, it also commonly afflicts obese women or those who have had many children.

A hiatal herniahappens when the upper stomach squeezes through the hiatus, an opening in the diaphragm through which the esophagus passes.

Ultimately, all hernias are caused by a combination of pressure and an opening or weakness of muscle or fascia; the pressure pushes an organ or tissue through the opening or weak spot. Sometimes the muscle weakness is present at birth; more often, it occurs later in life.

Anything that causes an increase in pressure in the abdomen can cause a hernia, including:

• Lifting heavy objects without stabilizing the abdominal muscles
• Diarrhea or constipation
• Persistent coughing or sneezing

In addition, obesity, poor nutrition, and smoking, can all weaken muscles and make hernias more likely.

A physical exam by your health care provider is often enough to diagnose a hernia. Sometimes hernia swelling is visible when you stand upright; usually, the hernia can be felt if you place your hand directly over it and then bear down. Ultrasound may be used to see a femoral hernia, and abdominal X-rays may be ordered to determine if a bowel obstruction is present.

In babies, umbilical hernias may heal themselves within four years, making surgery unnecessary. For all others, the standard treatment is conventional hernia-repair surgery (called herniorrhaphy). It is possible to simply live with a hernia and monitor it. The main risk of this approach is that the protruding organ may become strangulated — its blood supply cut off — and infection and tissue death may occur as a result. A strangulated intestinal hernia may result in intestinal obstruction, causing the abdomen to swell. The strangulation can also lead to infection, gangrene, intestinal perforation, shock, or even death.

Hernia surgery is performed under either local or general anesthesia. The surgeon repositions the herniated tissue and, if strangulation has occurred, removes the oxygen-starved part of the organ. The damaged muscle wall will frequently be repaired with synthetic mesh or tissue.

Increasingly, herniorrhaphy is being performed using a laparoscope, a thin, telescope-like instrument that requires smaller incisions and involves a shorter recovery period and less post-operative pain. Hernia repairs are usually performed as an outpatient procedure. There are usually no dietary restrictions, and work and regular activity may usually be resumed in one or two weeks. Complete recovery usually takes three to four weeks, with no heavy lifting for two to three months. Ask your surgeon for specific instructions after your surgery.

Hernias may return after surgery, so preventive measures are especially important to help avoid a recurrence.

The doctor inserts this tube into your urethra and on into the bladder. Your doctor can see areas of your bladder and urethra that usually don’t show up well on X-rays.

Your doctor can also insert tiny surgical tools through the tube to take samples of tissue (biopsy) or samples of urine.

Small bladder stones and some small growths can also be taken out this way. So the test may help keep you from having to go back for surgery.

Cystoscopy may be done to:

• Find the cause of many urinary system problems. Examples include blood in the urine, pain when you urinate, incontinence, frequent urinary tract infections, and blockages in the urinary tract.
• Remove tissue samples for testing (biopsy).
• Remove a foreign object.
• Insert a stent. This helps urine flow from the kidneys to the bladder.
• Treat certain problems. The test can be used to remove stones or growths, help stop bleeding in the bladder, or remove a blockage.
• Inject a dye that is used for a special type of X-ray of the ureter and kidney.

If you are put to sleep with a general anesthetic, you won’t feel anything during the test. After the anesthetic wears off, your muscles may feel tired and achy. The medicine gives some people an upset stomach.

If a local anesthetic is used, you may feel a burning sensation or an urge to urinate when the cystoscope tube is inserted and removed. When sterile water or saline is put in your bladder, you may feel a cool sensation, an uncomfortable fullness, and an urgent need to urinate. Try to relax during the test by taking slow, deep breaths. Also, if the test takes a long time, lying on the table can become tiring and uncomfortable.

If a spinal anesthetic is used, you may find it uncomfortable to lie curled up on your side while the anesthetic is injected. You will probably feel a brief sting when the medicine is injected. The day after the test, you may feel tired and have a slight backache.

Most people report that this test is not nearly as uncomfortable as they thought it would be.

Cystoscopy is generally a very safe test. General anesthesia has some risks. The test doesn’t affect sexual function.

The most common side effect is a short-term swelling of the urethra. This can make it hard to urinate. A catheter inserted in your bladder can help drain the urine until the swelling goes away. Bleeding sometimes occurs, but it usually stops on its own.

Diverticulosis is a condition that develops when pouches (diverticula ) form in the wall of the colon (large intestine). These pouches are usually very small (5 to 10 millimeters) in diameter but can be larger.

In diverticulosis, the pouches in the colon wall do not cause symptoms. Diverticulosis may not be discovered unless symptoms occur, such as in painful diverticular disease or in diverticulitis. As many as 80 out of 100 people who have diverticulosis never get diverticulitis.¹ In many cases, diverticulosis is discovered only when tests are done to find the cause of a different medical problem or during a screening exam.

The reason pouches (diverticula) form in the colon wall is not completely understood. Doctors think diverticula form when high pressure inside the colon pushes against weak spots in the colon wall.

Normally, a diet with adequate fiber (also called roughage) produces stool that is bulky and can move easily through the colon. If a diet is low in fiber, the colon must exert more pressure than usual to move small, hard stool. A low-fiber diet also can increase the time stool remains in the bowel, adding to the high pressure.

What Is a Hyphema?

A hyphema is bleeding or a broken blood vessel inside the eye that causes blood to collect in the anterior chamber of the eye — the space between the cornea and the iris that’s normally filled with a clear liquid called the aqueous humor.

A hyphema is dangerous, usually painful bleeding in the eye where blood collects in the anterior chamber (the space between the cornea and the iris).

The severity of a hyphema is graded by how much blood accumulates in the eye:

• Grade 0 (microhyphema): No visible pooling of blood, but red blood cells can be seen within the anterior chamber upon microscopic examination.
• Grade 1: Pooling of blood in less than the lower third of the anterior chamber.
• Grade 2: Blood filling one third to one half of the anterior chamber.
• Grade 3: Blood filling one half to less than all of the anterior chamber.
• Grade 4: Total filling of the anterior chamber with blood. If the blood is bright red, this is called a total hyphema. If it is dark red-black blood, it’s sometimes called an “8-ball hyphema.”

In general, the higher the grade of hyphema, the greater risk of vision loss and long-term damage to the eye. The dark red or black color of an 8-ball hyphema (the most dangerous type) is associated with decreased circulation of aqueous humor and decreased oxygen in the anterior chamber of the eye.

What Are Other Symptoms Of Hyphema?

In addition to the blood in the eye, the following symptoms usually are associated with hyphema:

• Blurry or distorted vision
• Eye pain
• Light sensitivity (photophobia)
• Headache

Eye pain, sensitivity to light and headache are especially likely to occur if a hyphema is causing increased intraocular pressure (IOP).

What Causes Bleeding In The Eye?

The most common cause of hyphema is trauma to the eye. This is why it is important to see your eye doctor immediately if you sustain an injury that causes a “black eye.”

In some cases, a traumatic hyphema also can occur after eye surgery, including cataract surgery. But this is relatively rare.

It’s also possible for a hyphema to occur spontaneously, particularly among people who are taking blood thinners (such as warfarin or aspirin) or have a blood clotting disorder (hemophilia). Diabetes also can increase the risk of a spontaneous hyphema, as can tumor growth in the eye (ocular melanoma).

Is A Hyphema Serious? Are There Complications?

Usually, the blood that collects in the anterior chamber of the eye due to a hyphema will be reabsorbed by the body without permanent damage to the eye.

But in some cases, clotting of this blood will clog or damage the structure in the periphery of the anterior chamber that controls the normal outflow of aqueous humor from the eye. This can cause increased eye pressure that can lead to glaucoma and permanent vision loss.

Also, in some cases, rebleeding can occur inside the eye after the initial eye injury that causes a traumatic hyphema. This new bleeding (usually occurring within a few days after the injury) can be more severe and more dangerous than the initial bleeding.

People with sickle cell anemia — a hereditary disease in which red blood cells are distorted into a crescent shape — or those who simply have the genetic trait for this disease have an increased risk of eye damage from a hyphema.

Hyphema Treatment

Depending on the severity of a hyphema and associated risk factors, your eye doctor may recommend a combination of the following precautions and treatments:

• Limited physical activity
• Head elevation (including when sleeping)
• Wearing an eye shield
• Frequent follow-up visits for a few weeks or months
• Pain medicine
• Anti-inflammatory medicine (topical or oral)
• Other medications

In the case of a severe hyphema, surgery may be required.

Do not use over-the-counter pain medications that contain aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) if you have a hyphema, as these medications can increase the risk of rebleeding in the eye.

Even if your eye feels fine and you don’t notice vision problems, see an eye doctor immediately if you have eye trauma that could cause a hyphema. Make sure to attend all follow-up visits your doctor recommends.

Also, routine eye exams are very important after having a hyphema, as your risk of elevated eye pressure and glaucoma may be higher even years later.

How Can I Prevent A Hyphema?

The best way to avoid a traumatic hyphema is to wear safety glasses or other protective eyewear whenever you are involved in potentially hazardous activities.

Protective sports glasses should be worn when playing baseball, softball, racquetball, basketball, hockey or other sports that pose a risk of trauma to the eyes.

Also, be aware that sports like boxing significantly increase your risk of a traumatic hyphema. And if you participate in paintball games, wear protective headgear that includes a clear, impact-resistant shield that fully protects your face and eyes.