I was on deputation abroad when I started suffered from huge abdominal discomfort and energy sapping. I was in my early forties. For eight months exact diagnosis eluded me. One day my doctor told me he was going to refer me to the psychiatry department for obtaining opinion of a fellow doctor. The spine-tingling comments shook my ‘amygdala’ so vigorously that I got flash from my deep memory of a doctor in Islamabad who had suggested I might develop hernia at some stage later in my life. I had never cared then and frankly I did not even know what a hernia was. “Doctor Haji! Please check if I have hernia,” I said, vehemently protesting being sent to Psychiatrist. There it was; a fully developed left inguinal. Surgery was performed and I was advised to come again after four months for the right side. Instead of following his advice, I started reading abdominal anatomy so that I could prevent it to develop further. … And indeed, I gave it a valiant try.

Hernia is a medical condition pertaining to intestinal displacement, heard quite often by people but rarely properly understood. Generally the doctors do have a propensity to ignore check up for hernia unless specifically alluded to by the patient. They are prone to attend other common complaints. There is a sizable percentage of patients who remain unaware that they are carrying hernia. So detection at the first visit remains mostly erroneous.

There are many patients who are aware of the onset of hernia but try to deal with it themselves with the help of belts and other methods. Based on my personal experience in respect of inguinal hernia, it is concluded that the best option is to go for timely surgery. It is the only sure option to avoid further deterioration of health. There may be one-in-million case that may be able to manage to live with it. Nevertheless, best possible recommendation is to seek advice for surgical solution. Belts and other precautionary measures are only temporarily useful under specific conditions.

Intestinal protrusion in adjacent spaces is caused by weakened muscular support system within the abdomen. First to go is peritoneum which allows intestine to slip and slide pushing itself through to undesired spaces. Types of hernias are categorized accordingly. Inguinal hernias are on left and right side of lower abdomen (above the groin). These may appear at any age but sports-persons are easy victim to such type. Unattended inguinal type may develop into a type known as scrotal hernia. Therefore, it is in best interest of patient to seek surgical solution at the earliest. Another route intestine may take is above femur area; it is known as femoral hernia. This type is more common in female patients. In case of children umbilical type is also sometimes observed. The area involved is navel. Most of these types are quite painful and may require emergent attention.

A very common hernia in middle and old age is called hiatus hernia, especially the sliding type. The stomach is partially or fully detached with respect to diaphragma. Function of Esophagus is disturbed and a life-long discomfort sets in. It is associated with GERD (Reflux regurgitation). Most of the people with varying severity of disease live with the problem. Only in very acute case, patient is asked to go for an operation. One of the treatments suggested by the doctors is to have a raised bed. In the long run, this may add to the misery of developing inguinal and other types of hernia (if it was not present earlier).

Other abnormal protrusions of intestine are also possible which would result in complications such as looping, obstructions etc. Intestinal part may find its way causing partial blockage and distension in the lower abdomen. In rare cases, a condition known as intussusceptions is also possible which may cause gangrene of bowel. Whereas it is most common in children below age four, possibility cannot be ruled out at any stage later in life, involving lower abdominal abnormalities.

I have ultimately undergone operation on my right side of inguinal hernia which could not be stopped from aggravating, although I managed to extend the period from four months to 24 years. Mesh hernioplasty is now well established and should be opted as first hand treatment, without wasting time. Proper positioning of mesh and suturing is an art and should be adequately updated so as to keep the discomfort and pain of these patients to minimum. Due care should also be taken to avoid contraction of abdominal infection. Doctors have to guide patients about the recurrence, as hernia tends to show itself again after some years (in some patients because of many reasons including constitution). It is felt that due to lack of knowledge about the post-operative care for hernia on part of patient, recurrence occurs. Doctors need to brief and forewarn them to fully appreciate ensuing difficulties and pitfalls.

Complete set of written instructions, preferably in a well-documented approved format are recommended to be given to patients who have been operated upon. Although many experienced surgeons give guidance, there is grave risk of missing some of very important part of instructions. That may cause great deal of trouble to patient.

Complaints about constipation, nausea and other maladies are common which could be avoided first hand. Patients are recommended to equip themselves fully well with the information regarding post-operative care through reading, as far as possible. Details are available on internet. The recovery phase heavily depends on one’s age, built and habits. Above all, information pays. I am a firm believer of “A little knowledge for self-awareness is not a dangerous thing!”

———————————————————————————————————————————————— The writer is a retired PTCL Chief Engineer. ———————————————————————————————————————————————— The views expressed by this blogger and in the following reader comments do not necessarily reflect the views and policies of the Dawn Media Group.