I recently called a client about the third hernia I had seen within a few weeks. “What are we doing wrong?” he asked. “How can we prevent this?”
Any repeated injury in a short span of time raises red flags. Hernias are less common than his experience (The Bureau of Labor Statistics reports 3.5/10,000 workers per year), so his concern was understandable.
What Causes a Hernia?
A hernia is an “out-pouching” of the lining of the abdomen through the muscles of the abdominal wall. The pouch or sac may contain abdominal contents (usually a small pocket or loop of bowel). It can be pushed back into place with minimal effort and little discomfort.
The sac protrudes through a tear in the muscle wall at an area of weakening, usually caused by age or congenital factors. The strain often is, but need not be, due to heavy lifting. A minor strain from a cough or sudden twist, marked weight gain or chronic constipation can be enough. Hernias are not dangerous as long as the sac can be “reduced” (pushed back into place).
How Can a Hernia be Treated?
The normal treatment for a hernia is surgical repair through an open incision or laparoscopically. Often a surgical mesh is sewn in place to strengthen the area of the muscle-wall tear.
According to a study by the American College of Surgeons recently published in the Journal of the American Medical Association, the surgical repair of a hernia is not medically necessary if the symptoms do not interfere with normal activities and the patient will remain under a physician’s care, sees a physician at least annually and is aware of potentially dangerous complications. The feared complication is a “strangulated” hernia, in which something is caught in the protruding loop of bowel, causing the segment of bowel to lose its blood supply and become gangrenous. In the study, only two patients of the 364 in the “watchful-waiting” group developed problems during the two to four-and-a-half year follow-up period. The reported physical functioning of the “surgical” patients was not statistically different from the “watchful waiting” patients.
How Can the Risk of Hernia be Reduced?
Congenital factors, a large component of the risk, leave little room for intervention. Other factors may also be addressed. Strains may be reduced by careful job assessment to help workers avoid heavy manual lifting. Other prevention includes good physical conditioning, proper lifting mechanics, maintaining a healthy weight and eating a healthy diet, including high-fiber foods such as fruits, vegetables and whole grains. Causes of persistent coughing, such as smoking, allergies and respiratory infections, should be addressed.
My client will direct more efforts toward eliminating tasks which require muscle straining. Beyond this, a healthy lifestyle and staying physically fit are the best interventions to help avoid hernias. IBI