The Hernia Problem

DID you know that hernias are among mankind’s most common ills? That is, at least as far as the menfolk are concerned, for 75 to 80 percent of them occur in males. It is said that as many as one in twenty, or 5 percent of the males, in such lands as the United States and Canada have this problem. In Great Britain from 10 to 15 percent of all hospital admissions are for hernias and the ratio is even higher in Nigeria.

While it is common to refer to hernias as ruptures, the medical profession prefers the term hernia as being the more correct one. Hernia literally means a protrusion, which is what any hernia is. It does not necessarily involve a rupture or tearing of the tissues, but as often as not is a mere distending or stretching of them. This is especially true of the kind of hernias more common in womenfolk. In other words, every rupture is a hernia but not every hernia is a rupture.

Hernias are described in medical literature going back thousands of years. In ancient times and, indeed, until quite modern times, hernias were treated in a great variety of ways, magical, medical and surgical, some of which were very painful. In view of the prevalence of hernias, it will be of interest to note the causes of hernias, what, if anything, can be done to prevent them, and the various ways of treating them.

Causes of Hernias

There are various causes of hernias even as there are various kinds of hernias. There are hernias of the brain, usually caused by accidents or tumors, and there are those of the iris or eyes. There are also hernias of the neck, found in wind-instrument players who put quite a strain on the muscles of their necks while playing their instruments.

Then again, there are what are known as “incisional” hernias. These are protrusions where there was previously an operation for some cause other than a hernia. (A hernia where there previously was an operation for a hernia is called a recurrent hernia.) There are some in the medical profession who hold that if surgeons were more careful when operating and sewing up their patients, there would be practically none of these incisional hernias; or at least very few of them, comparatively speaking.

Then again, a hernia could easily result from an accident. If someone were to suffer a fall on his feet, that could well result in a hernia. The most common form of hernia, that of the groin in men, usually is brought on by straining, as when straining to have a bowel movement or trying to lift some heavy object in an injudicious manner. It is called an “inguinal” hernia.

However, by and large, the medical and like professions agree that these are but contributing causes. The basic cause according to most authorities is an inherited or congenital weakness of the abdominal or other muscles. This seems to appear from the fact that hernias at times run in families. Thus, for example, the trumpet player who suffers a hernia in his neck no doubt brought it on because of straining while blowing; but he did not necessarily strain more than other trumpet players who do not suffer this injury. It is just that in the structure of his throat some of the muscles were not as strong as they should have been.

Prevention

But could this congenital or inherited weakness, except in the case of infants and children, be compensated in some way? Or could it be that in some cases, instead of being born with this weakness, some may acquire it because of neglecting their health? That is the position taken by some who hold that unwise health habits, such as insufficient exercise, overindulgence in eating or in other bodily pleasures could well be contributing factors. Those who hold that proper care of the body could well protect against at least some hernias point to the marvelous way in which the body is made. Thus in the abdomen there are several sets of muscles that cross one another at different angles​—really so designed as to give the maximum strength to the walls of the abdomen. These are known as the ‘transversal,’ the ‘oblique internal’ and the ‘oblique external’ muscles.

As for strengthening and improving the tone of the abdominal muscles, there are many things that one can do to acquire this result. Simply cultivating the habit of good posture, walking, standing, and sitting erect will be a great help. And since overweight, as well as an overloaded alimentary canal, is conducive to hernias, moderation in food and drink should also be practiced. Obviously a rupture or hernia can more readily occur where the muscles are fat and flabby.

Since hernias are not uncommon among muscular athletes, it is apparent that not just any exercises will help to compensate for an inherited defect that may result in a hernia. Exercises should be those that strengthen the muscles of the abdomen. These include climbing stairs, jogging, push-ups, horseback riding and, especially, bicycle riding. All these tend to strengthen the muscles of the abdomen as well as contribute to one’s general health.

Yes, the old saying, an ounce of prevention is worth a pound of cure might well be applied to the hernia problem. More care on the part of surgeons doubtless would notably decrease the number of incisional hernias. And learning to lift heavy objects properly might well keep many other hernias from happening. Instead of merely bending over and putting all the strain on the loins when trying to lift a heavy object, one should also bend one’s knees so as to employ the muscles of the legs. And there is also the factor of exercises that strengthen the muscles of not merely the arms and legs, but also the abdomen.

What Can Be Done About a Hernia

As with treatment of other physical infirmities to which man has fallen heir, there are wide differences of opinion as to what is the best thing to do. Not a few resort to a truss. The use of trusses goes back some five centuries or more. Some authorities recommend them as a temporary measure and in treating infants and very young children, among whom there is a good likelihood that the hernia will repair itself. Trusses are also recommended by some for very old persons, although more so in times past than at present. Some men prefer trusses because of the fear of an operation or the expense of it, but they leave much to be desired as they are wearisome to use (especially in hot weather), rarely remedy matters and at times may even make matters worse.

A few doctors treat hernias by injection of certain chemical substances that cause a fibrosis. That is, they cause an abundant producing of fibrous tissue that is supposed to close the hernial opening and so cure it. It is said by some to have advantages in certain cases.

Most physicians recommend surgery. But the record has not been altogether complimentary to the surgical profession as a whole. Thus Dr. A. A. Koontz, a United States authority on the subject, in his book Hernia (1963), tells about the recurrence rates. According to him they vary from 10 to 30 percent and more, depending upon the type of operation.a Apparently not all who operate for hernias are as skilled as they should be. He states that, while the situation is improving, the recurrence rate is still far too high and points to his own recurrence rate of less than one-half of one percent. He counsels surgeons operating for hernias: “Make the operation fit the patient. Don’t try to make the patient fit the operation.”

Also Dr. S. H. Wass, writing in Guy’s Hospital Reports, No. 3, 1968, says: “Our results leave much to be desired. Max Page (1934) surgeon to St. Thomas’ Hospital decried complacency and drew attention to the bad results of routine hernia surgery. In spite of innumerable modifications of the techniques of hernia repair over the past thirty years recurrences are still far too common.”

Surgery for hernias goes back to the ancient Orient. One who in more recent times did better than the rest was A. Paré of the sixteenth century, who is quoted as saying: “I cut them and God heals them.” The present-day methods by and large are based on those developed by an Italian surgeon, E. Bassini, and by W. Halsted, an American surgeon, both in about 1890.

A more recent innovator was the late E. E. Shouldice, of Toronto, Canada, who developed his system during World War I and whose clinic continues to specialize in only hernia operations. He developed a method of overlapping and reinforcing, using steel wire in adults and gut in infants and children. He brought down his recurrence rate to less than one percent and felt so confident of his method that he offered to repair any recurrences free of charge, even as does his clinic today.

A surgeon writing in the West African Medical Journal, December 1968, told of successfully performing hundreds of hernia operations with only local anesthesia, even as does the above-referred-to clinic. No doubt because of this, patients at this clinic are able to take exercises the very first day after the operation and to return home after the third day. Doubtless helping to account for the success of this method are the facts that overweight patients are required to reduce before being accepted and smokers are asked to cut down on their smoking two weeks before the operation.

Exercising Recommended by Some

There are some who speak highly of the value of certain exercises in remedying reducible hernias in those not beyond the prime of life. Reducible hernias are those that disappear when one is lying down or with gentle pressure. If they do not disappear under such conditions they are termed irreducible or incarcerated hernias, a more serious condition.b

Those healthy young men whose hernias are not too bothersome or serious might well want to try the exercise approach to their problem. Of course, all the exercises previously mentioned as strengthening the muscles in the abdomen would be helpful in reducing a hernia. But additionally there is a special set of exercises that is indispensable in reducing a hernia, namely, those that strengthen the muscles in the groin.

A great help for these exercises is a slant board. This is a board of some six feet in length, about 18 inches wide and one end of which rests on the floor whereas the other end is raised about a foot. This higher end has a strap around it under which a person can place his feet. With hands clasped behind the head, he endeavors to raise himself into a sitting position. Then in a sitting position he tries to turn his body as far as he can to the right and then as far as he can to the left, all the while having his hands clasped behind his head.

A similar exercise is to be turning once to the right as one raises oneself erect on the slant board and then the next time to the left. Such twisting exercises strengthen the muscles of the groin. Another exercise is to lie flat on one’s back on the floor and then, with the feet raised, try to imitate the motions used when swimming. Another is to sit in a chair and put the right hand on the left knee and the left hand on the right knee and oppose or try to push the knees apart while resisting the pushing with one’s legs as much as one can. Of course, all such exercises require determination, but those using them testify to their value.

Since hernias have been termed one of mankind’s most common ills, it does seem that more could be done to prevent both their occurrence and their recurrence. Also, the facts seem to indicate that one should exercise care in choosing a surgeon if an operation is deemed necessary. Each one faced with this problem will therefore do well to consider the pros and cons before making a decision as to what to do about it.

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