Hernia - causes, symptoms and treatment

Surgeon

Bohyan

Tigran Surenovich

Experience 36 years

Surgeon of the highest category, Doctor of Medical Sciences, member of the International Association of Surgeons, Gastroenterologists and Oncologists

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Author of the article: Bokhyan Tigran Surenovich, surgeon of the highest category, Doctor of Medical Sciences, member of the International Association of Surgeons, Gastroenterologists and Oncologists

A hernia is a fairly common disease, which is manifested by the protrusion of internal organs from the cavities in which they should be located. But there are certain types of this disease. Both abdominal hernia and spinal hernia occur. Their causes and symptoms are similar. Let's take a closer look.

Symptoms and signs of hernia

Diagnosing a hernia is quite easy. You can do this at home:

Using the palpation method, feel the areas on the body that concern you;
If you feel slight bulging or swelling, you most likely have a hernia. To see this, try coughing without removing your hands. If your finger feels a sharp push from the internal organs, then it’s time to consult a doctor, since an abdominal hernia or spinal hernia requires immediate treatment.

But it should be understood that the symptoms of this disease largely depend on the variety. For example, a femoral or inguinal hernia is accompanied by pain in the area of the inguinal fold. But with an umbilical hernia, there is not only pain, but also nausea.

It is important to remember that the main symptom of this disease is pain, discomfort and small local swelling.

What is the most effective method for removing a postoperative hernia?

Our surgeons are fluent in endoscopic technology, but this technique is not always applicable for complex hernias. Often, much better results can be achieved by open hernioplasty.

Based on many years of experience in hernia repair, our surgeon will choose the optimal access method based on the characteristics of your particular disease.

The main factor in the successful outcome of hernia surgery is its impeccable technical execution. Poor surgical technique can ruin any method, even the best one. If all stages of the operation are performed correctly, then with any type of access the probability of hernia recurrence is minimal.

Causes of occurrence and development

It all depends on the location of the disease. An abdominal hernia occurs more often in people who have weakened abdominal walls. Often appears with regular or frequent lifting, after childbirth and frequent strained cough. An abdominal hernia can also occur due to certain defects in the abdominal wall resulting from injury or surgery.

The appearance of a hernia of the spine is possible under the influence of the following factors:

increased stress on the spine, including excess weight;
changes in the osteoarticular apparatus of the spine;
spinal injuries.

Note that a spinal hernia is more dangerous. Because if an umbilical hernia can be cured in one visit to a doctor, then with a vertebral hernia the situation is different - a course of therapy is prescribed and a surgical operation is performed.

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Performing reasons

This type of reason differs in that the level of pressure inside the womb increases inside the body. A hernia begins to develop in weakened areas on the anterior wall of the abdomen:

stable physical loads on the body;
presence of extra pounds;
the occurrence of tumors in the abdominal area;
chronic cough that occurs due to lung diseases;
problems with urination;
presence of constipation;
pregnancy and difficult childbirth;
diseases such as cirrhosis, tuberculosis, etc.

The disease can only appear when one of these causes is present in a person for a long period of time.

Risk factors

A hernia of the spine or abdomen is the most common variant of this disease. And there are certain groups of people who fall under a special risk factor:

loaders and people whose profession involves constant lifting of heavy objects (hernia of the spine and lumbar region);
overweight people (both abdominal hernia and intervertebral hernia are possible)
pregnant women (both hernia of the spine and lumbar region and abdominal hernia can occur).

But it should be understood that no one is immune from this disease.

Medicines for the relief of acute back pain

These are medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), used intramuscularly for acute pain, centrally acting muscle relaxants, also used by injection, and local medications: gels, creams and ointments.

Narcotic analgesics are not used in our country for osteochondrosis. Such drugs are prescribed for oncological pathology, for example, with the development of metastases in the vertebrae. Even then, sometimes the patient cannot receive state-guaranteed care. If a doctor, seeing very severe pain, tries to help a patient in Russia by prescribing, for example, Durogesic in the form of a patch, then, unlike a doctor in the USA or Israel, what awaits him is not gratitude, but prison.

As a last resort, when the diagnosis is clear, confirmed by MRI, and the patient really has pain associated with a protrusion or hernia, a therapeutic blockade can be performed. But this manipulation is not performed at home, but in a hospital or treatment room. Let's look at the main groups of medications that help relieve pain in the first days of the onset or exacerbation of a protrusion or hernia.

NSAIDs: relieve pain and inflammation

Drugs from the group of NSAIDs, or nonsteroidal anti-inflammatory drugs, represent the “three pillars of the treatment of inflammation.” This is a decrease in body temperature, or an antipyretic effect, an analgesic effect, as well as an anti-inflammatory effect. We are not interested in the antipyretic effect, because with protrusions and hernias the body temperature does not rise, and paracetamol (Panadol) and other medications like ibuprofen (Nurofen) are not needed.

But the fight against pain and inflammation is what you need. The strongest analgesic effect of NSAIDs is the drug ketorolac (Ketanov), and in its strength it approaches the effect of narcotic analgesics. The anti-inflammatory effect, which consists in reducing edema, is expressed in drugs such as ketoprofen (Ketonal) and meloxicam (Oalis). The old drug diclofenac (Voltaren, Ortofen) has a very good anti-inflammatory effect. It can be used as a one-time injection, or in a very short course, no longer than 3 days.

We will not dwell in detail on dosages and administration regimens, since this is a matter for the attending physician. However, if the patient has a gastric ulcer or erosive gastritis, then drugs from the NSAID group are contraindicated for him. As a last resort, in the presence of gastritis and ulcers, you can simultaneously take these drugs along with proton pump blockers, such as Nolpaza, Omeprazole, Pariet. They protect the gastric mucosa from the destructive effects of NSAIDs.

After two to three days of intramuscular injections, they usually switch to tablet forms, which are also taken for several days. At the same time, from the very first day they begin rubbing ointments, creams and gels containing NSAIDs into the lumbar area. These are Fastum gel, Nurofen-gel, Dolgit-cream.

Attention! Warming ointments with capsaicin, for example, Capsicam, or Finalgon, can be used on the second or third day, when the pain has already begun to subside and the inflammatory edema has begun to resolve. On the first day, it is recommended to use ointments and gels with cooling, Deep Relief (ibuprofen + menthol), Ben-gay (methyl salicylate + menthol), or apply cooling and distracting essential oils to the lumbar area, for example, peppermint oil in a ratio of 1/10 s base oil.

Muscle relaxants: muscle relaxation

Unlike the relief of sharp and shooting pain, these medications are designed to relieve the persistent and aching pain component caused by excess muscle spasm. They cannot numb the very first, shooting pain. They were called centrally acting muscle relaxants because they regulate the functioning of spinal cord neurons and do not directly affect the muscle. They deceive her and allow her to relax. And this improves blood flow and allows you to eliminate the products of muscle metabolism. The most popular medications are Mydocalm, or tolperisone, and Sirdalud, or tizanidine. The first of them does not cause drowsiness, but the second is better taken at night or in the evening.

While taking muscle relaxants, it is better not to drive a car or work with moving machinery, since these drugs slightly increase the muscle reaction time. Muscle relaxants are also given intramuscularly during the first days of the disease, but they do not affect the gastric mucosa and can be prescribed as a course of therapy. As a result, chronic muscle spasm caused by protrusion and hernia is resolved, and persistent back pain also decreases or disappears.

Vitamins

The administration of B vitamins, or neurotropic vitamins, from the point of view of evidence-based medicine, does not affect the length of days of disability or the relief of pain. However, in the Russian Federation, doctors often use them for prophylactic purposes. Neurotropic vitamins are vitamins B1, B12 and B6, which take part in the functioning of the central and peripheral nervous system. Therefore, when there is swelling of the nerve roots, they are prescribed to create an excess depot, so to speak, just in case.

The most popular drug prescribed intramuscularly is Milgamma, which contains all these vitamin concentrates along with the local anesthetic lidocaine. He makes the injection painless. After a course of intramuscular injections, you can move on to the drug Milgamma compositum, this is a tablet drug.

Physiotherapy, exercise therapy and massage

All physiotherapeutic procedures associated with heat, mud therapy, balneological effects must be used outside the acute phase. Only then will physiotherapy, physical therapy and massage sessions have a beneficial effect. If you try to carry out a massage on the first or second day of acute back pain, it will only cause worsening, since the muscle is in a state of persistent spasm, and any shaking of the back will cause severe attacks of radicular pain. And standard massage techniques are not only relaxing, but also tonic. It is simply not appropriate to carry out one relaxing massage against the background of acute pain. Acute pain is a contraindication to any type of physiotherapy.

When to see a doctor

If you experience the first symptoms of a hernia, go to the doctor. Timely treatment of a hernia of the spine or abdomen in the center of Moscow will allow you to get rid of the disease once and for all. The clinic of modern medicine, which is located at 2nd Tverskoy-Yamskaya lane 10 (Mayakovskaya metro station), provides high-quality diagnosis of hernia, including hernia of the lumbar region, abdomen, groin, and spine.

A hernia in adults is identified by a therapist, after which the doctor refers the patient to one or more highly specialized specialists. It depends on the location and nature of the disease. It is important to understand that the treatment of cervical hernia is carried out by some specialists, and the treatment of inguinal hernia by others.

The therapist can refer you to a traumatologist, surgeon, orthopedist, or neurologist. To treat a herniated disc, you should contact a vertebrologist. In the central district of Moscow, you can find a competent specialist by contacting our multidisciplinary medical center at 2nd Tverskoy-Yamskaya per., 10.

Preparing to visit the doctor

There are no special recommendations here. But if you are going to see a doctor, do not forget that until the exact diagnosis is announced, you cannot be completely sure that you have a vertebral hernia or lumbar hernia. Still, a number of measures should be taken: do not lift anything heavy, do not overexert your body.

When the doctor makes an accurate diagnosis and prescribes treatment for the hernia, you should follow all the specialist’s recommendations. This is especially important if you are scheduled for surgery to remove a hernia.

How does a spinal hernia hurt?

Since a hernia means rupture of the fibers of the fibrous ring and extrusion, i.e., exit, of the nucleus pulposus into its thickness and beyond, this initially provokes irritation of the pain receptors of the outer third of the fibrous ring. The nucleus pulposus, which has penetrated outwards, also mechanically presses on the posterior longitudinal ligament. This may be asymptomatic, or due to the development of inflammation and swelling, it may provoke dull pain that tends to intensify when walking, sitting for long periods of time, moving, coughing, sneezing, defecation, etc.

They replace the sharp acute pain that occurs when the fibrous ring ruptures and the protrusion transforms into a hernia. Before this, there is usually long-term aching pain, concentrated in the spine and caused by the pressure of the nucleus pulposus on the weakened fibers of the fibrous ring. After their rupture, patients usually experience relief and temporary improvement in well-being. But sooner or later, this apparent improvement is replaced by dull pain in the spine, caused by irritation of the receptors of the outer third of the fibrous ring and the posterior longitudinal ligament.

If the body reacts to the changes with an inflammatory process, pain comes almost immediately. To eliminate them, anti-inflammatory drugs are usually used, which at this stage can completely eliminate discomfort. But since the cause of the development of painful sensations in the form of irritation of the receptors of the fibrous ring and ligament by the nucleus pulposus does not disappear, a chronic muscular-tonic reaction is gradually formed at the level of formation of the hernia and adjacent spinal motion segments.

This provokes the occurrence of dystrophic changes and fibrosis in the muscles, their spasms. As a result, they become denser and shortened, thereby causing displacement of the vertebrae and intervertebral joints. This leads to an increase in pain and the appearance of trigger points. Therefore, they begin to appear and intensify even after short physical activity, sitting, and heavy lifting, sudden movements, and hypothermia can cause sharp muscle spasms and acute pain.

Muscle spasm aggravates the asymmetry of the vertebrae at the level of the hernia and provokes a change in its position in the spinal canal. Therefore, at this stage, it often begins to mechanically compress the epidural venous plexuses, thereby blocking free blood circulation. Compressed vessels increase in volume, and their walls stretch. This leads to an increase in their permeability. As a result, edema develops and inflammatory mediators penetrate into the nerve root, provoking its chemical irritation. At the same time, it is also often compressed by a hernia, osteophytes, thickened ligaments, joint capsules and edematous tissues, which leads to the development of radicular syndrome with characteristic shooting pains, radiating to the parts of the body corresponding to the level of damage, neurological and movement disorders. In such situations, qualified medical care and the prescription of complex treatment are required, if it has not been started earlier. Otherwise, pain and other symptoms will worsen, and in the most difficult cases, irreversible damage to the nerve root cannot be ruled out.

Sequestered hernias, i.e. separation of the “prolapsed” part of the nucleus pulposus, provoke even more powerful autoimmune inflammatory reactions. At the same time, they tend to strongly compress nerve roots and blood vessels and cause severe neurological complications.

Whatever structure is the source of pain impulses, they are always transmitted to the spinal cord, and from there to the subcortical structures and cerebral cortex. As a result, the nervous system “realizes” the presence of pain, its nature, and sends specific painkillers – serotonin and norepinephrine – to the corresponding sensitive nerve roots. They inhibit their sensitivity and increase the pain threshold. Moreover, the higher the concentration of serotonin and norepinephrine, the less discomfort is subjectively felt.

At the initial stages of hernia development, this mechanism is sufficient to dull and eliminate painful sensations, especially in combination with timely and correctly selected therapeutic measures. Otherwise, this natural pain-relieving mechanism is depleted, the reserves of serotonin and norepinephrine are reduced, which leads to a progressive deterioration of the condition and the development of depressive disorders. At the same time, the number of pain impulses constantly increases, and subsequently the cells of the dorsal horn of the spinal cord themselves begin to generate them, which leads to chronic pain.

Diagnosis of hernia

A hernia in men and women is diagnosed at a doctor’s appointment. The specialist resorts to the following methods:

palpation (palpation);
percussion (tapping);
auscultation (listening to body sounds).

To get a more complete picture of the type and degree of development of the disease (vertebral hernia, cervical hernia, etc.), an instrumental study is carried out. This:

Ultrasound;
Radiography;
CT (computed tomography).

Competent treatment of lumbar hernia and other types of hernias is carried out by specialists from our clinic at 2nd Tverskoy-Yamskaya Lane, 10 (Mayakovskaya metro station).

Are there non-surgical methods for treating incisional hernia?

Treatment of postoperative hernia is carried out only with the help of surgery - hernioplasty. There are several methods used depending on the stage of development of the hernia.

The intervention must be performed as early as possible, because A long-existing hernia is prone to progression and the appearance of various complications.

The use of new technologies, the use of modern plastic and suture materials, and many years of experience of our surgeons guarantee the highest quality of operations to eliminate postoperative hernia, the absence of postoperative complications and relapse (recurrence of the disease).

Prevention

For prevention purposes, it is recommended to strengthen the walls of the internal cavity with the help of physical exercises. To do this, you need to pump up your abs. But this method is prohibited for those who have already undergone surgery to remove a hernia. You must follow simple rules:

do not overstrain the body;
try not to carry heavy objects;
watch your weight.