Ventral Hernia Of The Urinary Bladder With Mixed Urinary Incontinence: Treatment With Herniorrhaphy And Allograft Fascial Sling
- Eric S RovnerCorrespondenceAddress for correspondence: Eric S. Rovner, M.D., Division of Urology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104Affiliations
- Division of Urology, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USADepartment of Radiology, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
What Causes An Inguinal Hernia
An inguinal hernia usually happens when fatty tissue or a part of your bowel, such as the intestine, pokes through into your groin at the top of your inner thigh.
It pushes through a weak spot in the surrounding muscle wall into an area called the inguinal canal.
Inguinal hernias mainly affect men. Most are thought to be caused by ageing, although they can happen at any age.
This is because as you get older, the muscles surrounding your abdomen can become weaker.
Inguinal hernias can sometimes appear suddenly after putting pressure on the abdomen, such as straining on the toilet if you have constipation or carrying and pushing heavy loads.
They have also been linked to having a persistent, heavy cough.
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What Should I Expect After Surgery
- Following the operation, you will be transferred to the recovery room where you will be monitored for 1-2 hours until you are fully awake.
- Once you are awake and able to walk, you will be sent home.
- With any hernia operation, you can expect some soreness mostly during the first 24 to 72 hours.
- Most often the postoperative pain, if done laparoscopically, is not at the previous hernia site but around the edges of the mesh where the sutures have been placed through the muscle to fix the mesh in place.
- You are encouraged to be up and about the day after surgery.
- You will probably be able to get back to your normal activities within a short amount of time. These activities include showering, driving, walking up stairs, light lifting, working and engaging in sexual intercourse.
A Rare Cause Of Inguinal Herniation: Urinary Bladder Hernia
AS Prasanth, G Mahilrajan, S Pirasath
Herniation of the urinary bladder into the inguinal canal is rare and constitutes 13% of all inguinal hernias. Bladder herniation is usually asymptomatic and is determined incidentally however, it may rarely present with urinary obstruction symptoms. Here, we described an incidental bladder hernia in a 76-year-old man who is evaluated in radiology department for fever and left-sided flank pain for three days duration. He had no previous history of trauma, medication abuse, surgery or familial bladder disorders. His additional co morbidities included hypertension and diabetes mellitus. There were no remarkable findings on abdominal examination except left side loin tenderness. On evaluation Computed tomography revealed that a left inguinal hernia with fluid density lesion continuous with left lateral bladder wall. No bowel was contained in the hernia . The inguinal hernia was confirmed as bladder hernia by CT cystogram . Inguinal hernia usually contains the peritoneum that surrounds the abdominal organs. Bowel loops, omentum, or extraperitoneal fat can be detected within the hernia sac in the inguinal canal. However, as in this case, the bladder can also be present within the hernia sac. Early diagnosis with radiological imaging is important to prevent complications during surgery.
Indexing and Archiving
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Q: How Can You Tell If You Have An Inguinal Hernia
A: First, its important to understand that both men and women can develop inguinal hernias. People often believe that only men get them, and for anatomical reasons, they do have a higher risk. But women can certainly have inguinal hernias, too.
Many experts agree that women are likely underdiagnosed for this condition because they tend to have different symptoms than men. Women may not have a noticeable bulge. If symptoms indicate a possible hernia but your doctor cannot confirm it by an exam, an MRI can provide definitive evidence.
Signs That You Or A Loved One Might Have A Hernia
- A bulge in the groin or scrotum, or swelling in the scrotum
- Discomfort in the groin that gets worse when you bend or lift something
- Heaviness in the groin or abdomen
- Pain or discomfort during a bowel movement or urination
- Pain or discomfort toward the end of the day, particularly if you were standing a lot
- Any symptoms of a strangulated hernia, which include fever, vomiting, nausea and severe cramping
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Clinical & Imaging Findings
Spigelian hernias can be classified into two groups: a) interstitial hernias, which are located below the major oblique aponeurosis and b) subcutaneous hernias, which cross the major oblique aponeurosis and are thought to be the consequence of rupture. Most of them contain omentum, small intestine, or colon however, the hernia sacs have been reported to contain stomach, gallbladder, a hepatic lobe post-cholecystectomy, Meckels diverticulum, ovaries, and appendix .
Spigelian hernia can be also classified as congenital and acquired. Perforating vessels are thought to weaken the Spigelian fascia, and once a small amount of mesenteric fat enters that space a hernia gradually forms. Like other hernias, Spigelian hernia may also be related to increased intra-abdominal pressure and stretching in the abdominal wall. The main causes are obesity, multiple pregnancies, previous surgery or scarring, chronic cough, ascites with multiple paracenteses, and weightlifting. Prior abdominal surgery, placement of drains, or laparoscopic ports are also thought to be strong risk factors .
Is A Spigelian Hernia Dangerous
Spigelian hernias usually have the omentum, or intestines, passing through a narrow opening. Because the slit through which the spigelian hernia passes has rigid borders, the omentum or intestines may get stuck. If that happens, any of the following complications can arise:
- Incarceration. This happens when part of the intestine or abdominal tissue gets trapped in the hernias sac. Incarceration occurs in 27% of spigelian hernia cases.
- Obstruction. When a loop of the intestines gets stuck in a narrow opening, the contents cannot move ahead. Undigested food collects above the incarcerated point.
- It becomes a strangulated hernia. This happens when the intestine gets stuck through a narrow opening and the blood supply is blocked. Without a proper blood supply, the tissues will die.
All these complications are life-threatening and require immediate treatment. Seeking medical attention as soon as possible if you think you have them.
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What Are Hernias In Children
A hernia is when a part of the intestine pushes through a weak spot in the belly muscles. The hernia creates a soft lump or bulge under the skin.
In children, a hernia often happens in 1 of these 2 places:
The groin area. This is called an inguinal hernia.
Around the belly button. This is called an umbilical hernia.
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Bulge Turning Red Or Blue
If the skin over your hernia bulge changes color, it may be a sign of it getting worse. When the skin turns gray, red or blue, this tells us that the hernia is strangulated and swollen and needs medical attention. This is most common in the abdomen, near the navel. This an umbilical hernia , and its common for people of any age, but its seen more in woman than men. An umbilical hernia can also happen to you if other members of your family are prone to hernia.
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Watch Out Do Not Leave Hernias Untreated
7 minute read
Hernias occur when an organ especially small intestine protrudes through a weakened spot or tear in the abdominal wall. Hernias are commonly caused by a combination of muscle weakness and increased abdominal pressure.
Hernias cause a bulge or lump in the affected area such as groin , umbilicus or surgical incision which is not properly closed . If the protruding intestine is not pushed back in place, the contents of hernia might be trapped in the abdominal wall, then becoming strangulated which cuts off blood supply to surrounding tissue that is trapped. If it is left untreated, a strangulated hernia can lead to life-threatening conditions such as necrotizing enterocolitis and sepsis. Since hernias can happen to anyone at any age, knowing warning signs of hernias and being aware of them are essential. If suspected signs and symptoms are presented, early diagnosis and timely treatment must be provided as soon as possible.
What Should I Do If I Think My Child Or I Might Have An Inguinal Hernia
Seek medical attention for any signs of a hernia, or any kind of lump or fussiness in your child. An inguinal hernia in a child is usually treated as soon as possible. Even if your hernia isnt bothering you, its important to have it diagnosed and to rule out other possible causes of groin pain, lumps or scrotal swelling. Other possible causes include:
- Femoral hernia.
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What Does It Mean When You Feel Like You Have To Pee But Only A Little Comes Out
If a person has a constant urge to pee but little comes out when they go, they may have an infection or other health condition. If a person frequently needs to pee but little comes out when they try to go, it can be due to a urinary tract infection , pregnancy, an overactive bladder, or an enlarged prostate.
What Is The Treatment For A Spigelian Hernia
Surgery is the only way to treat a spigelian hernia, either by a regular surgical operation or through laparoscopic repair. Waiting isnt a good idea because the hernia wont get better on its own.
During regular surgery, your doctor will identify the gap in the spigelian fascia and will push the omentum or intestine back into the abdomen. After that, theyll close the gap by sewing it up or placing a mesh over it.
With laparoscopic repair, your doctor will only need to make one or two small incisions to your body. Your hospital stay will likely be shorter and so will your recovery time.
You should plan for surgery as soon as your spigelian hernia is diagnosed. You may need emergency surgery if incarceration, obstruction, or strangulation happens. Spigelian hernia treatment is safest when done early as planned surgery.
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How Are Inguinal Hernias Repaired In Surgery
The object of hernia repair surgery is to move the hernia contents back into your abdominal cavity and close the gap. This is also called herniorrhaphy. Sometimes, surgeons reinforce the weak spot with tissue from another part of your body, or with a fine synthetic mesh. This is called hernioplasty.
Hernia repair is one of the most common surgical procedures performed worldwide and can often be done on an outpatient basis. It can be performed under general, regional or local anesthesia. You can discuss the pros and cons of these different methods with your anesthesiologist.
- General anesthesia puts you to sleep for the procedure. You wont have any awareness or sensation.
- Regional anesthesia numbs your body from your waist down.
- Local anesthesia numbs only the part of your body being operated on, in this case, your groin.
Most hernia repairs can be managed by minimally invasive surgery methods, but hernias that are more complicated may require open surgery. Around 5% of hernia repair surgeries are emergencies. The type of surgery you have will depend on your condition, prior surgical history, and the experience and judgment of your surgeon.
If you have a pinched or strangulated bowel, your surgeon may have to remove the affected section . You might have to have a temporary ostomy while your bowel heals from surgery. Your bowel will be reconnected and your ostomy closed in a second surgery later on.
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What Can Be Expected Following Surgical Treatment For A Hernia
After surgery, you will be given instructions. These include what diet to follow, how to care for the incision site, and how to take care to avoid physical strain. Hernias may recur regardless of the repair operations. This is sometimes caused by inherent tissue weakness or protracted healing. Smoking and obesity are also major risk factors for hernia recurrence.
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The Most Common Types Of Hernias
- Inguinal hernia: When the intestine or the bladder extends into the abdominal wall or into the groins inguinal canal. This type of hernia mostly occurs in men.
- Incisional hernia: When the intestine protrudes through the abdominal wall at the site of a previous surgery. This mostly occurs people who are older, overweight or inactive following abdominal surgery.
- Femoral hernia: When part of the intestine causes a bulge in the upper part of the thigh, close to the groin. This is most common in women, particularly those who are pregnant or overweight.
- Umbilical hernia: When part of the intestine extends into the umbilical opening in the abdominal area. Infants are susceptible to this. These hernias are usually harmless in children.
- Hiatal hernia: When the upper part of the stomach squeezes through an opening in the diaphragm. A small one might be harmless, but a larger one can cause symptoms such as heartburn.
You may have heard that you can repair a hernia yourself if its small and not too painful, but its always wise to seek medical attention to make sure that the problem isnt more serious, says Dr. Gretschel. Hernias cannot heal on their own if left untreated, they usually get bigger and more painful, and can cause serious health risks in some cases.
If the wall through which the intestine is protruding closes shut, it can cause a strangulated hernia, which cuts off blood flow to the bowel. This condition requires emergency surgery.
Urinary Bladder In Inguinal Hernia: An Uncommon Finding
A 78 year old obese male with narrow angle glaucoma, BPH, hiatal hernia, abdominal hernia and right inguinal hernia presents with longstanding urinary symptoms of weak stream and incomplete emptying with increased urinary frequency and urgency during the day, while denying any history of gross hematuria or recurrent urinary tract infections. An initial renal ultrasound was obtained to assess his urinary symptoms, suggesting 1 nonobstructing stone in the left kidney without hydronephrosis. A CT scan to delineate the size and location of his stone confirmed that the patient in fact had one 6mm nonobstructing stone in the lower pole of the left kidney, however an incidental finding of a portion of the patients urinary bladder herniating into a large right inguinal hernia was reported . Patient was subsequently followed by surgical service, where he opted for an expectant management approach. The patients overactive bladder symptoms were managed with 3-receptor agonist Mirabegron as opposed to anticholinergic medication which is contraindicated in narrow angle glaucoma.
To cite this abstract:
URINARY BLADDER IN INGUINAL HERNIA: AN UNCOMMON FINDING.
Abstract published at Hospital Medicine 2017, May 1-4, 2017 Las Vegas, Nev..
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What Are The Surgical Options For Hernia
There are two types of surgical repairs if you have a hernia. These include the following:
- Laparoscopic hernia repair. In such cases, several tiny incisions are made in the abdomen, through which a camera, light, and tools for surgery are allowed to pass in order to fix the hernia. This type of surgery may be done with or without a type of mesh to reinforce the surgical site.
- Open Hernia Repair. In such cases, the surgeon opens the inguinal area near the site of the hernia and repairs the weakened muscles. This can be done with or without mesh to reinforce the herniated area. The surgeon uses this method to fix inguinal hernias if they are small, infected hernias, strangulated hernias, or in infants.
If you have a hernia that results in pain or other uncomfortable symptoms, surgery is needed.
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What Are The Symptoms Of A Bladder Hernia
Patients that are symptomatic most often present with nonspecific symptoms such as inguinal swelling, dysuria, hematuria, and urinary urgency . In advanced cases, patients must complete 2-stage urination in which they manually compress the scrotum after voiding for bladder emptying .
Can hernia cause pressure on bladder?
Sometimes a patients bladder will be trapped within the hernia. If this happens, you could experience urinary burning, frequent infections, bladder stones and hesitancy or frequency in urinating.
Can you have a hernia on your bladder?
Inguinal bladder hernia is rare condition. Urinary bladder is found in 15% of inguinal hernias , most data reporting 13%,. Incidence is higher in obese males, aged 50 years. Hernia sac could contain any portion of bladder .
Does a hernia make you pee a lot?
One of the dangerous aspects of hernias is that they can negatively affect your ability to defecate .
How do you fix a prolapsed bladder?
How is a cystocele treated?
Can a hernia cause you to pee a lot?
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