Age has no meaning when it comes to injuries. Of course, as you get older, recovery time and injuries increase. Father time is undefeated in life. Your youth also passes you by only once. My concern is over hernias that require a hernia mesh (#herniamesh) to repair. I have recently had surgery to correct a hernia. I have been living with it for over 3 years. Hernias are also ageless. How many times have you heard of sports stars who have to undergo surgery to correct hernias.
There is no single cause for getting one. Overexertion from exercise, picking up your children the wrong way or even picking up a case of water incorrectly can result in some form of hernia. You can even consider being constipated or not having enough fiber as a cause. If you have ever played competitive sports, some of you will develop hernias. It is a fact of life and the limits that our bodies face. Hernias are more common than you expect.
The medical definition of a hernia is when an organ or fatty tissue squeezes through a weak spot in a surrounding muscle or connective tissue. In simple terms it is a combination of pressure in the abdomen and a weak spot inside your body that creates hernias. The pressure pushes an organ or tissues into this weak spot. We have been lead to believe that parts of your body can’t move from location to location inside you. This concept is not completely true, since certain organs can shift.
Also consider that out bodies are not perfectly sealed. There are weak points within us. Take for example your belly button. Early in life your belly button was attached to the womb by way of an umbilical cord. This allowed the transfer of nutrients and oxygen between mother and child. At birth, the umbilical cord is cut and the body heals itself by closing the gap where the umbilical cord once stood. But nature doesn’t always do a good job of this. Even later on in life, when we try to do too much, we create weaknesses. One of those weaknesses can be seen as hernias.
Five Main Types Of Hernias
There are five main types of hernias. First there are inner groin or inguinal hernias. Next there are incisional hernias which are a result from surgery, followed by femoral hernias or the outer groin. Finally we have umbilical and hiatal hernias. Keep in mind that hernias are not age nor race specific and occur in both men and women. Let’s begin in the groin area where you will find two main types. On the men’s side you have inguinal which is associated with the inner groin. For this type of hernia, the intestine or the bladder protrudes through the abdominal wall or into the inguinal canal in the groin. The inguinal canal is a natural weakness for men. Many prominent sports stars have undergone corrective surgery in this area.
On the women’s side, you have the femoral hernia which is associated with the outer groin. Typically the intestine enters the canal carrying the femoral artery into the upper thigh. This type is most common in women who are pregnant or obese. Next up are incisional hernias which is when the intestine pushes through the abdominal wall at a previous site that you had surgery. It is prevalent in elderly and overweight people who are inactive after abdominal surgery. Umbilical hernias are seen when part of the small intestine passes through the abdominal wall near the belly button (navel). Finally you have the hiatal hernia which happens when the upper stomach squeezes through the hiatus. The hiatus is an opening in the diaphragm which the esophagus passes.
Anything that causes pressure in the abdomen can cause a hernia. Remember how trainers or workout gurus teach you to lift with your legs? Guess why? Because lifting heavy objects without stabilizing your abs can cause a hernia. You can also add diarrhea, constipation, persistent coughing as in COPD and sneezing as causes. You can also consider poor nutrition, obesity and smoking which can weaken muscles and increase your chances of a hernia. Pregnancy which is the ultimate pressure exertion is also a source of hernias.
Genetics also plays an important role in hernias. If you track you family tree closely, you might find relatives that regardless of physical condition have a higher incidence of developing hernias. We are all part of our ancestors and any defect they had, we will carry it in our genome. You can also hide your hernia in some cases. The trick is to lie down on your back and gently push the protruding mass back in. If pain develops, stop, otherwise you can proceed. If the gap is too large, the hernia will continue to show itself.
Symptoms Of Hernias
Based on the types explained above, we can expect the majority of the impact to be in the groin or abdominal area. The most common side effects include pain or discomfort especially when coughing, exercising or going to the bathroom. Typical relief occurs when you lay down. For the groin, you can typically see a bulging area that wasn’t there before. Groin areas usually occur more on the right than on the left. If your bulging area produces severe pain or redness, it usually means and organ is being choked from blood supply. Vomiting or stomach pain is a clear indication that your intestines have been impacted. As was in my case, you might not feel anything but just see something protruding from your belly button.
Most surgeries are managed at same day surgery centers and depending on the type of work, are able to return to work within a week or two. Intense activities such as lifting and exercise are prohibited for a longer period such as a month. Patients who have hernia repair with mesh often recover faster although the pain can last longer. Surgical complications include pain that lasts more than three months, surgical site infections, nerve and blood vessel injuries, injury to nearby organs, and hernia recurrence. Pain that lasts more than three months occurs in about 10% of people following hernia mesh surgery.
There are different ways to repair hernias. The most common way to repair any hernia is through the use of a hernia mesh during surgery. This mesh is a medical device used to provide additional support to weakened or damaged tissue. It used to be that hernia repairs were only done surgically with the use of stitches. Studies have found that within 3 years, you have a higher rate of repeat surgeries or infections when using stitches. Using stitches also requires an experienced doctor to perform the surgery. The hernia mesh reduced these complications. Let’s face it, who wants to go back to fix the same issue over and over again.
Some of the more traditional hernia meshes have been around for over 50 years and are quite effective. My doctor equates older meshes to a 1957 Chevy (classic and reliable). There are different characteristics that need to be considered since there is no perfect mesh. The first characteristic is pore size or rather the size of the holes in the mesh. If the pore size is too small, bacteria can get trapped, grow and cause an infection. If it’s too big, you get parts of your body trapped in it. Second is the material you use for the mesh. You have choices just like if you were to set up a kitchen. It can be knitted or non knitted, absorbed by the body or permanent or even a combination of both.
Keep in mind that the absorbable mesh are made of bovine (cow) or porcine (pig) tissue and your body might reject it. Finally you have to consider the type of material used. The traditional hernia mesh is a basic polypropylene mesh. Used in the majority of surgeries. Other options include polytetrafluoroethylene (PTFE), polyester, polyglactin and polyglycol. Each has its strengths and weaknesses and shrinkage has to be considered.
When dealing with scientists, constant improvement is always on the forefront of any medical device. The need to make it better and safer will always prevent the status quo. This desire for improvement is also a detriment to those who first pioneered the innovation. As an example, its like taking the hula hoop and adding bells and lights.
It has also become a bonanza for the lawyers. If we begin with the absorbable mesh concept, it is a noble one since the immune system will attack any foreign substance in the body. This type of hernia mesh will degrade and lose strength over time. The intent is for the new tissue that grows to provide strength to the repair. Unfortunately if it degrades too quickly, you will have a repeat hernia.
Johnson & Johnson issued a voluntary hernia mesh recall worldwide for its Physiomesh brand in 2016. Physiomesh is a flexible composite mesh. Soon after approval and use, patients started to react negatively to the mesh. It turns out that the mesh was failing at a much higher rate than other meshes on the market. This failure cause more additional surgeries to either recorrect the hernia, replace the mesh or even correct infections. Hence a class action lawsuit is in progress. Another example C-QUR mesh by Atrium Medical. This hernia mesh was coated with a fish oil substance (omega 3s). Interesting concept except if you are allergic to fish. In addititon, the mesh stuck together with tissues and organs caused by abnormal scar tissue. As you can imagine, lawyers are having a field day.
This impact is not just for men but women also. Women suffer from Pelvic Organ Prolapse or POP which is a condition when the muscles and ligaments supporting pelvic organs weaken. The pelvic organs can slip out-of-place. Surgical mesh is usually implanted to reinforce the vaginal wall. Now, most mesh are made out of polypropylene which is a petroleum-based product. In addition, the mesh has to have a certain firmness to hold back the force imposed by the body. Over time, the mesh begins to erode and with it, it can damage the vaginal wall, nerves or tissue. This will cause infections, pain, urinary problems and recurring surgeries to correct the mesh implant. Other side effects from this issue include inflammation, painful sex and scar tissue. this has been such a huge problem that the FDA has deemed it a high risk procedure.
Another impact on women’s health is the use of mesh for the treatment of Stress Urinary Incontinence (SUI). This I know has happened to few women that I know. Have you ever seen a woman laugh so hard that they peed themselves or even peed themselves when they sneeze. That is what SUI is, an unintentional loss of urine due to a physical movement or activity that puts pressure or stress on your bladder. These activities include coughing, sneezing, running or heavy lifting. A mesh is implanted through the vagina to support the urethra or bladder neck. But when it goes wrong, the same side effects as POP are observed. Good intentions but poor execution.
Have you had a negative hernia mesh experience?