Types, signs and treatment of inguinal hernia in women

Inguinal hernia is a pathology in which, due to the weakening of the wall of the abdominal cavity, the part of the peritoneum and internal organs fall into the inguinal region, in women, the disease usually develops after 40 years. This condition brings a lot of inconvenience to a person and can lead to serious consequences.

Most often, hernias are found in men, but women are also susceptible to the development of the disease, especially those who give birth.

Code for micro-10

In the classification of diseases 10 revision inguinal hernia is under the code K40.

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Causes of inguinal hernia in women

As already mentioned, inguinal hernia in women is less common, in comparison with men.

The main cause of this condition is the physiological characteristics of women, even during intrauterine development in the abdominal cavity develops a hole (in boys through a similar hole the testicles descend into the scrotum). Usually, such a hole in women is much smaller, but in some cases it is the cause of the peritoneal prolapse.

Also, the hernia can be caused by weight lifting and other factors that increase pressure in the abdominal cavity (obesity, weightlifting, severe coughing, frequent constipation, etc.).

Also, the hernia can be a consequence of surgery on the inguinal or abdominal cavity.

[3], [4]

Pathogenesis

The inguinal canal is located in the lower part of the inguinal region, it has four walls, which are formed by oblique and transverse abdominal muscles. From the inside, the canal is covered by connective tissue, on the lower side - the inguinal ligament. When injuring or loosening the ligaments or muscles, a hole is formed through which the peritoneum extends.

Symptoms of inguinal hernia in women

Inguinal hernia can be asymptomatic without causing discomfort, revealing pathology mainly occurs on a routine physical examination.

In most cases, the development of a hernia is accompanied by a feeling of discomfort in the groin area (pressure, burning, dull pain on one or both sides, etc.). Often the discomfort appears only after a long sitting, lifting the gravity, etc.

Pointing to the formation of a hernia may bulge, which appears, as a rule, some time after the appearance of unpleasant sensations (weeks or months).

The bulge can disappear after the woman lies down, since a reclining position helps reduce pressure inside the abdominal cavity.

When the hernias are pressed in the inguinal zone after pressing the bulge, the internal organs return for a while to the place, but if there is a pinching, it is impossible to return the hernia in this way, there is severe pain in the groin, problems with the stool, temperature, vomiting, weakness, skin over the hernia becomes red.

Slanting inguinal hernia in women

The oblique hernia in the inguinal region falls through the inner inguinal ring. Congenital pathology of the inguinal can sometimes lead to the development of a hernia, but more often this kind of hernia is acquired.

The course of the oblique hernia occurs in several stages, at the initial there is an insignificant fall into the inguinal canal, it is practically impossible to see a hernia, pathology is revealed when examining the inguinal canal.

Over time, a small tumor appears within the inguinal canal, which becomes noticeable during exertion and disappears after relaxation.

With full hernia in women, the internal organs are protruded into the large lip.

With hernias of impressive size, most of the internal organs fall out, in which case the hernia can not be corrected by pressing (in some cases, they may fall to the knee).

If the hernia has reached a large size, then the hole through which the internal organs fall is also stretched, the inguinal canal changes its shape and the natural oblique direction acquires the shape of a ring.

Direct inguinal hernia in women

Direct hernia is only acquired, develops and falls out such a hernia from the internal inguinal cavity, closer to the middle (the loop of the intestine gradually begins to fall outside the abdominal cavity).

This type of hernia most often develops in women of adulthood, provokes pathology of physical overstrain, in rare cases, operations in the groin.

[5], [6], [7],

Injury of inguinal hernia in women

Infringement is called the transmission of a hernia, which leads to a violation of blood circulation and the death of tissues.

In most cases, the increase in pressure inside the abdominal cavity and the loss of more than usual volume of internal organs result in infringement, as a result the fallen organs are jammed and remain outside.

Infringement is the most dangerous and most common complication of inguinal hernia, in this case it is important to know the symptoms and to consult a doctor in a timely manner.

One of the main problems of infringement is the variety of symptoms that depend on the stage of the disease, the general condition of the patient, gender and external factors. Suspicion should be caused by pain in the lower abdomen (in the groin area), vomiting, nausea, when pressure is applied to the bulge, pain develops; in the supine position, the tumor does not disappear, but when there is more tension.

In addition, the symptomatology depends on the restrained organ, for example, when the intestine is jammed, frequent vomiting occurs, when the omentum is seized, only mild pain is felt, and there will be no vomiting and nausea. In addition, it can raise the temperature, there is a fever.

If a person knows about the presence of a hernia, then any changes will immediately become noticeable.

First signs

The inguinal hernia develops gradually and has its signs, which are quite difficult not to notice.

The first sign of the pathology is pain in the inguinal zone, in addition, in the supine position there is discomfort and pain in the lower abdomen.

Over time, a tumor begins to appear, which disappears in the supine position on the back. These are the first signs of the disease and with a timely call to the doctor to cure the pathology is quite simple.

Also, one of the symptoms of hernia development is constipation, especially during child bearing.

Problems with urination, pain in the groin, stomach - the main signs of the formation of a hernia.

In addition to pain, a woman may have an unpleasant sensation while walking, even at a slow pace there is weakness, burning, pain.

Cope with the pathology in the early stages can and without surgery.

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Pain in inguinal hernia in women

Pain in inguinal hernia may be of different intensity and severity (strong, moderate, pulling, etc.). The hernia can develop acute form, in this case the symptoms appear unexpectedly, the patient complains of severe pain and characteristic protrusion in the lower abdomen.

If the disease develops slowly and hernia has small dimensions, the pain is usually mild or completely absent.

With a prolonged course of the disease or a large hernia, there is an unceasing pain in the inguinal zone, which can give into the sacrum, the lower back.

What is dangerous inguinal hernia in women?

Inguinal hernia is a dangerous pathology that requires prompt treatment. In the process of protrusion of the peritoneum there may be a pinching, which will lead to the hardening of the hernial sac, the death of tissues, the inflammation of the internal organs.

In some cases, in the early stages, the fallen organ can be brought back into place by pressing, but if the procedure is delayed, inflammation of the internal organs and pinching can begin.

Contraindicated surgery to restore the hernia only to women during pregnancy (if there is no pinching), in this case, the expert recommends that you temporarily wear a bandage so that the internal organs are in place.

Effects

The consequences of inguinal hernia begin from the moment of its appearance, first of all, the inguinal zone changes. Since the internal organs penetrate into the groin and form a "bag" in some way, various diseases can begin, in particular, inflammatory processes, pinching, infertility, trauma, intestinal obstruction, stagnant processes in the intestine, tuberculosis of the internal organs.

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Complications

The most common complication of inguinal hernia is infringement, which requires immediate surgical treatment. If infringement can begin necrosis of tissues - enter into the hernial sac of the intestinal loops, omentum, uterine tube, etc., as well as inflammatory processes in the abdominal cavity.

Less dangerous complications are stool disorder, digestive problems, swelling, etc.

[10], [11], [12]

Diagnosis of inguinal hernia in women

If you suspect an inguinal hernia, an examination is performed, the specialist probes the groin in various positions (standing, lying, sitting). If the hernia is small or at the initial stage, the specialist also uses the palpation method to establish a preliminary diagnosis - he applies a finger to the inguinal canal, and the patient must cough at this time if there is a characteristic protrusion at the time of stress, this indicates the development of pathology.

In women, inguinal hernia is more difficult to diagnose than in men, since pain in the lower abdomen leads women to a gynecologist and hernia is often mistaken for other pathologies (cyst, swelling, etc.).

[13], [14]

Analyzes

When a hernia is detected, tests are given before operations. The blood test (general, biochemical, for sugar), urine, tests for hepatitis and venereal diseases (AIDS, syphilis) must be submitted without fail.

[15], [16], [17], [18], [19], [20], [21], [22], [23],

Instrumental diagnostics

In case of inguinal hernia, various instrumental diagnostic methods can be used to confirm the diagnosis.

Ultrasonic examination of inguinal canals is widely used in inguinal pathologies.

Usually, ultrasound is assigned in case of a specialist's doubt or special cases (for example, with too small formations).

This method of diagnosis is effective only if part of the interior has already penetrated the inguinal region, in other cases, ultrasound will not show anything.

Irrigoscopy also helps to identify inguinal formations, usually this method is prescribed if the expert suspects a sliding hernia, which is rather difficult to diagnose and has little expressed symptoms.

This method of investigation consists in introducing contrast material into the intestine and performing X-rays. Irrigoscopy allows to study the state of the intestines, to reveal pathologies and various diseases.

If suspected of a sliding hernia, ultrasound of the bladder, cystoscopy, cystography can also be prescribed.

Gerniography is widely used in the diagnosis of hernias. With this method of investigation, a special substance is injected into the abdominal cavity with the help of a thin needle, then the person should lie on his stomach to cough and strain his stomach, at this time the specialist makes several X-ray photographs showing the location of the hernia.

Differential diagnostics

Differential diagnosis consists of eliminating diseases that do not fit into symptoms or other indicators, until eventually the only likely diagnosis remains.

An inguinal hernia is important to distinguish from a lipoma, a tumor, an inflammation of the lymph nodes, a femoral hernia, a cyst of the round ligament of the uterus.

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Treatment of inguinal hernia in women

If an inguinal hernia is detected in a woman, treatment is prescribed depending on the size of the hernia, concomitant diseases, etc. If the hernia does not cause severe discomfort, the doctor may decide to conduct a dynamic observation that will show how the hernia develops. With stability, additional treatment may not be required, the doctor prescribes special nutrition and sparing loads, so as not to provoke impairment. With the increase in hernia and the ineffectiveness of preventive measures, the only possible method of treatment is the operation.

During the operation, the surgeon returns the dropped organs to their normal position, removes the hole through which the prolapse occurred, restores the disturbed blood circulation.

Surgery to remove the hernia does not apply to complex and almost always has a favorable outcome. Approximately 14 days after surgery, a woman can return to her usual lifestyle, she just has to adhere to a sparing regimen, do not raise the severity to avoid relapse.

Bandage in inguinal hernia in women

Wearing a bandage is the only conservative remedy for inguinal hernias. The bandage is recommended to be worn with large hernias that develop after an operation on the groin or if surgical treatment is not possible (with suppuration, relapse, elderly or childhood, during pregnancy, any contraindications to the operation).

Wearing a bandage does not correct the situation, but only relieves unpleasant symptoms and improves the patient's well-being, prevents cramping and further growth of the hernia. When you stop wearing the bandage, all signs of pathology immediately return.

Bandage should be worn on the naked body and only lying down. In the beginning, a person may experience discomfort, but eventually the bandage does not deliver.

Usually it is recommended to take off the bandage for the night, but if during a person's sleep a cough or sneezing disturbs, then it is better to leave it for the night, in this case it can be removed only for the time of taking a bath or shower.

With prolonged wearing of the bandage, the muscles of the press can atrophy, so surgical treatment remains the most effective method of treating pathology.

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Medications

There are no special medicines for inguinal hernia, as this condition is caused by weak muscles of the press, traumas or operative intervention in the groin area, excessive physical exertion. The prolapse of the internal organs is treated exceptionally quickly, in some cases, to relieve the symptoms, a bandage is worn, a sparing regimen (reduced physical exertion, no weight, etc.), and nutrition is regulated.

Treatment with alternative means

After consulting a doctor, to ease the symptoms of inguinal hernia, you can use some alternative medicine:

• 500ml of boiling water, 4 tsp. Leaves of gooseberries, insist about two hours, strain and drink 4 times a day for half a glass before eating.
• daily do compress with sour cabbage leaf
• make a compress with a strong infusion of wormwood (1 tablespoon herbs, 200ml boiling water, insist 2-3 hours).
• crushed leaves of nettle mixed with sour cream of high fat content and put on the skin (thicker), covered with cabbage leaf or burdock and fixed with a bandage, leave for the night. The course of treatment is 1 month.

Operative treatment

The surgeon can use the patient's own tissues or mesh implants during the operation.

Most often, an open method of conducting an operation using special equipment is chosen.

Young girls and girls usually use their own tissues, since at a young age there is an extremely low risk of relapse and recovery after surgery is better. At a more mature age, the hernia is eliminated with a reticular implant, as this reduces the risk of relapse and speeds up the recovery process.

Usually, the operation is performed under mild general anesthesia, in exceptional cases, local anesthesia is used.

After the incision, the surgeon returns the fallen organs to their normal position, after which the cut section is sewn layer by layer.

Laparoscopy can also be performed (surgery through small incisions - up to 1 cm). Just like with open surgery, general anesthesia is used, several small incisions are made in the groin, then the patient's stomach is inflated with carbon dioxide to expand the surgical area.

The operation is performed using a laparoscope (a miniature optical device with a camera), which is inserted into one of the sections, and the rest are inserted surgical instruments. With the help of a monitor, the surgeon can control his actions.

Laparoscopy is less traumatic, so the process of recovery is much faster, in addition, due to small incisions, the risk of infection is reduced.

Postoperative period

After the operation, the patient is shown a full rest for several days, usually these days are spent under the supervision of doctors in the hospital. Every day the medical staff makes dressings, the seams are processed by special means. From the hospital discharge for 7-10 days (with laparoscopy for 3-5 days).

Within a month after the operation, a sparing regimen is appointed - avoid physical exertion, wear a bandage, do not carry weights, etc.

Complete recovery occurs after 3 to 6 months, depending on the age, the chosen mode of operation, concomitant diseases, etc.

Exercises for inguinal hernia in women

Hernia often develops with weakened muscles of the anterior wall of the abdomen, so experts recommend doing special gymnastics to strengthen this group of muscles, which will help not only prevent the development of pathology, but also prevent the re-formation of a hernia after surgery.

The following exercises will suit people of any age and help strengthen the straight and oblique abdominal muscles:

• lie on your back, legs straighten, put a weight of 1 kg on your stomach (you can use a bag filled with sand) and inhale the belly with a bag as high as possible, letting go as low as possible while exhaling. With time, you can increase the weight to 2 and 3 kg.
• lying on the back to lift first left, then right and two together to an angle of 45 ^o, (hands along the body). Over time, you can wear weighting on your feet.
• lying on his back, legs to arrange and slightly bend, on exhalation to raise the pelvis (the support goes only to the elbows, feet and shoulders).
• lying on his back, fix his legs (under the couch or ask someone to hold them). On exhalation sit down, then inhale and lean forward, on exhalation return to the starting position.
• sitting on a chair, lean back on his arm, take hold of his hands, raise the pelvis with inspiration (resting on arms and legs), relax with exhalation.

Special gymnastics is recommended to be done three times a day.

When inguinal hernia, you can not engage in heavy physical exercises (swing the press, engage with dumbbells, etc.).

With contraindications to surgery, exercises should be done throughout life, but the complex of exercises should be selected by a specialist, taking into account the degree of the disease and the general condition of the patient.

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Food

In some cases, inguinal hernia in women is the result of regular constipation, so proper nutrition is one of the main preventive measures. In the diet should be a sufficient amount of fiber, which improves the functioning of the intestine.

After the operation, in the first few days, a special diet is also prescribed, the food should be liquid, in a warm form (diet broths, herbal decoctions, vegetable soups, fruit and berry juices, cereals, soft-boiled eggs, protein omelettes).

Follow the diet after the operation only a few days, but you should adjust your diet and exclude caffeine, alcohol, chocolate, fatty foods and eat in small portions.

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Prevention

The main preventive measures of inguinal hernias are:

• reduction in physical activity (do not carry weights, avoid overvoltage)
• exercise
• control your weight
• adjust the food (exclude pickles, fatty foods, include more fiber).

Forecast

The prognosis of inguinal hernia is favorable in most cases, the recurrence can not be ruled out, but if the doctor's recommendations and basic preventive measures are followed, the risk of re-formation of the hernia can be significantly reduced.

After the operation, full recovery of work capacity is observed.

Inguinal hernia in women is not as common as in men. In the female body, there is a whole mechanism of properties that prevent the development of pathologies, in particular, in women, the inguinal space is much narrower than in men, and there is no spermatic cord that interferes with the resistance of inguinal muscles.

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