Definition:
The protrusion of a structure through a weakness in the abdominal wall.
Etiology:
Inguinal:
1.
indirect: a protrusion through the inguinal ring, often producing a bulge over the middle of the inguinal ligament a.
common in both sexes and occur often in children b.
males: often protrudes into the scrotum; palpation with examiner’s finger into the inguinal canal reveals a mass meeting the finger in the canal
2.
direct: a protrusion through the posterior wall of the inguinal canal (Hesselbach’s triangle), the bulge is noticed close to the pubic tubercle, that is more medially than the indirect hernia a.
infrequently seen in females b.
usually occur in men over 40 c.
males: rarely extrude into the scrotum; palpation reveals a bulge anteriorly which pushes the examiner’s finger forward
Femoral:
1.
protrusion occurs through the femoral canal
2.
males: do not protrude into the scrotum and the inguinal canal is empty; palpation below the inguinal ligament and medial to the femoral artery and vein
A weakness in the wall of he abdomen allows protrusion of a serosa-lined pouch to protrude into the femoral or inguinal canal.
The danger lies in the possibility of strangulation and infarction of the protruding structure, commonly the small intestines.
Inguinal hernias are more common in males than females since the spermatic cord and testes descend through the inguinal canal, leaving it more patent and therefore susceptible
Signs and Symptoms:
1.
pain may or may not be present
2.
hernia may or may not be reducible
3.
(+) physical exam, however, it is hard to perform the exam for inguinal hernias on women
4.
males: a.
pain and swelling in the femoral canal or scrotum b.
constipation
Course/Prognosis: c.
a palpable mass felt by the examiner’s finger inserted into the inguinal canal or over the femoral canal or over the femoral canal; the mass is made more obvious as the patient stands or bears down (Valsalva)
1.
unless the hernia becomes strangulated and lead to gangrene
2.
the prognosis is favorable
3.
surgery is the treatment of choice for conventional physicians
4.
various treatments are available to replace the protruding tissue and maintain closure of the hernia opening
5.
males: a.
may cause strangulation of the structures involved and subsequent infarction as the structure swells and cuts off blood supply b.
various treatments are available to replace the protruding tissue and maintain closure of the hernia opening
Differential Diagnosis:
1.
lymphadenopathy
2.
saphenous vein varicosity
3.
females: a.
uterine prolapse
4.
males: a.
hydrocele b.
varicocele
Nutrition:
1.
liver cleansing foods: beets, carrots, artichokes, lemons, parsnips, dandelion greens, watercress, burdock root
2.
squash, almonds, sesame seeds, tahini, kelp
3.
vitamin E foods
Remedies: a.
take 30g dried green peach (pitted young green fruit left to dry in the sun) and a fresh mango, cover with water and simmer until cooked, serve BID b.
take 30g of tangerine seeds, stir fry until yellow then crush finely, add 30-60g of rice wine and drink BID
Supplements:
1.
vitamin C (6-8g QD)
Hydrotherapy:
1.
to reduce hernia: apply hot compress to relax tissues then manually put mass back in place
1

2.
to hernia region: alternating hot and cold
3.
after reduced: sine wave: apply small pad hernia and large pad on back, then move small pad to hepatic flexure, then to splenic flexure region, 5 min. each region, intensity to just see contractions, 3x/week
Physiotherapy:
1.
abdominal exercises: after hernia has been corrected
2.
breathing exercises: after hernia correction to strengthen diaphragm
3.
support: use pressure belt
Botanicals:
1.
Atropa belladonna (toxic): strangulated, to reduce; topical application of extract (Atropine sulfate) over hernia
2.
Chamaelirium luteum (Helonias): sense of pelvic weight and congestion
3.
Collinsonia canadensis: sense of pelvic weight and congestion
4.
Hamamelis virginiana
5.
Lobelia inflata (toxic): strangulated, breaks spasm
6.
Senecio aureus (toxic): sense of pelvic weight and congestion
7.
Symphytum officinale (toxic): local application of fresh root
See: Uterine prolapse in females
Homeopathy:
1.
Aesculus hippocastanum: for inguinal hernias
2.
Aurum metallicum: pressure in abdomen ring as if hernia would protrude while sitting; protrusion of inguinal hernia with great cramp-like pain; inguinal hernia in children if others fail
3.
Belladonna: strangulated hernia; intense local inflammation; distension of abdomen either hard or painful
4.
Calcarea carbonica: a leading remedy; start treatment with it, will cure most cases; where walls of abdomen are thin and truss cannot be worn; infantile hernia
5.
Cocculus indicus: incarcerated hernias; umbilical hernia; protrusion takes place slowly as if from paralytic state of abdominal ring; when Nux vomica and Lycopodium fail
6.
Coffea: strangulated inguinal hernia
7.
Colocynth: pain in groin like from a hernia and on pressure sensation as if hernia would recede
8.
Cubeba: femoral hernia
9.
Granatum: inguinal, umbilical hernia
10.
Lachesis: hernia strangulated, sloughing; gangrene threatens strangulated hernias; very sensitive
11.
Lycopodium: umbilical hernias, right sided, abdomen distention with rumbling of gas; femoral hernia
12.
Magnesium muriaticum: congenital scrotal hernia
13.
Nitric acid: inguinal hernia, also of children
14.
Nux moschata: umbilical hernia; abdomen enormously distended
15.
Nux vomica: use every 10-15 min., esp. on left side; right side if Lycopodium fails
16.
Opium: strangulated inguinal hernia; redness of face; distension of abdomen; vomiting of putrid matter or of feces and urine
17.
Plumbum metallicum: intussusception with colic and fecal vomiting; strangulated hernia whether femoral, inguinal or umbilical
18.
Silica: hernia of rickety children
19.
Spigelia: inguinal
20.
Sulphuric acid: violent protrusion of inguinal hernia
21.
Thuja: congenital hernia
22.
Tabacum: strangulated hernia
23.
Veratrum album: incarcerated hernia, not inflamed; cold feeling in abdomen; great sinking of strength and empty feeling
24.
Wiesbaden: femoral and inguinal
25.
Zabacuon: strangulated hernia
26.
Zincum metallicum: inguinal
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