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Healthy Men

...and cough
Hernias are life threatening only if ignored


By Johnny Lucas

Every man knows the routine: drop your shorts, look the other way and pretend that this is not happening to you. You ignore your doctor's cold hands, which are cradling the family jewels. And cough. And again. OK, that's good.

Do you know what he's doing down there and why? I don't know about you, but I've never been one to ask questions of anyone while they've got me in that position.

Your doctor is checking for hernias. Three to five percent of men will get some kind of hernia at some point in their lives. Hernias are the protrusion of an organ, such as the bowel or the intestine, through the abdominal wall which is supposed to contain them. You might get an early warning of a hernia from a bulge in the abdomen or from a strong stomach pain. Sometimes you don't get a warning.

The most common hernia occurs in the inguinal canal, the passage through which the testes descend into the scrotum. If, when you strain or cough, the doctor feels a bulge in that delicate place, you've got the beginnings of an inguinal hernia ("inguinal" just means "in the groin area".) No bulge, no hernia.

Untreated, hernias usually get larger, they become strangulated when their blood supply is trapped, and then they can get gangrenous. By the time this happens you've got an emergency. But if you look after them with a surgical repair, hernias are very rarely life threatening.

There's a photo of a hernia posted on a medical supplier's web site. But before you click, be warned that it's an extreme example and quite gruesome.

Most hernias take a long time to develop, and most often erupt in later life, but in some cases hernias can be present at birth. The idea that hernias are caused by the stress of lifting heavy objects, coughing or even straining to defecate is just "an old saw" according to Dr. Robert Bendavid, a surgeon at the Shouldice Hospital in Thornhill, Ontario.

Heavy lifting or coughing, says Dr. Bendavid, may reveal a hernia or be the final straw that would cause it to finally break out, but, in almost all cases, a hernia develops over a long period of time.

Dr. Bendavid asserts that "Nothing that is known can be done to prevent a hernia, absolutely nothing." Although there is some evidence that a genetic risk factor may exist, geneticists have yet to provide convincing evidence as to what extent hernias are inherited.

More bad news is that hernias occur 20 times as often in men as in women. One hypothesis is that the angle of the pelvis, which is different in men than in women, could make a difference, but again, no one really knows.

The good news is that hernias can be repaired by surgery. There are three main surgical techniques: the Shouldice Operation, a pure tissue repair introduced in 1945 by the Canadian, Dr. E.E. Shouldice; tension-free repairs which insert a prosthetic mesh at the site; and laproscopic surgery in which the surgeon enters the abdominal cavity through tiny incisions.

On the Web, other than the Shouldice site, there's the National Ambulatory Hernia Institute. This southern California medical company owns the Internet domain name "hernia.com" and aggressively advertises its services in a large website.

Whatever technique you and your doctor choose, it seems important to put your bulge in good hands. If you don't, your hernia could erupt again. At the Shouldice Hospital, 15 to 20 percent of the 7,000 to 8,000 operations they perform each year are repairs to hernia operations not done at the Shouldice Hospital, which have to be done again.

If you can't predict a hernia, can't prevent it, the least you're going to want to do when you get one is to get the best care for it so that when it's gone, it's gone for good.

Health Links Button For more information on men's health and hernias, visit these HealthyWay™ Health Links


Johnny Lucas is a Toronto writer.

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