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Living With Hiatus Hernia

LIVING WITH HIATUS HERNIA

A hiatus hernia can often present different symptoms in patients. While some may experience reflux and heartburn on a regular basis, others may only feel slight discomfort when doing strenuous activities.

While the only long-term solution to hiatus hernia is surgery, there are things you can do which will help manage your condition and minimise your discomfort.

 

Avoid heavy lifting

Avoiding heavy lifting really does make a difference if you have been diagnosed with a hiatus hernia. If you cannot avoid doing this completely, use a cart or trolley to move heavy objects, or ask someone to help move it for you. If you are a keen gym goer, be mindful of your workout routine if it incorporates heavy lifting, and try to avoid exercises such as squats and crunches which place excessive stress on the stomach muscles.

Relax

Stress can impact the way in which our body reacts to reflux symptoms; if you are suffering from a hiatus hernia it can help to regularly practice relaxation techniques. Sitting calmly and engaging in deep breathing exercises or meditation can often help your body relax. If you are suffering from reflux, try finding a quiet place you can sit comfortably and practice these until your symptoms pass.

Take a fibre supplement 

Chronic constipation and straining can often exacerbate hernia symptoms and cause discomfort. If this is something you suffer from, it can be useful to take a daily fibre supplement to improve regularity and ease hardened stools. Mineral oil and psyllium husks are supplements which work well. You can also add more fiber to your diet by eating dark green leafy vegetables such as spinach, kale and cavolo nero.

Elevate the head of your bed

Using additional pillows or lifting the head of your bed by 4-8 inches is very useful if you suffer from gastroesophageal reflux disease (GERD) or are overweight. When the stomach is in an ascending position it significantly reduces the risk of gastric backflow related to hiatal hernias and can help to prevent nighttime coughing from reflux. 

Loosen your belt and replace tight clothing

Any item of clothing which constricts the abdomen can trigger symptoms, avoid cinched waistlines, tight belts, or anything that places direct stress on your stomach.

Give up smoking

Smoking can affect gastric motility and the way in which food moves through your esophagus. It can make your LES (lower esophageal sphincter) less responsive and in turn make swallowing more difficult. These effects can be long-lasting, and can become permanent in heavy smokers, often turning a small hernia into a much larger source of discomfort.

Looking forward

At present the only way to completely be rid of a hiatus hernia is through surgery.
We are now offering this service at the Birmingham Hernia Clinic and are happy to see patients for consulations and advice regarding their hernia. 

Get in contact with us today.

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Urinary problems and inguinal hernia surgery

INGUINAL HERNIA SURGERY

Over 60 000 primary inguinal hernia repairs are carried out in England each year. Most of these are in men. Urinary retention, that is the inability to pass urine, after groin hernia surgery is not uncommon. The reported incidence varies from less than 5% to nearly 25%. The risk of urinary retention increases with age. It is also more if patients have any urinary symptoms already.

Why is it important?

Urinary retention may result in some patients requiring catheterisation and spending longer in the hospital. In some cases, patients may require further surgical procedures to allow them to pass urine again.Urinary retention is one of the most common causes of delayed discharge after groin hernia surgery.

Why do patients get urinary retention after hernia surgery?

Patients may develop urinary problems after inguinal hernia surgery as a result of overstimulation of muscle in the bladder neck and prostate causing an obstruction.There are some drugs that can block stimulation of these muscles.
These drugs are already used for treating urinary symptoms in men. They are known as alpha-blockers and the commonest used one in use in the UK is Tamsulosin.

 

Can drugs help prevent urinary retention?

A study published in the American Journal of Surgery last year by Clancy and colleagues, from Ireland, has suggested drugs might help.

They conducted a meta-analysis which involved pooling data from 5 previous studies that had compared treatment with an alpha-blocking drug to no treatment at all for patients undergoing open groin hernia surgery under general and spinal anaesthetic.

Their study concluded that the use of the alpha-blocking drug reduced the risk of postoperative urinary retention by just over 20%. There were limitations to this study, not all the blocking drugs were the same in each study. The studies included were quite small and comprised only 456 patients it total. The techniques of hernia repair differed between some of the studies. The type of anaesthetic used also differed between some of the studies.

 Alpha-blocking drugs can have side effects. The commonest side effect is low blood pressure on standing or a headache. These side effects were found to be uncommon.

Despite the shortcomings, this is an interesting study. A larger study in older men needs to be carried out before any definitive recommendation can be made about the routine use of alpha-blockers in patients undergoing hernia surgery.

All patients should certainly be warned of the risks of urinary retention after hernia surgery.

 

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Preventing risk in hernia surgery

In a recent article published in the Daily Telegraph, the president of the Royal College of Surgeons has stirred up a mini-controversy. He suggested that policies of not operating on patients for planned procedures who have problems such as obesity and/or who smoke were “draconian and discriminatory”. This drew a response from Mr Windsor on behalf of the British Hernia Society. Mr Windsor stated that “The key to good surgical outcomes is to understand patients and tailor surgery to their needs. Part of that process involves optimizing their health and clinical condition”

What are the risk factors?

There is plenty of evidence about risk factors for hernia surgery. Smoking, obesity, and diabetes are probably the most significant.

Many UK plastic surgeons had a policy not to carry out elective, non-cancer operations in patients who continue to smoke because of the increased risk of complications. Most other surgical specialties have not taken the same stance despite there being evidence of poorer outcomes in those patients who do continue to smoke.

Obesity is also associated with poorer surgical outcomes in hernia patients. The surgery can be more challenging. There are also greater risks of general postoperative complications such as wound infection or breakdown as well as recurrent herniation.

The numbers of patients suffering from diabetes are increasing. For many, the development of diabetes is directly related to diet and obesity. There is good evidence that dietary control leading to weight loss can improve diabetes and diabetic control. Patients with diabetes are more likely to develop complications following hernia surgery. Better control of diabetes before an operation is associated with fewer risks of complications.

Reducing risk

Nobody would deny a patient an urgent or emergency operation based on whether or not they smoke, are overweight or have diabetes. These patients need an operation often to save life or prevent a more serious complication. In these circumstances, we can accept the additional risks that their smoking habits, obesity or diabetes may bring.

But if we have the chance to reduce those risks before an elective or planned hernia operation we should do so. The burden of a potentially preventable complication from a planned operation may be considerable not only for the patient but for their surgeon as well.

Is it fair for us to simply say “go away, lose weight or stop smoking before we operate”?.
If we do so we must also give advice to patients about the issues and the risks that may ensue. We should also help patients with achieving weight loss, stopping smoking and getting tight diabetic control. This could be through a targeted weight reduction program, a smoking cessation program or with the help of GP. There’s a lot that can be achieved. If followed the effects should go beyond reducing the immediate risk of postoperative complication. They will be translated into a longer and healthier life too.

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Preventing Parastomal Hernias

Parastomal hernias present a huge problem for our patients. Apart from being unsightly they can become uncomfortable. Many patients have problems getting stoma bags to fit and, occasionally, serious complications such as obstruction or strangulation require emergency surgery. Surgery to repair parastomal hernias is not easy and recurrence rates are high.
So how do we avoid the development of parastomal hernia in the first place? Good surgical technique may simply not be enough. In some cases patient factors are undoubtably important; obesity and smoking put patients at greater risk of getting a hernia.

Hernias are more common when stomas are made during an emergency operation as the bowel may be thickened or widened. When it shrinks back to its normal size the space left behind can easily give rise to a hernia.

One way of preventing hernias during a routine operation might be reinforcement of the abdominal wall with mesh material placed behind the muscles. A group of researchers from the Netherlands using this technique have recently published their one year results in the Annals of Surgery. In their study -the PREVENT trial- patients were randomised to have no mesh, or a light weight polypropylene mesh placed behind the muscle of the abdominal wall at the time of surgery. The researchers found that in the 66 patients who had a mesh inserted, only 3 developed a hernia (4.5%) when compared with 16 out of the 67 patients (24.2%) where no mesh was used. They also found that skin problems, leakage and pain were less common in patients where mesh had been used.
The researchers concluded that the use of a lightweight mesh was feasible, effective and safe in preventing parastomal hernias. In this study the researches did not identify any issues with mesh erosion, strictures or infection although these complications can arise when meshes are used.

It will be interesting to see if these promising results are continued as the study continues to follow these patients over 5 years.

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Newcastle star in Double Hernia Op.

Newcastle star Jamaal Lascelles is to finally undergo hernia surgery after playing with the injury for most of this year. Manager Rafa Benitez had insisted on keeping the problem secret with only Newcastle’s medical staff aware of the situation during 2017.

Defender Lascelles, 23, had been playing through the pain barrier as he been determined to lead the club to an instant return to the Premier League – and Benitez saw him as a key part of the team so was keen to delay surgery.

The former Nottingham Forest centre-back had been managing with the injury but went to see a specialist after the club’s sealed promotion with a 4-1 win over Preston – his 47th game of the season.

The specialist was shocked that Lascelles had been playing for so long despite needing a double hernia operation and urged immediate action.

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Juan Mata comeback from hernia surgery

Juan Mata is targeting the second leg of Manchester United’s Europa League quarter-final at home to Anderlecht a fortnight on Thursday for his comeback from a hernia operation, providing there are no setbacks during his recovery.

Mata underwent successful surgery last Thursday and, if necessary, the Spain midfielder is prepared to play with some discomfort if it means returning in time for what could prove to be United’s biggest game of the season to date.

United face Anderlecht in the first leg in Belgium next week, with the Europa League offering an alternative route into next season’s Champions League as the club face a growing battle to finish in the Premier League’s top four.

Mata will undergo regular tests and observations but there have been several instances of players returning from hernia operations within a three week time frame free of any problems.

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Our New Website

We are here to help. We have tried to include as much information as we can so that anybody who thinks they may have a hernia, can learn more about their condition and the treatments available.

This site will develop into a leading resource for patients, we hope you find it useful.

The Birmingham Hernia Clinic

BMI The Priory Hospital, Priory Road, Edgbaston, Birmingham B5 7UG

0845 903 7833
info@thebirminghamherniaclinic.com

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Call us today on 0845 903 7833 or EMAIL US

 

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