I HAVE A BULGE ABOVE MY PENIS

INGUINAL HERNIA

The past year has been a hell coaster ride for a family friend who lives two blocks away from where I live. He had a bulge in his pelvic region which disappears upon lying down only to reappear upon standing. Anytime he urinates, defecates or coughs, this bulge appears. He has to mostly apply pressure on it so it disappears. This enables him to wear pants. Upon him complaining about this ordeal to me.I was intrigued to learn more about it and ask my professors in school too .I was told it is hernia. And because he is in his sixty’s, his muscles are weak and this likely explains the reason for the hernia.

A hernia is a protrusion of a viscous or part of a viscous through a defect or weakness in the wall of the cavity within which it is normally contained. The defect is a deliberate opening left in the wall of a cavity. Examples of such defects in the body include foramen magnum, inferior vena cava opening, thoracic aorta hiatus ,oesophageal hiatus, deep inguinal ring, superficial inguinal ring, femoral ring, linea alba, linea semilunaris, umlical ring, paraumbilical weakness, Hasselbach’s triangle etc.

Repetitive increase in intra-abdominal pressure will cause the abdominal viscera to enter through the defect. Clinically, a hernia is a swelling with a visible and palpable cough impulse and reducibility. To explain reducibility, when pressure is applied on the swelling, the swelling disappears. When the pressure is removed, the swelling still disappears until another pressure is generated for the swelling to reappear. Let’s focus more on inguinal hernia. It is more commonly in males.

Risk factors for inguinal hernia include male sex ,old age, coughing, constipation,micturition and lifting of heavy objects. It is very important to find out if a hernia is a direct one or an indirect one.

To know this,occlude the internal inguinal ring with your thumb and index finger.Ask the patient to cough,if no swelling emerges,ask the patient to cough again but this time,disocclude the ring.If the swelling emerges,then it is an indirect hernia which means it passed through the internal inguinal ring. In the situation where no swelling appears after disoccluding the ring, then it is a direct hernia. That means,the swelling did not pass through the internal inguinal ring but rather the Hasselbach’s triangle. A complete indirect inguinal hernia moves into the scrotum where as an incomplete inguinal hernia does not descend into the scrotum.

 A week getting to know it is hernia, he started complaining of excruciating pains which prompted me to help him go to the hospital regardless. At the hospital, the general surgeon explained to us that since he was in pain,it is an indication for surgery. A s curious as I am, I asked the big question WHY? He explained to us that the hernia sac has a mouth, neck, body, and fundus.The bulge mostly seen is mostly intestines passing through a defect in the abdominal wall into the pelvis.Whatever compresses the sac externally compresses the blood vessels tthat supply the viscuous or intestines. If there is a reduction or loss of blood supply, there will be pain and necrosis of the viscous or intestines.This explains why our family friend was in pain and the need to have an urgent surgery dine to prevent the bowel from getting necrosed.This whole phenomenon of arterial compression with the resultant pain is known as strangulation.

The surgeon explained that there could be a venous component of strangulation where the vein draining that particular part of the bowel or viscuous gets compromised or compressed.The basic function of a vein is to return tissue fluid back to the heart. If this is compromised, fluid builds up in the tissue and the tissue gets swollen or oedematous. In such cases, it becomes biger than it used to be so when pressure is applied on it,it cannot go back to its original position.This is known as an obstructed hernia. A hernia could also be obstructed if there is repetitive inflammation and scarirng of the neck of the hernia sac preventing the bowel from going back to its original position. I must also add that one of the commonest cause of intestinal obstruction in males is hernia. It basically affects the continuity of the loop of bowel and free flow of its contents be it solids or liquids. Intestinal obstruction, when ,left untreated for a long time leads to bowel ischemia, bowel necrosis and bowel perforation setting in the cascade for chemical peritonitis. And this is a surgical emergency. Lo and behold, my family friend was brought back from the theatre and he was doing just fine just a little pain at the incision site.The specific surgery done was hernia repair or hernioplasty. Hernia repair consist of herniotomy whichis the repair of the hernia sac and herniorrhaphy which is the repair of the defect in the anterior abdominal wall.You should see the glow in his eyes:he was just grateful,I mean more than grateful. That is the joy in helping humanity. It gives you this sense of accomplishment and energy in doing more to help others

Post- operatively ,he was given some intravenous pain medications and fluids to resuscitate him .He was on a two way foley’s cathether. The nurses did a good job by regularly keeping it clean to avoid infections. The surgeon was very much worried than I was. He constantly came to check up on my family friend to make sure there is post-operative bleeding,pain,surgical site infections, and nerve damage. He explained that in situations of a vascular damage,vessels like testicular artery and vein and the femoral vessels may be compromised causing infarction. In cases of nerve damage, the testicular nerve and the genital branch of the genitofemoral nerve could be compromised leading to erectile dysfunction. Again, there could be visceral damage such as injuery to the bowel or urinary bladder. Bowel injury most likely leads to post-operative ileus,that is, loss of peristaltic activity after surgery. For urinary bladder damage,there would be bloody or cola like urine. Hence the need to check urine colour and volume in patients with urinary catheter insitu.

In summary, I would say it was a very nice experience. I got to learn much from the surgeon.Mr. Smith, my family friend, was improving well and he was discharged after a week. Early detection and seeking of the right medical help contributes a lot.It just prevents so many complications from occurring. In as much that our minds may be tuned to the fact that inguinal hernia happens in the old adult male, it happens too in the young even children. As a parent,guardian or sibling,if you notice something like that or even if your child complains to you about something like that, do not hesitate to go to the hospital.