IT'S IMPORTANT TO KEEP AN EYE ON HERNIA
Six months ago I was diagnosed with a groin hernia. At the time, my doctor said that eventually I'll need surgery. The hernia doesn't bother me, so I have not been back. Is surgery always necessary, or do some hernias go away on their own? Is it dangerous to ignore it?
Abdominal hernias are common and not necessarily dangerous. But, a hernia doesn't usually get better on its own. In rare circumstances, it can lead to life-threatening complications. Consequently, surgery is usually recommended for a hernia that's painful or becoming larger.
An abdominal hernia occurs when part of an organ or tissue bulges through a weak spot in the wall of muscle that surrounds your abdomen. Some hernias don't cause any symptoms, and people might not even know they have one until their doctor discovers it during a routine medical exam. More often, it's common that patients can see and feel the bulge created by the hernia. The bulge is usually more obvious when you're standing upright or straining. You might feel pain, weakness or pressure in the affected area.
There are two different types of groin hernias: inguinal and femoral. Inguinal hernias are some of the most common hernias, occurring more often in men. The weak spot is in the inguinal canal. In men, this is where the spermatic cord exits the abdomen and enters the scrotum. In women, the inguinal canal carries a ligament that helps hold the uterus in place. Often, an inguinal hernia is present at birth, especially for boys, but it may develop later in life due to factors such as aging muscles, strenuous activity or chronic coughing.
Femoral hernias are far less common and are more often seen in older women. They form along the canal that carries the principal blood vessels (femoral artery and vein) into the thigh. This hernia usually produces a bulge that's slightly lower than an inguinal hernia.
Even though your hernia isn't causing any symptoms, it's important that you have it regularly evaluated by your doctor. He or she will want to keep an eye on it and reassess the situation — even if it becomes just slightly uncomfortable. Some people wear a supportive belt or undergarment to hold the hernia in, but this isn't a long-term solution.
Fatty tissue in the abdomen is usually the first tissue to exit the hernia. This is beneficial, because it plugs the hole. Problems arise when part of an organ — typically the intestine — pushes through the weakened muscle and becomes trapped on the outside (incarcerated). You can tell when this happens, because the hernia can't be returned into the abdomen by application of gentle pressure. It typically causes constant discomfort.
An incarcerated abdominal hernia may prevent passage of contents through the intestine (bowel obstruction). The hernia also may be cut off from the body's blood supply, a risk that increases with age. This can lead to gangrene, a life-threatening condition that requires immediate surgical attention. See your doctor promptly if you can't push the hernia back in with gentle pressure, or you experience increased pain, nausea, fever, swelling or darkening of the skin over the hernia.
The best treatment for bothersome abdominal hernias is an operation to push back the protruding organ or tissue into the abdomen and reinforce the weakened muscles. Sometimes, this involves placing a synthetic or biological mesh against the weakened area to help with reinforcement.
Some evidence suggests that laparoscopic surgery, which involves inserting surgical instruments through several small incisions, results in quicker recovery. But, conventional open surgery may be appropriate with hernias that are larger or more difficult to treat. If you require surgery to fix the hernia, your doctor will be able to help you determine which type is best for your specific situation.
Kristi Harold, M.D., General Surgery, Mayo Clinic, Phoenix (adapted from Mayo Clinic Health Letter)
STRENGTH TRAINING BENEFICIAL FOR TEENS
My daughter is 15 and lifts weights regularly to stay in shape. Lately, she has complained about stretch marks on her legs as a result of weight lifting. She doesn't like how they look, but I'm more concerned that she is doing too much. Is weight training healthy for girls who are still growing? How much is too much?
Muscle-strengthening activities, such as lifting weights, can be beneficial for teens. But, weight lifting is not the only way to increase strength. Encourage your daughter to consider varying her workouts to include other kinds of strength training. That may reduce the risk of unwanted side effects, such as stretch marks, that can come from doing just one activity. Also, muscle strengthening shouldn't be the only activity a teen uses to stay in shape. It needs to be part of an overall fitness program that includes aerobic activity, as well.
In general, a safe and effective workout routine for teens involves strength training three times a week on nonconsecutive days. Your daughter can change up her activities throughout the week and still continue to build strength.
For example, with some activities, she can use her own body weight for resistance — a technique called body weight training. Examples include exercises such as rope or tree climbing, swinging on bars or other playground equipment, games such as tug-of-war, pushups, squats, lunges, abdominal crunches, pullups or stepups.
Another option is to work muscles using resistance tubing. A lightweight, portable, inexpensive strength-training tool, the tubing provides resistance when stretched. Resistance tubing can be used to strengthen almost any muscle group.
When your daughter lifts weights, they can be free weights or part of weight machines. It's important that a trained professional supervise weight lifting to ensure teens use proper technique and lift the appropriate amount of weight.
Overall, strength training is safe for teens. The rate of injuries is low, with the most common injuries related to inadequate supervision or instruction, using improper technique or trying to lift too much weight. In the past, there was some concern that muscle strengthening may have a negative impact on a teen's growth, but recent studies have found that growth is not affected by strength training.
To reduce the risk of injury, it's best to do a 10- to 15-minute warmup of light aerobic exercise before strength training. Stretching is not necessarily needed before strengthening; however, stretching can be performed afterward with at least 30 seconds of stretch per muscle group.
In addition to increased strength, teens can gain a variety of benefits from regular strength training, such as better physical endurance, enhanced self-esteem and higher self-confidence. Teens who engage in regular strength training often see improvement in their cholesterol levels, blood pressure, blood sugar and body weight. Research has found that they tend to perform better in school and that they have lower levels of depression and anxiety than other teens. Muscle strengthening also contributes to building bone strength. That's important for teens, because 95 percent of a person's bone mass is accumulated by the end of the teenage years.
To achieve overall fitness, aerobic activity should be part of your daughter's routine. High-impact aerobic activity also provides the added benefit of building bone strength in teens. A good goal for teens is at least one hour of moderate to vigorous physical activity every day, with at least three days a week of aerobic activity at a vigorous level.
Moderate aerobic exercise includes brisk walking; games that require catching and throwing, such as baseball and softball; and active recreation, such as canoeing, hiking, skateboarding or inline skating. Examples of vigorous aerobic exercise are jumping rope; running; cross-country skiing; games that involve running and chasing, such as flag football or tag; and sports such as soccer, hockey, basketball, swimming and tennis.
Bradford Landry, D.O., Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minn.
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