Assessing the risk of strangulation in a hernia
Today, I want to talk about the 5 characteristics of a hernia that your surgeon will want to know so that they can assess whether a hernia is at risk of strangulation.
Generally speaking, the risk of strangulation of a hernia is quite low. Only one in a hundred hernias becomes strangulated. But even then, it's still a considerable risk and a threat to a person's life. So, it is important to be able to assess the risk of strangulation.
Reducibility: The first thing that your surgeon will want to know is whether or not you are able to push that hernia back in. The technical word for that is reducibility. If your hernia is reducible, (i.e. you are able to push it back in), then that means the hernia is at a lower risk of strangulation than one that you can’t reduce. Some hernias are reducible as soon as a person lies flat while other hernias require a bit of manipulation to push back in. Some hernias cannot be reduced at all back into the abdomen. These are known as incarcerated hernias and are at most risk of strangulation.
Location: The second thing that your surgeon will want to know is where the hernia actually is. Femoral hernias (a type of groin hernia) have the highest risk of strangulation compared to other hernia locations because of the size of the hernia hole and the inflexibility of the tissue around it. Inguinal and umbilical hernias carry an intermediate risk of strangulation, whereas incisional hernias (which arise from surgical scars) tend to have a lower risk of strangulation, particularly if the hole (defect) underlying the hernia is large.
Severity of symptoms: The third consideration that the surgeon will want to assess is the degree of symptoms that the hernia is causing. The more severe the symptoms arising from a hernia, the more likely it is to become strangulated. So if you're experiencing more and more pain with the hernia or developing digestive symptoms associated with it like increasing difficulty in opening your bowels, or periodic bloating then these might be early signs that the hernia is about to strangulate. Please note that severe bowel symptoms might be an indication of bowel obstruction. This is another complication of hernias and is considered a medical emergency which requires immediate surgical attention.
Previous hernia complications: The fourth thing that your surgeon will want to know is the history of this hernia and if it has caused trouble in the past or not. If you have previously presented to A&E with bowel symptoms or an irreducible hernia, requiring surgical attention to push the hernia back in and resolve the symptoms, then this is a sign that the hernia is likely to develop further complications in the near future, including strangulation. Remember never to trust a hernia that has caused problems in the past.
Size: The fifth and final thing that a surgeon will want to understand is the size of the hernia and the size of the underlying hole (or defect) from which the hernia arises. In inguinal and umbilical hernias, there is a correlation between the size of the hernia and its potential to become strangulated. Interestingly, the size of an incisional hernia does not dictate its potential for strangulation, but rather, the size of the underlying defect from which the hernia arises is more important. The bigger the defect, the easier it is for an incisional hernia to bulge out and go back in again without risk of strangulation. In summary, the risk of strangulation in inguinal and umbilical hernias increases with the size of the hernia, while the risk of strangulation in incisional hernias is greater with smaller defects.
Remember, always consult a specialist if you have any concern about a hernia.