Alternative medicines

Posts Tagged ‘Frozen Shoulder’

Everyone suffers difficulties and adversity of some kind, examples of which are mental illness, disability, pain, illness and stress. Not everything is under our control and we have widely varying ways and success of dealing with these stresses. How content we are with our lives and how effective we are at life management depends on our ability to cope with these events. If we can be realistic and generate a plan for managing then success is the more likely outcome. What happens to us when we suffer setbacks is complex and we need to address several parts of the situation.

Loss figures in many of the challenges we face and this needs to be recognised as many consequences flow from this. We accept without question when we do not have any pain and feel a loss when our bodily comfort is removed. Simple activities are affected such as doing the gardening, getting the shopping and sitting in a restaurant or cinema. As we get older many changes creep up slowly upon us and we may not be happy with these and find them hard to accept. A sudden and dramatic change in our comfort or ability is much more difficult to accept, particularly if we are young or very active.

There are many potential losses such as the death of someone close, losing our job or our role in life, losing our income, breakup of a relationship and the loss of a part of the body. These losses affect and dent our self esteem. Depression is the most disabling mental difficulty in the world and largely caused by a loss of some kind, unless endogenous. Depression causes our brain chemistry to alter so that we think more negatively about what happens to us and interpret our findings in the same negative way. Depressive thinking is important due to the feelings of the person and their actions but also because depression is commonly associated with pain.

We may not be that successful in coping with and coming to terms with these losses. Hopelessness may be the result if we become depressed so we lose the motivation to take the required actions which would ameliorate our condition and situation. Cognitive therapy and antidepressant drugs can be used as required to kick start the improvement process of more realistic thinking and begin generating helpful approaches to our troubles. We can react in an entirely different manner to these challenges by fighting strongly against them.

I’m just not going to let the pain beat me is a very common sentence uttered by pain patients, turning their condition into a competition which pain is not going to win. This strategy is commonly pursued as people try to maintain control in bad circumstances, pushing themselves to keep going with their duties. There is a significant downside here though and that is the very high costs of holding a continuing battle with pain by pushing on, leading to a decline of ability, increasing pain and depression.

Conflict is one of the most important concepts here. The conflict exists between what we think we should be able to do and what we can. We can feel aggressive towards the pain and towards the world which demands things we cannot supply. We can thereby develop a relationship of conflict with others and within ourselves which can obstruct us from generating alternative approaches to our problems and gets us stuck in a rigid behaviour. These problems are all related to not accepting the reality of our situation and we cannot move forward as those actions are not acceptable.

The idea of acceptance is important and should not be mixed up with resignation. In resignation we feel helpless and that we just have to accept everything, thinking that nothing much will change things for the better and we have to put up with the situation permanently in this way. This kind of very negative assessment of the problem will lead most likely towards depression and make it unlikely the person will take actions to get themselves out of their situation. It is undesirable to feel resignation and more functional to learn acceptance and so work at changing the future for the better.

As children we have the great gift of a mobile, strong, well designed and painless spine and it is unusual for stiffness to be an issue as the lumbar spine has evolved to do the job of weight bearing and providing movement. Intervertebral discs separate the spinal vertebrae, allowing more movement in areas where they are thicker and also coping with variable loads. The posterior spinal facet joints limit and control segmental movement, preventing the spine from displacing inappropriately under the shear forces. Strong, balanced and coordinated muscle actions complete the picture.

An acute episode of low back pain inhibits the core stabilising muscles from working well and can cause wasting of them with time. Segmental loss of stability control can make the occurrence of further low back pain episodes at the same level more likely. As time and injuries change the spine, degenerative changes can occur in the facet joints and discs, leading to segmental stiffness and chronic back pain. The force of gravity pushes fluid from the discs by compression and is opposed by a chemical absorption of fluid which is more powerful in lying.

As compression forces tend to be more powerful as time goes on, dehydration of the disc occurs to some extent as it narrows and stiffens. This can be imaged on x-ray but the disc is likely to show changes and painful problems long before the results can be seen on x-ray. A segment is defined as two adjacent vertebrae and the intervening intervertebral disc, an altered disc contributing to an abnormal segment which moves abnormally and pushes abnormal loads onto tissues where they are not designed to take them. Physiotherapists can feel the restrictions in spinal movements which occur when a stiff segment limits segmental excursion.

Protective muscle spasms are common after an injury and this splints the affected area and allows the process of inflammation and healing to get started. With the gradual resolution of the injury and its pain reduction the amount of back spasms normally lessens and slowly normal movements begin to be apparent again. But muscles can remain in muscle spasm in some cases, leading to a stiffened and shortened group of spinal structures which, by this adaptive shortening, leads to the production of shortened and abnormal spinal joints, ligaments and muscles.

Increase of the compression forces through the spine can be promoted by sitting for long periods, leading to increase in the fluid loss from the discs. Discs rely on us repeatedly bending forwards for disc health and nutrition and avoidance of this movement compromises disc wellbeing, leading to an increased potential risk of degenerative change. A weakness in the abdominal muscles and the development of abnormal postures also contribute to these problems.

A typical history is to have an episode of severe low back pain which gradually develops into a segmental stiffness problem. The stiff areas may be present asymptomatically for many years in many individual areas of the spine before one of them develops into a painful segment which causes restriction. Sitting for a long time or spending time bent into flexion will tend to aggravate this condition once established as joints are moved beyond their comfortable limits. The lumbar facet joints become fixed into extension and the whole segment suffers from adaptive shortening, forfeiting its ability to move normally. I have back problems very like this and it can be quite difficult, forcing me to limit heavy or repetitive work or any significant time in flexion.

Sarah Key, a physiotherapist who is well known in the UK, has produced the Sarah Key’s Back Sufferers Bible, a book in which she sets out her views of what is going on in this most common of musculoskeletal syndromes. She does acknowledge that it is hard to bring solid evidence for many of her interpretations but seems to have many good and practical therapy ideas to approach the back pain problem with. She covers the main syndromes which typically occur, giving treatment routines for self management of each one, all of which I have found very useful for my own lower back pain. Now I have something I can do about it rather than accept it as a fact of life.

Pets: you can love them and hate them simultaneously. One moment they are peeing on your favourite shirt, and the next they give you more TLC than you have ever received in your life. But regardless of what they do or how you feel about them, there are many health advantages to having a pet:

1) Lower stress levels and blood pressure. According to studies conducted at the University of Warwick, interacting with pets (such as stroking them or playing with them) has the tendency to lower a persons blood pressure and relax them. In another study, stockbrokers with high blood pressure readings were asked to adopt a cat or a dog, and those who did were later found to have much lower blood pressure levels in stressful situations that those who did not adopt a pet. Of course, this will not work if you do not like animals or are afraid of them ” then they will probably cause more anxiety than they resolve.

2) Recovery from illness. Pets have been known to help people in astounding ways, but they have the greatest number of success stories with heart attack patients. Various studies show that patients who have suffered from a heart attack tend to live longer if they have a pet at home, and they are also less prone to heart disease than non-pet owners. Pets can also serve as a loyal support system to their bed-ridden owners, providing them with the comfort that results in a quicker recovery.

In extreme cases, such as when a person is in a coma, surgeons have even recommended for a pet to be brought to the patients bedside. While there is no real evidence to support this claim, there have been incidences when the pets presence helped the patient awake from their coma. Dogs, in particular, have also been known to offer relief to Alzheimers and Parkinsons patients.

3) Improves social life. Many domesticated animals are social creatures, and therefore provide much social interaction ” whether it is a cat that curls up and falls a sleep on your lap or a dog that follows you from room to room ” a pet owner is very rarely alone. Pets also serve as great ice-breakers or conversation starters among strangers, both inside and outside the home.

4) Happiness. It is often underestimated how much pets can influence our happiness. In many cases they have helped their owners deal with loss and hardships, even helping them fight depression. Some psychologists have even recommended the use of pets in therapy sessions, as petting a rabbit or playing with a dog raises the serotonin levels in our brain. Being greeted by an energetic dog or purring cat that is excited to see you can be very uplifting if you feel like the life just isnt going your way. This is why pets are also used in elderly homes, to help individuals feel less lonely and isolated.

Regardless of whether you break up with a loved one or lose your job, your pet will love you no matter what; and that, in itself, is an essential quality that human beings cannot live without.

It often seems as though Eastern and Western approaches to health are often at odds with one another. This is not always true. More and more osteopaths are now suggesting that clients try a combination of both practices, fusing Western osteopathy with Eastern acupuncture.

Acupuncture is holistic approach to health that has its origins in China, having been refined and developed evolved over 2000 years. It is based on the philosophy that our health relies on the free flow of our bodys energy ” known as Qi ” through a system of channels that lie beneath our skin. The pathways are all connected to the bodys vital organs, so if the flow of Qi is upset in some way (either by physical illness or emotional disturbances), the health and harmony of our body comes out of balance.

Acupuncture therapies are carried out by having very fine needles playing along the energy channels at specific pressure points in the skin. This is done to encourage the flow of energy and get rid of any physical tensions. By placing the needles in specific places the body is forced to tap into its own healing response, helping restore its natural balance.

But what does acupuncture have to do with osteopathy? Acupuncture and osteopathy have very similar philosophies, both view the body and mind as interconnected entities. They both believe a condition can only be cured if you eliminate the root of the problem, rather than merely treating its symptoms, and this is why osteopaths advise patients to do acupuncture in addition to osteopathic treatments.

While some people see acupuncture as simply a way to alleviate pain, it helps heal specific complaints as well as illnesses. Here are some of the problems and conditions that acupuncture can help with:

- High blood pressure and circulatory problems

- Cranial problems, including headaches and migraines

- Respiratory problems. These include asthma, breathlessness, and various others.

- Musculo-skeletal problems, helping to soothe pain in the muscles and joints. Deals with many osteopathic problems such as stiffness in the knees and neck, sciatica, frozen shoulder, and arthritis.

- Allergies

- Insomnia or aiding relaxation

A lot of patients have also expressed that acupuncture has given them gives a better sense of wellbeing ” improving their energy levels, vitality, and overall health.

Many people tend to shy away from acupuncture because they are uncomfortable with the idea of needles. Therapists often reassure their clients that the needles used for acupuncture are very different from the ones used to administer injections: they are a lot small and do not penetrate the body in the same way. While everyone responds to pain in different manners, most do not find the experience painful at all.

Not everyone is convinced that practices such as acupuncture work better than painkillers or sleeping pills. Others are adamant that natural healing processes are the only option. There does not always need to be a choice. If you have suffered from chronic pain or feel constantly overwhelmed by stress, combining East and West may be your best option to feeling healthier, refreshed, and more energetic.

Non-bony Structures in the Foot

The foot does not consist only of bones but also of tendons, muscles and ligaments. Ligaments are tough, relatively non-elastic straps or sheets which are designed to hold bones together. Ligaments allow the intended movements of the joint to occur and give the joint the stability it requires for normal function. Ligament capsules surround all the many joints of the foot, stabilising these joints and allowing the synovial lining inside them to secrete synovial fluid. The plantar ligament underneath and along the foot arch is the largest foot ligament.

The plantar ligament holds the arch in place to some extent and stores up energy when we are walking to use in the next step, giving us the spring in our step. A strain of the plantar ligament can be sharp and painful in the ligament and have knock on effects due to its supporting role. At the back of the heel is the Achilles tendon, a large and strong tendinous band which is a continuation of the fibrous tissue in the calf muscles, the soleus and gastrocnemius. The calf muscles provide propulsion in walking and running and allow us to stand on tiptoe.

The complex nature of walking has been called controlled falling but is managed easily by the majority of humans. Gait is a repeating pattern of specific bodily movements and when we stand still our weight distribution is even between the front and back of the foot. The outside border of the rear of the heel strikes the ground first as the foot contacts the ground, with weight then transferring forwards and inwards towards the big toe and ball of foot. Absorption of some of the load occurs in the plantar ligament, with the arch flattening by some amount and the foot attaining the position of pronation.

Hitting the ground and bearing weight on the midfoot brings the foot posture towards the outside into supination as the foot rises to push off on the ball and the big toe and the foot leaves the ground. Exaggeration of these postural positions during gait is an example of pathological changes which can occur. The big toes take around 60 percent of the weight being transferred through the foot in walking, and this can be abnormally increased if the foot overpronates and throws weight medially. The opposite tendency is underpronation as the person throws their weight laterally onto the outer foot border.

Problems with Gait

Changes which occur in one bodily area can have distant effects on other bodily regions due to the connected nature of body systems. A typical gait pathology is the antalgic gait, a gait where the body attempts to avoid a painful position or weight bearing posture. One of my neighbours attempts to minimise the forces which are being transmitted through his low back by gliding around smoothly, limiting spinal movement and using his legs almost exclusively to perform his gait. Pathologies can develop in other areas of the body as it attempts to limit forces by adopting an altered gait.

Foot pain does not typically occur in children and adolescents despite the many forceful activities they pursue. However, if a young person describes a pain problem with their feet it should be noted and action taken to solve a small initial problem as opposed to a later much more major one. In the twenties it is uncommon to report any problems with the feet apart from fungal infections and sport and activity related injuries.

Children and adolescents rarely have foot pain even pursuing the many, varied and vigorous pursuits they love to do. If they do report a pain problem it is worth paying attention and getting advice as it’s much easier to fix an early, minor problem than having to cope with a much more difficult one later. During one’s twenties feet typically do not have great problems apart from sporting and other injuries and infections such as athlete’s foot.

In an age where we can access information with the click of a mouse and receive messages from across the world the very second they are sent, the internet is frequently applauded for making our lives easier. Even the rise of social networking sites such as MySpace, Facebook, and the BBCs myCBBC have been met with general positivity ” that is, until recently. Psychologists, health experts, and even biologists have lately been criticizing social networking cites for being hazardous to our health.

Experts are now warning us that new research suggests that we dont have nearly as much face-to-face contact with others as in the past, and it is making us more and more isolated. In a recent issue of Biologist, the journal of the Institute of Biology, Dr Aric Sigman explains that our body oxytocin levels have declined as a result of less physical interaction. Oxytocin, also known as the cuddle chemical, is a chemical that our body produces when we bond with another person. The fact that it is in decline shows that we are not bonding with others on a regular basis, which can have serious consequences.

Signman warns that extreme devotion to the virtual world can increase the risk of both physical and mental health problems such as cancer, dementia, depression, strokes, and heart disease ” not exactly something we think about when we are checking our inboxes. Too much time on MySpace also allegedly has the potential to alter the ways in which our hormone levels and immune systems are regulated. It all comes down to our lifestyles ” with a greater number of people working from home rather than going out and physically interacting with people, the lack of regular and deeper human contact have a negative effect on our body.

Psychologists also warn us about the this problems implications for the family unit. Research shows that children as young as five years old use the internet on a regular basis. Experts say that this undermines a childs ability to learn to interpret body language and acquire important social skills. In many cases not even the parents are not very helpful, either. Dr. Signman was quoted as saying “Parents spend less time with their children than they did only a decade ago. Britain has the lowest proportion of children in all of Europe who eat with their parents at the table.

While most of these allegations (about physical health, in particular) have not undergone extensive scientific investigation, there is an element of truth in each of the warnings. Common sense says that spending much time behind a computer screen is not good for your health, if you neglect exercise and proper social interaction.

Social networking can therefore be seen as either a blessing or a cure (or, in some cases, both). They can be a negative influence that stimulates isolationism and anti-social behaviour. Or they can simply be a place to get back in touch with old friends and classmates. The bottom line: everything in moderation. As long as social networking sites do not become a substitute for face-to-face relationships, there is no reason why we should fear of sitting behind our laptops.

Patients recover very quickly from this abdominal operation and it is rare to suffer serious side-effects. Cholecystectomy produces a number of minor post-operative complications so it is important to understand these as well as the rare potential for more critical complications.

About Gall Bladder Removal

The gall bladder is situated beneath the liver and holds bile in a small sac, bile which the liver secretes. Bile is releases in the gut to assist in the digestion of food fats whenever we have a meal. Gall stones can develop within the gallbladder and can be of various types and sizes. It is common for people in the middle of life or older to have gallstones which are not symptomatic and do not require surgery.

Sometimes the stones can lead to pain or inflammation with the gall bladder. In some patients stones may escape from the gall bladder and get into the main bile duct (the main tube connecting the liver to the gut) where they can cause an obstruction leading to jaundice (yellow pigmentation of the skin). In these cases it may be necessary to perform a cholecystectomy (surgical removal of the gall bladder).

Is Gall Bladder Surgery Harmful?

Many people live a completely normal existence without their gall bladders as it is only an organ to store bile. Cholecystectomy should cause no serious long-term side effects.

The way Gall Bladder Operation is Performed

Surgeons can use the more traditional open surgical technique or the more modern laparoscopic or keyhole surgery which is the overwhelmingly more common method but about one in twenty or five percent of operations are through an open incision. This is because the surgeon decides it is safer and the most common reasons for open surgery are because the gall bladder is very inflamed or if it has a lot of adhesions sticking it down to nearby organs.

Although surgeons mostly intend to perform the gall bladder removal laparoscopically, patients need to understand that during the operation the decision may be made to convert to an open operation on clinical grounds.

Keyhole Surgery for Gall Bladder Removal

The surgeon will make four small cuts so that he or she can insert the instruments they will use into the abdominal cavity. The main instrument is a laparoscope, a flexible device which has a small video camera and a bright light attached, allowing a clear view of the inside of the abdomen. This allows surgeons to view the abdominal contents on a television screen, find the gallbladder and guide the operation procedure.

The surgeon needs a good view of the abdomen so carbon dioxide is passed into the cavity to increase the room for manoeuvre. An incision below the umbilicus (tummy button) is used to insert the telescope and further instruments are introduced through three smaller cuts below the right ribs. The umbilical incision is used to withdraw the gallbladder and gallstones.

Open Cholecystectomy

Removal of the gallbladder via open operation sometimes cannot be performed, meaning that an open operation will have to be done. The incision is about four to six inches long below the right cage to allow the surgeon to locate the gall bladder. Then the organ can be removed and a drain inserted to drain off any excess fluid from the abdomen.

What about the Anaesthetic?

The anaesthetic is usually started by giving an injection into the hand or arm. The operation usually takes about one hour and the surgeon will often inject some long-lasting anaesthetic into the incision sites to try and make the patient as comfortable as possible afterwards.

In addition some surgeons insert a long-acting painkiller in the form of a suppository into the back passage when the patient is asleep. Patients are advised clearly about having no food for about 6 hours before the operation and nothing to drink for about 2 to 3 hours beforehand. After the operation patients can get up as soon as they feel able with a nurse making sure they can manage when they first get up.

Diverticulosis is the medical description for the presence of diverticula in the colon. A diverticulum involves a small pouch being formed as a part of the inner intestinal lining pushes through muscular outer layer of the intestine, leading to a narrow-necked pouch. Diverticula mostly occur in the colon on the lower left side and diverticulosis is the term when many are present in the gut.

Is the cause of diverticula known?

The small intestine is the commonest place for a diverticulum to naturally occur. As people get older the number of diverticula increases as later life is the commonest time for these to occur. Diverticula in the large intestine occur in more than half the people over 70 in Britain while in the world’s rural areas, especially Africa, diverticula occur rarely. It is not known why other areas differ from western countries in this condition but diet may be important as the colon is the processor of dietary fibre present in poorly digestible plant foods.

Fibre rich materials form a much smaller proportion of western countries’ diets compared to the mostly vegetarian other parts of the world. The bulk of intestinal contents maintains the shape of the colon if the diet has the right levels of fibrous material to allow it to function well. Firmer and harder stools result from low levels of dietary fibre and when the colonic walls tighten the reduced contents fail to adequately keep the walls apart. The ring like contractions move and mix the contents along the colon and there can be closed sections where the pressure is much higher than normal, perhaps leading to pouch formation.

Is the presence of diverticula harmful?

We all begin life with an appendix, which is a diverticulum in many ways, and we do not worry about it. In the same way many of us have diverticula projecting from the wall of our colon. We do not know we have them and they cause us no trouble. However, just like the appendix, a diverticulum can become inflamed due to infection. If this occurs it causes local pain, can make a person feel ill, and can be dangerous because it may perforate or bleed. Inflammation of one or more diverticula is called diverticulitis.

A description of diverticular disease

In most people with diverticula the intestinal muscle is normal in appearance and thickness, but in some people it becomes thicker than normal and has an unusual structure under the microscope. The thickening of the muscle narrows the colon which becomes irregular in outline. The reason for this is not known but it is important to realise that it is not due to infection and may not be related to diet. The muscle abnormality can develop when very few diverticula are present and occasionally it occurs without any diverticula. The combination of abnormal muscle and diverticula is known as diverticular disease. This is confusing because diverticula and diverticular sound the same, hence the use of the word disease.

What are the symptoms of diverticular disease?

The muscle abnormality is the reason for the symptoms of pain in the lower and left side of the abdomen, bloating, irregular timing of the bowel opening with stools like pellets and also bowel actions containing small amounts of blood. Irritable bowel syndrome has similar symptoms as both of these conditions are partly related in that there is abnormal function of muscle.

The necessity of investigation

When conditions such as bleeding rectum or pain in the abdomen are investigated by endoscopy (sigmoidoscopy or colonoscopy) or x-ray barium enemas then diverticula are often discovered as a side effect. Elderly people who are well typically have diverticula so their importance as to the cause of the symptoms or not is important to establish. Evidence of inflammation on blood tests and tenderness of the diverticular area indicate the diagnosis is diverticular disease. The increased folds in the left, lower colon lining which can be present are the abnormal muscle finding in diverticular disease.

Explaining the situation

Reassurance that a more serious disorder is not present helps people not to worry about the symptoms. An explanation of the difference between symptoms due to infection and those due to abnormal contraction of the muscle, without inflammation, helps people understand why one treatment may be advised and not another.

Back problems can often be very uncomfortable, making it difficult to bend down, lift objects, sit on a soft sofa ” common things that many people take for granted. GPs advise you to go on diets, take medications, and follow special treatments to deal with the more painful symptoms, but in recent years there has been an upsurge of interest in non-western solutions to psychical problems. And apparently, they work. One eastern alternative has been particularly helpful for dealing with back pain: yoga.

What yoga does

Yoga comes in many different forms, some of which are more of a workout and others which soothe the mind and body. Through a combination of poses and breathing exercises, yoga aims to help your body get aligned, improve you posture, and make you more aware of what your body is doing.

Osteopaths and yoga experts recommend a gentle yoga style called hatha for back patients, as opposed to the more challenging types such as Bikram and Ashtanga. Hatha involves careful stretches, basic yoga poses, and slow breathing exercises that not only makes a stiff back more flexible, but stronger as well. Hatha yoga also tends to speed up the recovery of back problems such as Sciatica, Osteoarthritis and Fibromyalgia, and can help prevent these from developing in the first place.

What you can do

Here are some exercises that you can do on a regular basis to make your back stronger, more flexible, and less painful:

1) Begin with some stretches before moving on to the more complicated poses. Get into the Mountain Pose: stand up straight with your feet touching, balancing the weight of your body over the feet evenly. Keep your arms at your sides, slightly pressed into the body. Tighten your buttocks and stomach muscles but maintain a firm posture. Whole holding the pose, breathe in through your nose, out through your mouth.

2) Crescent Moon Pose: this pose strengthens your back, legs, and shoulders, helping you build extra stamina. Complete it in two steps:

Kneel down onto your knees and keep a straight back. Take a step forward with your right foot until the foot is a little past your right knee. Keep the leg parallel to the floor.

Stretch your arms above your head and hook your thumbs together. Now lift your left knee off the floor, stretching the leg, and divide your weight between the front and back legs. Dont puff your chest up to avoid having a hollow back.

3) The Child Pose: this pose helps you stretch your spine, hips, and thighs, and should help alleviate the psychical and emotional stresses in your body. Carry it out in three steps:

Kneel down to your knees, with the legs slightly parted, and your feet pointing outwards in opposite directions.

Now, carefully place your forehead on the floor and swing both arms forward, around the head at the height of the ears.

With your head still touching the floor, bring your arms around to your sides, palms facing upwards.

These traditional ways of healing the body can therefore be a great supplement or alternative to western back treatments. As long as each pose is exercised with caution, hatha yoga can ensure that your mind and body feel better and refreshed.

When a hernia occurs a part of the bowel or abdominal fat, normally within the abdomen, protrudes out through a weakened part. An inguinal hernia is the commonest type and occurs in the groin. There is a small gap deep in the wall of muscle in the abdomen, just above the ligament in the groin, through which the veins and arteries course to reach the testicle. If the gap or the tissues around it stretch or weaken then part of the peritoneum (lining of the abdomen) can protrude through. This protrusion can occur, with fat or bowel bulging out, on vigorous activity, coughing or standing.

The bulging hernia area can cause discomfort, with the contents of the hernia sac usually going back into the abdomen on lying down, although sometimes they need to be pushed back gently. Sometimes a small hernia can cause aching without an obvious bulge and the hernia is then only found during examination by a doctor. If a hernia has been present for a long time then it can become very large, and in a man it can even fill the scrotum. When this happens, it may stay out most of the time, and prove very difficult to push back.

Inguinal hernias occur less frequently in females than males but femoral hernias, a different type, occur more frequently in females and can mostly be found on examination by a specialist. Femoral hernias are more likely to need to be repaired.

Hernias are usually troublesome only because they cause a bulge and aching whilst the most serious risk of a hernia is strangulation which means the bowel which becomes completely trapped and its blood supply may become cut off. The produces sudden severe pain and requires an urgent operation when the affected piece of bowel may need to be removed. Strangulation is not very common and many people have hernias for years without them ever becoming strangulated. Obstruction of the bowel can also occur it the bowel becomes trapped and this demands an operation even if the blood supply has not been cut off.

An operation is the only permanent cure for a hernia and can prevent the long term presence or increase in size of the hernia. Hernias can cause discomfort and strangulation can occur but is not common. An operation is not mandatory if the hernia is not causing any trouble and patients should discuss this with their surgeons. A symptomatic hernia can be held in place by a truss which needs to be put on before the patient gets up and makes the hernia bulge. A symptomatic hernia is mostly much better treated by an operation. Having medical problems or being older should not stop hernia repair due to the safe use of local and general anaesthetics.

A groin incision about 12 centimetres in length is used for the repair of a hernia, with an opening of a layer of muscle and then the careful separation of the bulging hernia sac from the veins, arteries and tube to the testicle. The protruding fat or bowel from the abdomen is compressed back in and the sac is then stitched back into the abdominal cavity or tied off at its narrow neck area.

The weakened area is then repaired and strengthened and the hole for the veins and arteries to the testicle is recreated back to its usual size. The hernia will be likely to return if it is not repaired, with surgeons typically using a plastic mesh which they stitch over the herniated area. Stitches can also be used without employing the mesh and this is more likely in femoral hernias. Good long term results have been shown with both techniques and the typical chance of hernia reoccurrence is 2%.

Some surgeons do the operation laparoscopically, under general anaesthetic. The telescope is inserted just below the tummy button and gas is introduced through the telescope to open up the space between the muscles in the lower part of the abdomen and groin. Two tiny 5mm incisions are made in the lower abdomen for further instruments to be inserted which are used to place a sheet of plastic mesh to repair the hernia.