Do you have a protruding bulge?

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Do you have a protruding bulge?  No, the speaker at the Sunday, August 19 Pattaya City Expats Club was not talking about waistlines. Rather, Gavin Waddell, Head of the Phyathai Sriracha Hospital International Department, was talking about a more serious bulge; one that is the result of an abdominal hernia. Gavin also brought along a nurse to provide free blood pressure checks for members and guests.

Gavin started his presentation by mentioning that abdominal hernias are a very common condition as 20 to 25 percent of the population will most likely have one during their lifetime. He then explained that the abdominal cavity is surrounded by a membrane that separates it from the abdominal muscles. When there is a weakness in the muscle, a portion of the intestines or fatty tissue can protrude through the abdominal muscle and is usually first noticeable as a bulge.

PCEC member, Gavin Waddell, also Head of the Phyathai Sriracha Hospital International Department begins his presentation on the diagnosis and treatment of abdominal hernias by mentioning that hernias typically will afflict 20 to 25% of the population during their lifetime.PCEC member, Gavin Waddell, also Head of the Phyathai Sriracha Hospital International Department begins his presentation on the diagnosis and treatment of abdominal hernias by mentioning that hernias typically will afflict 20 to 25% of the population during their lifetime.

There are four main types of abdominal hernias. The inguinal hernia occurs in the groin area where the skin of the thigh joins the torso; it usually is noticeable as a bulge in the groin area (inguinal crease). The femoral hernia is where abdominal contents, usually intestine, protrude into the femoral canal (the path through which the femoral artery, vein, and nerve leave the abdominal cavity to enter the thigh); it usually shows itself as a bulge just below the inguinal crease in roughly the mid-thigh area and is more common in women. The umbilical hernia shows up as a protrusion at the bellybutton (the umbilicus). Although it is more likely at birth, it can also develop in adults.  The fourth is the epigastric hernia which occurs between the navel and the lower part of the rib cage in the midline of the abdomen; these are usually composed of fatty tissue and rarely contain intestine.

Gavin explained that there can be several causes for hernias such as obesity, heavy lifting, coughing or sneezing, strained bowel movement or urination, or pregnancy. Likewise, it could be the result of a genetic weakness. The sign of a hernia is usually a painless lump or bulge. But, if it is strangulated (twisted or being pinched by the muscle), it can be a severely painful, tender, swollen protrusion of tissue that you can’t push back into the abdomen. Strangulated hernias are surgical emergencies because blood flow to the trapped intestine is cut off and it can become gangrenous in as short a time as six hours. He warned that if a strangulated hernia is not treated quickly, it could be fatal.

Gavin explained that the sign of a hernia is usually a painless lump or bulge.Gavin explained that the sign of a hernia is usually a painless lump or bulge.

Many hernias are reducible, meaning that you can push the intestine back into the abdominal cavity. It can be treated by surgery, but it is not an emergency.  An irreducible hernia (incarcerated hernia) is one that is there constantly – you may be able to push it back in, but it comes back out. Surgery is usually recommended because of the heightened risk of strangulation. Gavin pointed out that diagnosis of a hernia can be done by physical examination or with ultrasound. He emphasized that the only treatment option for a hernia is surgery. This can be open surgery (most common) or laparoscopic (key hole surgery) and is usually performed using a general anesthetic or a spinal block.  Although in the US and UK, it is usually done on an outpatient basis, Gavin said that in Thailand, the doctors prefer to keep you in the hospital overnight.

Twenty or 30 years ago, the surgery usually consisted of pushing the intestine back into the abdominal cavity and stitching the muscle; however, because of the pliability of the abdominal muscle, it was not uncommon to have the hernia return. In the 80’s, doctors started using a mesh that was placed between the muscle and intestines being kept in place by the pressure from the intestines.  Gavin said that there is only about a 3 percent failure rate when using the mesh. He concluded his presentation by describing how to prevent hernias: lose weight, be careful when lifting heavy objects, try not to overstrain during bowel movements or urination, take medication to reduce coughing and sneezing, and for males, wear some kind of groin support during strenuous exercise.

After Gavin answered several questions, MC Richard Silverberg updated everyone on upcoming events and called on Roy Albiston to conduct the always interesting and lively Open Forum where questions are asked and answered about expat living in Thailand; Pattaya in particular. Read more about the Club’s activities on their website at www.pattayacityexpatsclub.com.

Board Member Darrel Vaught discusses recent revisions of the website with PCEC members and guests.Board Member Darrel Vaught discusses recent revisions
of the website with PCEC members and guests.

Chairman Pat Koester reports the results of the recent board meeting, including the suggestions submitted by members.Chairman Pat Koester reports the results of the recent board meeting,
including the suggestions submitted by members.