Inguinal Hernias – The Good, The Bad and The Ugly 

As many of you know, I sustained an inguinal hernia in April 2020 – while exercising and focusing on “core” strength of all things – and I needed it repaired.  An inguinal hernia is a situation where fat or small intestine can come through the weakened abdominal wall and causes a bulge. If it gets caught or “strangulated” it is an emergency because the tissue will die without blood due to the strangulation. In most cases, as with mine, I existed with it for many years with very minor discomfort…. but it was starting to be more of an issue with long distance bumpy biking and was limiting my weight training, so I set up a surgical date last December to finally get it repaired. 

 

Fast Facts on Direct vs. Indirect Inguinal Hernias 

• Symptoms of both include groin pain, which can be severe. 

• Direct inguinal hernias are often caused by age-related/weakened muscles in the inguinal canal. 

• Indirect inguinal hernias are caused by a persistent opening that does not close during fetal development. 

• The only way to repair an inguinal hernia is through surgery. 

 

 

What You Need to Know About MESH Repairs 

For those who are not in the know, most inguinal and for the most part all hernia type surgeries and bladder lifts are done with a MESH. The mesh is a medical device used to provide support to the weakened or damaged tissue. It is typically made of synthetic materials like polypropylene.  

 

No one talks about it, but there is a fairly large percentage of the population that have hernia surgeries who get allergic reactions, infections, and movement of the MESH. Therefore, subsequent repairs may be needed with sometimes multiple surgeries! These issues have huge ramifications to the function and lifestyle of the individual. I know because I see these people for scar tissue release and pelvic and hip work where I help restore function and mobility and encourage them to do daily hip work to keep it moving.  

  

Because of the nature of scar tissue to be infiltrative, the bound-up facia can spread to surrounding tissue thus requiring periodic percussor and laser treatments. Hip position corrections and stretching and mobility exercises should be part of a post-hernia program to avoid the mobility issues that will come with this surgery as well as aging. 

 

Options – Shouldice Clinic, Markham, Ontario  

May I recommend to you, the Shouldice Clinic in Markham, Ontario – 80 years of service to the Hernia community – one of the best hernia clinics in the world. After doing it for 80 years, you’d think they got it right!  

 

To them, using MESH is the last-ditch effort – instead they use 4 layers of stainless steel (inert, doesn’t react with your tissue, like your hip appliance) stitches, i.e. they spend the time to do it right. If you go on their website, they will tell you why they don’t use MESH because many of their patients, after having failed MESH surgeries, finally go to them. 

 

So, What Did We Do? 

Bill went to see his MD last November, and his MD, who knows me asked about what we were doing for Xmas – Bill said that we were going to Toronto to get my hernia repaired at Shouldice and then off to San Jose del Cabo to recover.  He said “I tried to find a surgeon who would do my inguinal hernia repair here in BC with stitches and I couldn’t find one” so he went to Shouldice to get his repair as well.   

  

So, if an MD can’t find a surgeon who will stitch a hernia in BC, then you probably won’t find a surgeon in this province who will do it! I know I tried on 2 different occasions to discuss stitches with surgeons here in BC. 

  

 More on Shouldice and My Experience 

Shouldice is private surgery where you pay up front. MSP will cover some of the cost, in my case 40%. I also paid for a semi-private hospital room which was covered by my Extended Health.  

 

What I see with people that have had inguinal hernia surgery is a very definite impairment in the mobility of the involved hip. The other hip can be involved as well as a compensation. The MD’s who do the MESH surgery do not give you any post rehab to work on your mobility of your hip and pelvis. They are more concerned about wound care and any complications, which is absolutely correct, but your mobility? Not a word. 

 

As for Shouldice, instructions regarding wound care, or complications are reviewed. As you are in the facility for 3 nights, they get you up the next day and you do a stretching program in the lounge every morning until you leave.  They do a “nod” to the concept, but it is done standing, and most people are a bit dizzy from the conscious sedation, so they are just having difficulty standing on two legs and shifting weight.  Don’t know why we weren’t on yoga mats on the ground, which is what I did after the session. 

 

In all honesty, post-surgery I could feel the fascial pull all the way to my neck/shoulder and my ribcage was restricted. I had my myofascial percussor and laser with me at the hospital so when I returned from my surgery, I was able to release the bound-up facia around the wound and use the laser to speed up the healing. I had immediate relief from working around the lower abdomen and rib cage, to the degree I could reach it myself. Of course, I did not use the percussor over the surgical site. 

  

Post-Surgery Work 

I have worked around and on my surgical site when appropriate since having the surgery on Dec 20 and was released from Shouldice the morning of Dec 22 (a day early due to Xmas). I was on the airplane to Cabo on Dec 24th. I travelled and moved well during this travel time and Bill did the moving and heavy lifting. I treated myself 2 x per day while away in Cabo for about a total of 30-40 mins of work.  

 

Then, I saw my trainer Briana 3 weeks + later in January and she could not tell that I had surgery. She has seen post hernia surgery patients before and most people she said, you could tell they were still not completely mobile even 3-4 months later. That was similar to Bill’s MD who reported it took him 4 months to heal. Me? I’d say in 3 weeks I was 95%. 

  

 

So, What Is the Takeaway from All This?  

If you don’t have any of the aforementioned side effects from the MESH, your movement pattern will be affected profoundly. Here’s where it gets important – women don’t get inguinal hernias very often; we get another one called a femoral hernia or an umbilical hernia from pregnancy. Men get the inguinal one and is often felt as a drawing or pressure into the scrotum. You can be sure that anything to do with that area for guys is dealt with quickly as they want it to make sure their parts department is fully functional!  However, the big red flag with inguinal hernias is that post surgery many patients develop hip issues, which are the precursor to hip replacement. It happens astonishingly quickly – maybe 1-3 years to needing a hip replacement. 

 

If They Only Knew This Information 

Having gone through this process personally and dealing with it professionally – it is a common and completely avoidable problem. 

 

I still work on my scar and will continue to do so because I don’t want a hip replacement. I already have issues on that left side due to a 2008 knee injury, so it gets plenty of attention. I am doing Pilates 2 x per week and with Briana my trainer 1 x per week, and I can tell you that my left core and hip/pelvis are coming back from the dark side. I’m getting stronger and have less issues with my left lower extremity because I don’t have to “baby it” like I did before.  

 

Why did it take so long for me to get the surgery? Good question! I just couldn’t make it work into my schedule and didn’t prioritize getting it done until it started to interfere with my sporting life! Guilty as charged! 

 

Final Thoughts 

So now you know a bit more about hernias, more specifically inguinal ones, but the principle applies to ALL surgery – if you cut the fascia to get inside the body, you will affect the fascia tissue throughout the body and there will be scar tissue.  Some people scar more than others – you know who you are because you get keloid scars fairly easily. Blondes are more prone to this – so in this case, they don’t have more fun! 

 

This is very true of C-section scars, especially if they cut across the inguinal ligament (I don’t understand why this is necessary) but they do this on a second C section to cut the first scar out. I have many women who come for scar release on their C-section scar with lower back and hip pain. 

 

Don’t get me started with breast surgery, augmentation, reduction, or mastectomy/lumpectomy. Some of this is choice or not a choice, some is just not being happy with what you have. If we knew more about how our choices affect our bodies, we wouldn’t have had that tummy tuck or augmentation. These poor people cannot stand up straight, have chronic neck and upper back tension, cannot breathe deeply (not great for the brain) and generally don’t understand the connection.  

 

I hope you hung in there and actually got some information that you didn’t before!