More than a million hernia operations are undertaken in the UK every year and millions more choose to manage their hernias non-operatively and continue with daily life experiencing unease and discomfort. In addition to the Covid lockdowns of 2020 and the restrictions placed on elective surgeries throughout the UK, hernia operations have seen a reduction of 40%, with over six million patients still pending on waiting lists. With extended estimated lead times for non-urgent hernia repairs, it looks like waiting times could be anywhere up to 5 years. With this is mind, there is now an even higher demand for Orthosis to manage hernias in a non-operative capacity.
Hernias occur when part of your internal soft tissues protrude through a weakness in surrounding tissues and muscle walls. These weaknesses can naturally occur from a multitude of different causes. These could include muscle wastage associated with age, general wear and tear, prolonged stress or strain which forms increased intra-cavity pressure and can also occur secondary to a surgical incision.
Inguinal and Femoral Hernias
Inguinal hernias are the most prevalent hernia contributing to over 90% of hernias. They occur in men and appear when the intestine finds a weakness in the upper part of the groin and thigh. The hernia originates after passing through a natural aperture in the groin area called the inguinal canal. This canal is the pathway for the spermatic cord and associated blood vessels and nerves for the testes and lower limb. Due to its natural opening, it acts like a gateway and allows easier passage for the intestine to herniate through it. The prevalence in men is also increased due to straining or excertive exercise which can further exacerbate the issue. Lifting heavier items, heavy weightlifting or excessive toilet straining furthers the risk of developing an inguinal hernia.
Femoral hernias result in a comparable way to that of inguinal hernias. These mostly occur in women rather than men and are less prevalent than inguinal types, usually only contributing to 6-8% of hernias in the groin area. The femoral canal, like the inguinal canal, allows for easy passage for the intestine to pass through the muscle walls and herniate. The femoral canal is slightly lower in nature to the inguinal canal and is located more at hip level. Women have a naturally wider hip, and this results in the femoral canal being stretched. This therefore makes the gateway for the hernia to be larger allowing the intestine to pass much easier in this area in-comparison to than of a man.
Traditionally, groin related hernias were treated with belts and leather padding via an orthosis called a truss. These would work by means of promoting a reducible hernia by hand and then applying the belt and pad over the area to plug and filling the void.
Abdominal Hernias
Abdominal Hernia’s are much less prevalent than inguinal / femoral hernias. These can occur through the umbilicus at birth, via weakness in the abdomen wall, or can result due to pendulous stomachs, pregnancy, surgical incision, or from stoma care. Primary midline hernias are the most common type of abdomen hernia and will include umbilical hernia, para-umbilical, supra-umbilical, and epigastric types.
Birth related hernias usually occur around the umbilicus and result from the separation of the umbilical cord from the baby. The cord runs through the abdominal wall to provide nutrients to the baby during pregnancy. This opening will usually close naturally after birth, however, sometimes can remain open. With a newborn crying and the increased physical exertion in their abdomen, the belly button herniates. These can be massaged and supported with umbilical belts that help support and correct the protrusion, and will usually naturally disappear within the first few years of the babies life. Umbilical hernias are low in prevalence, however, 1 in 5 babies suffering from them. As mentioned earlier these can still occur in adults and are supported with similar belt like navel orthosis that support the waist and the navel area to alleviate pain and reduce any prominence.
Other abdominal hernias commonly arise in the midline where a fibrous tissue called the Linea Alba separates. Its weaker structure compared to than of its surround muscles (rectus abdominus aka the six pack muscles) means its more prone to herniation. The Linea Alba is also known to stretch and thin with larger abdomen types, so it’s also more prevalent to separating if you are overweight or pregnant.
Incisional hernias occur around the abdomen as a result of abdominal surgery. The Linea Alba plays a role in this when there is midline incision. The reason for this is that it has limited blood supply meaning it is a good insertion site for surgeons due to its lack of blood loss in theatre. However, with the incision this creates a further weakness in the abdomen muscles and can force the intestine to re-herniated around the surgical site. Even with gauzing placed subcutaneously to limit post operative displacement, the weakness through the incision can still appear elsewhere and therefore binders can be used to promoting compression and act as a second abdomen, helping to improve healing and aiding in swelling reduction and mobility post operatively.
Products to assist with Common Hernias.
Orthotix are a UK based NHS supplier of class 1 medical devices and the off the shelf range of modern and discrete hernia supports are now available to the NHS and the public and cover a wide array of hernia conditions as mentioned above. Manufactured by both of our partners, Pavis and Orliman, the range encompasses a selection of machine washable hernia supports with innovative materials and cotton-based products to cover a wide array of hernia presentations.
A new innovative way to treat groin related hernias such as inguinal and femoral types is via Hernia Underwear. Used as an alternative to the traditional leather truss type belts, these highly compressive briefs, boxer shorts, and Y front type slips provide uniformed compression around the pelvis and groin and can also provide mild abdominal compression when chosen in the deeper variants. Designed by Healthcare Professionals to effectively reduce pain and discomfort, the low profile, discrete hernia underwear improves cosmetic appearance, offers unparalleled comfort, and are unrestrictive to allow for uninhibited mobility, making them ideal for prolonged daily use.
In addition to this innovative hernia underwear range, Orthotix also offer a selection of other hernia supports including traditional truss’s, elasticated abdominal binders, Stoma care supports, and a selection of genito-hernia supports such as jock straps, bag truss’s and prolapse truss’s.
