Direct or Indirect – that is the question

[William Bryant]

Thanks Good Intentions.

One other thing my testicle aches sometimes. Nothing major. 2 doctors and 1 consultant have examined that area. All have said both my tesicles look and feel normal.

I asked the consultant what happens if hernia goes into scrotum. He said “Not a lot”, verbatim.

I meant signs and symptoms? Are there any? How do you know if it is or has.

Agree some people will probably amend lifestyle and carry on seemingly normally. The body does do that, most likely subconsciously in many cases.

It does seem some people may be able to be as before after surgery but a minority. I know of 3 males, noty friends but they sde of my close associate, all had mesh. 1 is back to normal. But the other 2 have major problems/pain.

It was partly that failure rate, albeit anecdotal rather than scientific, that put me off mesh surgery.

Thank you for all your replies, you have helped me greatly and others too I expect.

It’s a shame some other people don’t post more. I did wonder if all my questions put them off. Hope not?

[Good intentions]

I have had talks with surgeons who describe that the hernia defect is actually intact tissue that has stretched beyond its elastic limit. Sometimes it stretches so far that is almost disappears, it’s so thin. In other words, it’s not an actual hole but just a very over-stretched area that will try to regain its original shape. But, it will still be weak and easily over-stretched again.

That fits with what I remember about the early stages of my hernia. I would get the odd effects but they would resolve with rest. Then come back again at the next exertion, typically a soccer game. Maybe if I had just stopped playing soccer the problem would never have come back and I would say that I had healed. I did have some longer periods of time off between games where I did not feel the effects and felt “healed”, but the effects kept coming back when I played soccer, until I realized it was a hernia. I wanted to maintain my active life so chose a mesh repair, which produced a worse effect than living with the hernia.

In short, I think that many of the hernia healing stories are actually activity reduction stories. Accepting a diminished lifestyle in order to avoid the aggravation of the hernia. Which makes sense. But the typical surgeon tends to promise that the former life will be restored with a mesh repair. I think that many people with “successful” mesh hernia repairs have actually just accepted their new diminished life. There’s nothing wrong with that, but promising a restored life when it’s known that it isn’t likely is wrong.

[William Bryant]

Mine is kind of in between the two on that diagram.

I can see the hernia bulge when standing too.

My BMI is between 23 and 24 at present.

One weird thing is I read about a handful of people who cured hernia by rest, food, etc and one who wrote a blog said when sufferer defecates, the hernia bulge virtually goes. They were right! I’d not noticed until I read that.

I also read, in relation to direct v indirect that after lying down/reducing a direct hernia bulge appears quite quickly on standing, an indirect mite slowly.

At first, going on that I’d have said direct but as I wrote after carrying that 5kilo container the bulge got bigger, still reducible but initial bulge appeared then quite quick on standing but gradually got bigger, so I began to think indirect.

Now I’ve worn hernia pants it seems to have reverted to how it was initially.

Strange. I have gone 3 days without wearing them, and not carrying, and it’s stayed as it was. Not sure what’s happened

[Good intentions]

Here is a link with a good illustration. Medially means toward the middle. In my case a very distinct bump appeared when I was standing. I am low body fat, but high BMI. In other words, there’s not much between my skin surface and the abdominal wall. I can still feel the spot now, it is more sensitive than surrounding tissue.

The labels of direct and indirect seem backward to me. In an indirect hernia the material actually enters the canal directly, through the same opening that the spermatic cord does. In a direct hernia it enters the canal from the side, which seems indirect to me. But, somewhere in the past, those labels were determined. Part of the mystery of medicine and what all of the words mean.

https://www.saintlukeskc.org/health-library/what-hernia

[William Bryant]

It’s funny you should mention the right testicle Good Intentions as I’m convinced mine isn’t the same as it was before I had a hernia.

But to get back to the indirect diagnosis, there was no ultrasound, instead the doctor (consultant) pressed in several areas, asked me to cough and that from memory was about it

I’m (a bit) ashamed to say I haven’t grasped what medially means!

[Good intentions]

It’s not clear if you are a skinny low body fat person with defined musculature of the abdomen or if you have some coverage by fat. On a skinny person the signs of a direct hernia are very clear, a pyramid shaped bump appears in a certain area of the abdomen, medially to the crease of the groin. You can find illustrations around the internet showing the location. It’s what I had. As material pushed in to the canal, my right testicle would twist and behave abnormally. This would be after rigorous activity. A physical exam at that point might look like an indirect hernia because there is material pressing on the spermatic cord.

I would think the imaging would be more likely to be correct. It’s not clear what criteria the doctor who did the physical exam was using to make his/her determination.

[Alephy]

@good-intentions I agree 100% with your post!

I wonder whether in the future genetic engineering of the problematic tissue might provide the ultimate cure to the problem…whether this will happen or not, the PT component will never go away i.e. one should always exercise the body, whether with or without an hernia, or after an hernia fix…
and of course adjust to what one can do at any one time…

As for the doctors providing wrong information and expectations, I think this is close to criminal practice (I saw one such doctor, who turned out to have an infamous reputation among his peers too)