general. Variables that influence the surgeon’s
decision about the type of operation include the
location and size of the hernia, the person’s age
and general health status, and whether the hernia
is reducible or incarcerated.
For most hernia repairs the surgeon places a
small piece of plastic mesh behind the opening in
the muscle wall to help support the muscle layers.
The surgeon then sutures those layers together to
restore stability and STRENGTHto the muscle wall.
Recovery takes about two weeks for a laparoscopic
surgery and up to six weeks for an open surgery.
Once repaired, hernias do not generally recur
though it is common to feel twinges of discomfort
and even PAINperiodically at the site up to several
years after the surgery.
Risk Factors and Preventive MeasuresRepeated straining, such as with bowel move-
ments or because of chronic COUGH, can pressure a
weak place in the abdominal wall. Though sud-
den, strenuous movement can bring out a hernia,
such movement can occur with a strong SNEEZEor
cough as easily as lifting too heavy a weight.
Regardless of the activity that bears blame, the
underlying cause of a hernia is a weakness in the
muscle structure. Though exercises to improve
muscle strength may prevent injuries such as
strains and muscle tears, exercises cannot prevent
or treat hernia. There are no known measures for
preventing hernia.
See also SURGERY BENEFIT AND RISK ASSESSMENT;
SWALLOWING DISORDERS.
herniated nucleus pulposus Damage to the
structure of the CARTILAGEthat cushions the verte-
brae, also called a herniated, slipped, or ruptured
disk. A herniated nucleus pulposus becomes
increasingly common with advancing age, the
result of wear and deterioration of the tough outer
cartilage (called the annulus fibrosus) that allows
the soft inner portion of the disk (called the
nucleus pulposus) to bulge beyond its enclosure.
Often there is a clear tear in the outer cartilage (a
rupture). A traumatic injury, such as a motor
vehicle accident, or heavy lifting may also cause a
disk to herniate.
This deterioration and bulging is common
enough that doctors believe in itself it does not
represent a health condition that requires treat-
ment. However, the situation becomes problem-
atic when the herniation places pressure against
the roots of the SPINAL NERVESor the SPINAL CORD,
causing PAINand weakness or numbness in the leg
(typically only one leg). Though symptoms may
seem to start suddenly, they reflect processes that
usually have been under way for a considerable
time.Symptoms and Diagnostic Path
The main symptom of herniated disk is sharp,
shooting pain in the low back and in the leg
(called radiculopathy). The pain in the leg is more
significant for many people, and the leg may feel
weak or numb in certain areas, depending on
which spinal NERVE roots the herniation com-
presses. Some people experience discomfort in
both legs, may have difficulty walking, and may
have partial or complete loss of bladder or bowel
function.Sudden loss of bladder or bowel control
is a serious symptom that requires
immediate evaluation from a doctor.The diagnostic path begins with a comprehen-
sive medical examination, including NEUROLOGIC
EXAMINATIONand detailed PERSONAL HEALTH HISTORY.
Diagnostic imaging procedures such as X-RAYof
the spine, COMPUTED TOMOGRAPHY(CT) SCAN, MAG-
NETIC RESONANCE IMAGING(MRI), and myelography
(dye injected into the spinal column and viewed
with X-ray) often reveal the location and severity
of the herniation. The doctor may also request
nerve conduction studies and electromyogram
(EMG) to assess neuromuscular function. It is pos-
sible for diagnostic tests to be unable to pinpoint
the precise cause of the symptoms, which does not
necessarily rule out herniation.Treatment Options and Outlook
Most doctors prefer, and most people respond to,
conservative, nonsurgical treatment that targets
relieving the pain and INFLAMMATION. Such an
approach may include- NONSTEROIDAL ANTI-INFLAMMATORY DRUGS(NSAIDS)
- heat or cold to the area
326 The Musculoskeletal System