Inguinal Hernia
More than 2.3 million inpatient abdominal hernias were repaired in the U.S. over a 10-year period (2001 to 2010).[2] IH, which involves the protrusion of a visceral structure or adipose tissue through the abdominal wall, is the most prevalent subtype of abdominal hernia and accounts for nearly two-thirds of cases in the U.S.[8] Risk factors for developing IH include a history of hernia or hernia repair, older age, male sex, Caucasian ethnicity, low BMI, systemic connective-tissue disorders, smoking and associated chronic cough, chronic constipation, and low birthweight.[7] Signs and symptoms of IH may include a visible lump, heavy discomfort around the gut, pain or aching upon exertion, enlargement of the lump upon coughing, and constipation.[7] Severe pain and discomfort with a visible bulge may indicate a strangulated hernia, a phenomenon in which the blood flow in part of the intestine is cut off, resulting in necrosis.
IHs are usually identified via physical examination. Ultrasound imaging may be used to diagnose groin hernias that are difficult to visualize or palpate.[9] For many patients, the presence of a small IH does not cause significant pain or discomfort that would affect day-to-day quality of life. In fact, more than one-third of patients who present with an IH are asymptomatic. The international guidelines for groin hernia management recommends that asymptomatic and some mildly symptomatic patients enter a watch-and-wait period following initial diagnosis.[7] It is also recommended that surgery be withheld in male patients with minimal symptoms that do not significantly affect their physical activity.[10,11]
There are a number of nonpharmacologic and nonsurgical approaches to IH management (Table 1). One nonsurgical method is the use of a truss.[12,13] A truss is similar to an athletic supporter, with a hard plug positioned over the hernia site.[14] The efficacy of truss use is questionable, but when fitted appropriately, the hard plug exerts pressure to keep the hernia contents in the abdomen. Trusses may be available through an outpatient pharmacy.
Symptomatic management of IH is crucial to a patient's quality of life. OTC analgesics can help ameliorate pain symptoms both before and after surgical repair. More than 15% of patients experience pain that significantly alters their quality of life within 6 months after surgery.[15] Postoperative pain occurring within 3 months of surgery can be managed with nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids. Pain occurring 3 to 6 months after surgery, known as chronic postoperative inguinal pain, is often treated with neuropathic pain analgesics (e.g., tricyclic antidepressants, selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors, gabapentinoids) and NSAIDs (Table 2).[16] Other postoperative complications that a patient may experience include chronic constipation and superficial incisional surgical-site infections requiring the initiation of empiric antibiotics.[17]
US Pharmacist. 2022;47(6):HS-2-HS-6. © 2022 Jobson Publishing
