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Hernias, surgeries and scars, oh my!

I’m going to finish up this abdominal series by discussing some other factors that can cause dysfunction in the abdominal cavity.

Let’s start by looking at hernias. There are a few common types of hernias:

  • Inguinal hernia:  The inguinal canal is formed by the external oblique, which essentially forms a tube by connecting with the transverse abdominis from behind. This canal houses the spermatic cord in males and the round ligament in females; it also houses t2 major nerves that supply the pelvic region. A hernia in this area occurs when the abdominal organs protrude through the inguinal canal. These can occur with repeated straining or poor regulation of intra-abdominal pressure.
  • Femoral hernia: The femoral canal exits just below the inguinal canal. Just like an inguinal hernia, femoral hernias can occur with repeated straining and poor intra-abdominal pressure regulation. These hernias would be seen in the inner thigh or groin.
  • Umbilical hernia:  Umbilical hernias occur at the belly button and often accompany diastasis recti and can be related to pregnancy. However, umbilical hernias can develop in both men and women and at any age.
  • Epigastric hernia:  These hernias are very similar to umbilical hernias in that they occur at the midline of the abdomen, but they occur above the belly button. They are often related to pregnancy, but also occur throughout the lifespan in both men and women.
  • Incisional hernia: Incisional hernias occur when intestines protrude through abdominal incisions related to surgery.
  • Hiatal hernia:  The esophagus passes through your diaphragm before it empties into your stomach. Hiatal hernias occur when the stomach protrudes upward through this hiatus in the diaphragm. Symptoms often include chest pain and heartburn.

Now, you can see how a hernia is a breech of the abdominal wall. What that means is that the abdominal muscle can’t work properly to regulate intra-abdominal pressure. And human body is smart – it will compensate in an attempt to try to keep the organs inside the body. If you’ve been following along and have read my earlier posts, I’ve compared the abdomen to a tube of toothpaste. Imagine there is a leak in the tube: In order to prevent leakage you squeeze the toothpaste away from the leaky area. That’s what happens in your body! Other muscles (including your superficial abdominal muscles, hip flexors, pelvic floor and diaphragm) can become tight and dysfunctional.

Let’s think about what a hernia actually indicates: poor coordination and strength of your abdominal wall. Hernias won’t occur in muscle tissue that is strong and functional. However, pregnancy, surgeries and lifestyle factors lead to weakness in the abdominal muscle, especially the transverse abdominis. Couple that with poor habits (e.g. repeated straining with bowel movements or poor lifting mechanics) and you could be at risk of developing a hernia.

Now let’s shift gears and talk about surgeries and scar tissue. Any time an abdominal surgery (even laparoscopic surgery) is performed, there is a breech in the integrity of the abdominal wall. Think about it – in order to access any of the abdominal organs, surgeons must first get through ALL muscles of the abdominal wall. These incisions in the abdominal wall are a source of injury and must heal. However, it seems to me that there isn’t any discussion about how to rehab the abdominal muscle following abdominal muscle. That’s probably because the doctors doing these procedures aren’t even thinking about the muscle. But, that’s the problem, because the abdominal wall IS affected and needs appropriate care in order to heal appropriately.

This is especially true for women that have cesarean deliveries. Their abdominal muscle is already lengthened and then is cut! That muscle tissue becomes very inhibited, meaning, it doesn’t want to contract. Consider this: if you had a muscle tear in another part of your body, you would rest it and focus on healing before you get back to using that muscle, right? Well, the thing that is so tricky about the abdomen is that we need our abdominal muscle for nearly all movement. This is why it is SO imperative to learn to contract your deepest abdominal muscle (transverse abdominis) appropriately. Otherwise, you can develop compensatory tendencies that can lead to problems down the line.

Here’s how it presents clinically: a patient has an abdominal surgery, and with passing time they develop pelvic pain, pain with sex, or even urinary or bowel dysfunction, likely related to pelvic floor dysfunction that has developed as a compensation for abdominal muscle inhibition after surgery. However, they rarely recognize that their symptoms all stem back to their surgery!

The other major consideration with abdominal surgery is scar tissue. Scar tissue in the abdominal cavity can significantly impair how our abdominal muscle functions. When scar tissue gets restricted, it can shorten muscle tissue and can even make a muscle weaker! Furthermore, muscle can affect our viscera! Our abdominal organs are tightly housed within our abdominal cavity and must be able to slide and move against each other in order to function appropriately. When the motion of our viscera is impaired due to scar tissue, people may experience pain and other gastrointestinal symptoms (indigestion, nutrient deficiency/malabsorption of nutrients, constipation).

3d rendered medically accurate illustration of a mans internal organs

Here is my bottom line: No matter what your medical history or current symptoms, you really ought to learn how to regulate your intra-abdominal pressure appropriately. This will help to fend off low back pain, pelvic floor dysfunction and organ dysfunction!

If you have any questions about your abdomen, I encourage you to seek a consultation with a physical therapist! A skilled PT will be able to assess your posture, your breathing patterns, as well as the strength and coordination of your abdominal muscle in order to assign you appropriate exercises!

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