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Hernia's and Fabric supports

Anatomy

The organs that are situated within the abdominal cavity are covered with a fine continuous lining membrane called the peritoneal membrane, or peritoneum. The part of this membrane that covers the intra (inside) abdominal organs is called visceral peritoneum and the rest of the membrane, which lines the abdominal walls, is called parietal peritoneum. The peritoneal cavity is the enclosed free space within the belly that is outlined by the parietal and visceral peritoneum.

Abdominal walls – large fibromusclur diaphragm is the roof, pelvis is lower, side walls made up of abdominal muscles and posteriorly lumbar vertebrae and a lower ribs. 

Contents of the abdomen -  

  • Stomach
  • Small and large intestines
  • Liver
  • Pancreas
  • Spleen
  • Kidneys
  • Urethra
  • The abdomical aorta and inferior vena cava

Types of Hernias

A Hernia is a  protrusion of organs of the abdominal through an abnormal cavity (rupture)

Hernias are named by the site of weakness/location of the rupture i.e abdominal or inguinal

A Hernia is formed as fat is pushed through a weak point in the muscle and drags the peritoneum out with it. The sac will then enlarge with repeated pressure (any expulsive action e.g coughing) and allow the intra-abdominal contents to come through.

Adhesions can then form between peritoneal lining of the sac and the peritoneal surface of the hernia preventing the hernia from being reduced. Complications include abdominal pain, intestinal obstruction and strangulation.

Ventral Hernias

Epigastric hernia

Herina in the Epigastrium section of abdomen which is below sternum but above belly button. 


Spigelian hernia

Hernia through the spigelian aponeurosis next to the rectus abdominal muscle. Common hernia in sports people. Most common group over 50s active men.


Umbilical hernia

Hernia through the umbilical region, most common in infants, usually painless. 

Direct inguinal hernia

A through the weakened posterior wall of the canal usually at the medial inguinal fossa of peritoneum.


Indirect inguinal hernia

Hernia which passes obliquely along the inguinal canal. This type of hernia can ultimately become a scrotal hernia. Both result in a painful dragging sensation and pain in the groin.


Obturator hernia

Hernia through the pelvic floor, more common in women due to anatomy.


Femoral hernia

Hernia through the femoral canal (houses femoral artery and femoral vein) found above the psoas muscle. This type of hernia is less frequent than inguinal and more common in women especially post pregnancy. Very often not reducible.


Richters hernia

A form of strangulated hernia often found in femoral region, increased likelihood of gangrene in this area


Incisional hernia

A hernia at the sight of previous surgery hernia along scar. 


Parastomal hernia

A colostomy is an opening of the colon through the abdominal wall when the bowel is unable to function in a normal way. An ileostomy is the opening of the latter part of the small intestine (the ileum) to the abdomen instead of the colon. These patients will now have an aperture (stoma) on the abdominal wall.  A hernia can develop directly over the stoma site due to the weakness created in the abdominal wall.

Causes in adults:

  • Obesity
  • Multiple pregnancies
  • Previous abdominal surgery
  • Fluid in the abdominal cavity (ascites)
  • Long-term peritoneal dialysis to treat kidney failure – CAPD Continuous ambulatory peritoneal dialysis due to fluid staying in the peritoneal cavity during the day
     

Indications for hernia support 

  • Co-morbidities preventing surgical management
  • To prevent a small reducible hernia from progressing
  • During pregnancy if hernia appears
  • Following surgical repair to aid recovery.

Types of Orthotic Support

Abdominal binder

Generally afull elastic step through or wrap around design

Model H Belt

 

Fabric Abdominal Support

Prim Abdominal Support

High Uniband

Chest and abdominal Support

 

Abdominal support

Generally has bones in back with left or right opening front and is custom made

LS support

Lumbosacral supports steels in back with central opening front

Fast Wrap with pendulous front

 

Inguinal truss

There are a few different designs and they can be bilateral or unilateral.

Bilateral Inguinal Support

Unilateral Inguinal Support

Scrotal bag truss

A belt with bag to support genitals due to hernia weight

Parastomal Hernia Support

Buchanan Stoma belt with an aperture for stoma bag