Do you have a hernia like this? Let's learn about Obturator Hernia!

Have you ever heard of an "Obturator Hernia"? Maybe this name sounds a little strange. But this is also a type of hernia. But it is a little rare, especially in women between the ages of 70 and 90. So today we will talk about what this obturator hernia is, how it develops, what are the symptoms, and what are the treatments. Very simply, I will explain these things in a way that you can understand.

What is this Obturator Hernia?

Simply put, an obturator hernia is a hernia in our pelvis, the part of the hip bone that is inside the pelvis, that has a small opening in it, called the obturator canal , through which part of the intestine or the fat in the abdomen protrudes. Think of it like a little air coming out of a small hole in a balloon.

This obturator foramen is like a small passageway between our pelvic bones. Normally, nerves and blood vessels pass through it. However, when our pelvic floor muscles , the muscles inside the lower abdomen that help hold our internal organs in place, become weak, part of the intestine, especially the small intestine , and sometimes the large intestine, can push through that passageway.

This can be a dangerous situation. Because the part of the intestine that comes out like this can get stuck between the pelvic floor muscles or inside the obturator duct. If that happens , a bowel obstruction can occur. That means the intestinal passageway becomes blocked. This is a condition that requires emergency medical treatment. You may even need to have surgery right away to fix this.

What are the symptoms of this? Do you have these too?

The symptoms of an obturator hernia may not be immediately apparent, but be aware of these things:

• Abdominal pain: This usually starts in the lower right side of the abdomen and can then spread throughout the abdomen.
• Constipation: Difficulty going to the toilet.
• Distended stomach: Feeling as if the stomach is bloated.
• Nausea and vomiting: Feeling sick and vomiting.
• Pain in the thigh area: This is a somewhat specific symptom. The pain starts in the groin area and spreads down the inner side of the thigh. Sometimes this pain can be felt all the way down to the knee. This is also called the Howship-Romberg sign . This means that the pain is caused by the blocked part of the intestine pressing on the obturator nerve.

If you have one or more of these symptoms, especially if you are older, it is a good idea to see a doctor.

Why does this obturator hernia occur? What are the risk factors?

As I said before, the main cause is the weakening of the pelvic floor muscles. So there are several things that can weaken these muscles, which increases the risk of developing an obturator hernia:

• Age: As we age, all the muscles in our body, including the pelvic floor muscles, weaken. Also, the membrane that covers the opening of the obturator canal changes with age. Both of these factors increase the risk of a portion of the intestine protruding. That is why it is more common in older people.
• Chronic constipation: When you have to strain and have to go to the bathroom frequently, it puts a lot of pressure on your pelvic floor muscles. Over time, these muscles can become weak. Think of it like lifting a heavy weight all the time.
• Chronic obstructive pulmonary disease (COPD): People with diseases like COPD often cough. When this cough occurs, the pressure inside the abdominal cavity increases. This pressure also affects the pelvic muscles, which can weaken them.
• Being underweight: Especially when you lose weight suddenly as you get older, the amount of fat around the obturator duct decreases. This increases the chance of a hernia growing inside the duct. If your BMI (Body Mass Index) is less than 18.5, you are considered underweight.
• Multiple births: The pelvic floor muscles of mothers who have given birth to multiple children may be somewhat weakened.

If one or more of these things apply to you, it's worth taking some precautions against an obturator hernia.

What complications can this cause?

If an obturator hernia is not treated properly, dangerous complications can occur.

1. Incarcerated obturator hernia: This is when the hernia becomes trapped between the pelvic muscles and cannot go back in. This can lead to an obstructed bowel , which is a blockage of the small intestine.

2. Strangulated obturator hernia: This is the most dangerous condition. The part of the intestine inside the hernia loses blood flow. It's like someone strangling your neck. If it doesn't get blood, the intestinal tissue starts to die. This is called necrosis . This is a life-threatening emergency.

Important: If you suddenly experience severe abdominal pain, nausea, or vomiting, it could be a sign of a strangulated hernia. If this happens , you should go to the hospital immediately.

How do doctors recognize this?

When you go to see a doctor, he or she will first ask you about your symptoms. Then they will do a physical exam. They may also do tests like these:

• Howship-Romberg test: In this test, the doctor moves your hip joint and asks if you feel any pain on the inside of your thigh.
• Hannington-Kiff test: In this test, the doctor gently taps on certain areas of your shin bone (tibia) or thigh bone (femur). This is done to check if the hip muscles contract.

After these tests, a CT scan (Computed Tomography scan) may be performed to confirm the presence of an obturator hernia. This can clearly show the location and size of the hernia.

How is it treated?

The only permanent treatment for an obturator hernia is surgery . Surgery is performed to repair the hernia.

During the surgery, the surgeon makes a small incision in your lower abdomen or groin area and approaches the hernia in the obturator canal. Then, the protruding parts of the intestine are put back into the abdominal cavity and the weak spot in the abdominal wall is repaired. Sometimes, something like mesh may be used to strengthen the weak spot.

This surgery can be performed in several ways:

• Open surgery: Surgery performed through a large incision in the traditional way.
• Laparoscopic surgery: A surgery performed through just a few small incisions, using a camera and delicate instruments. This is also called "keyhole surgery."
• Robotic hernia repair surgery: This is similar to the laparoscopic method, but the surgeon performs the surgery using a robotic arm.

The surgeon will explain to you which surgical procedure is best for you.

If there is an emergency, such as a strangulated obturator hernia , and the intestine is damaged, further surgery may be required. This may include a colectomy to remove the damaged part of the intestine.

Are there any problems after the surgery?

Minor complications like these can occur after any hernia surgery, but they don't happen to everyone.

• Bleeding
• Damage to the obturator nerve (this is very rare)
• Surgical site infection

Your medical team will inform you about this.

How long will it take to heal?

Recovery time after surgery can vary from person to person. It depends on factors such as:

• What type of hernia surgery was performed: For example, the recovery time after laparoscopic surgery is shorter than after open surgery.
• Whether you had a colectomy (removal of part of your intestine): If so, it may take a little longer to heal.
• Your overall health: If you have a condition like malnutrition or other illnesses like COPD , it may take longer to recover.

However, because everyone's situation is different, your surgeon will explain what you can expect and how soon you can resume your normal activities.

What will happen in the future with this situation?

After hernia surgery, an obturator hernia will most likely heal and the symptoms will go away. But remember, this surgery only heals the hernia. If you have other underlying conditions, such as malnutrition or COPD, that increase your risk of developing a hernia, you will need ongoing medical care and support. It is important to control those conditions.

When should you see a doctor? When should you go to the hospital immediately?

If you have persistent abdominal pain or thigh pain, don't ignore it and see a doctor for advice. These symptoms may or may not be signs of an obturator hernia. But it's important to find the cause.

It's an emergency! Go to the hospital immediately if you have these symptoms:

• Very severe, sudden stomach pain.
• Nausea or vomiting.

These may be signs of a strangulated obturator hernia , a condition that requires emergency treatment.

The most important things for you to remember

As we age, we may think that it's normal for our bodies to change. We may dismiss minor aches and pains in our abdomen or thighs as "just the way things are with aging." However, these symptoms could be the result of an obturator hernia. Although these are rare types of hernias, they can occur, especially in women in their 70s, 80s, and 90s.

So, if you have symptoms like abdominal pain, talk to a doctor. It may not be an obturator hernia. But sharing your symptoms and your concerns with a doctor is the first step to getting better. Don't worry, doctors are here to help.

I hope this information is helpful to you. If you have any further questions, don't hesitate to ask a doctor. Stay healthy!

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