An inguinal hernia occurs when a portion of the intestine or fatty tissue pushes through a weak area in the lower abdominal wall, typically near the groin. This protrusion creates a visible, often painful, bulge in the groin or scrotum. The manual technique of gently pushing the protruding tissue back into the abdominal cavity is known as taxis, or reduction. This information details the safe steps for attempting reduction but should never replace professional medical advice. Anyone experiencing a hernia should consult a physician immediately, as improper technique or delayed treatment can lead to severe complications.
Differentiating Reducible and Non-Reducible Hernias
The first step in considering manual reduction is determining the type of hernia, as not all can be pushed back in. A reducible inguinal hernia is one where the protruding tissue can be returned to the abdominal cavity, either spontaneously when lying down or with gentle, manual pressure. This happens because the tissue is not tightly trapped within the opening in the abdominal fascia. A reducible hernia often temporarily disappears when a person is relaxed or reclined, and reappears when straining, coughing, or standing.
In contrast, an incarcerated hernia is one where the tissue is trapped and cannot be manually reduced. The contents, which may include a loop of the small intestine or fat, are caught within the fascial defect of the inguinal canal. An incarcerated hernia is generally more painful and represents a greater risk because the trapped tissue can become swollen, potentially leading to a loss of blood supply. If the tissue is trapped for a prolonged period, it can progress to a life-threatening emergency.
Emergency Symptoms Requiring Immediate Medical Care
A trapped hernia can quickly become a medical emergency if the blood supply to the incarcerated tissue is cut off, a condition known as strangulation. Strangulation is a severe complication that can lead to tissue death, or gangrene, and requires immediate surgery. If any signs of strangulation are present, manual reduction must not be attempted, and the individual should seek the nearest emergency department right away.
Symptoms indicating potential strangulation include:
- Sudden onset of severe, rapidly worsening pain at the hernia site.
- Skin over the bulge appearing red, purple, or dark, and becoming tender to the touch.
- Systemic symptoms, such as fever or a rapid heart rate.
- Signs of bowel obstruction, including nausea and vomiting.
- An inability to pass gas or have a bowel movement, suggesting the bowel lumen is blocked.
The presence of any of these signs means urgent medical intervention is necessary to prevent severe complications.
Step-by-Step Guide for Attempting Gentle Reduction
If the hernia is known to be reducible and none of the emergency symptoms are present, a gentle manual reduction, called taxis, may be attempted. The goal is to use gravity and relaxation to assist in guiding the tissue back into the abdominal cavity.
Positioning and Relaxation
The individual should lie flat on their back and slightly elevate their hips to allow gravity to pull the abdominal contents away from the inguinal canal opening. Using a pillow or books under the hips can achieve a slight Trendelenburg-like position, approximately 20 degrees, which helps retract the herniated tissue. The muscles surrounding the groin must be completely relaxed, as muscle tension increases intra-abdominal pressure and works against reduction. Deep, slow breathing or a warm bath may help encourage muscle relaxation. Applying a cold compress or ice pack to the hernia site for several minutes can also reduce swelling, making the reduction attempt easier. Wait 5 to 15 minutes, as some hernias will reduce spontaneously once the patient is relaxed and gravity is assisting.
Manual Technique
To begin the manual process, place fingertips on the most distal part of the hernia, which is the farthest point from the abdominal wall opening. Apply steady, gentle pressure toward the opening in the abdominal wall, pushing in the direction of the inguinal canal. The pressure should be a slow, constant, guiding force toward the abdomen, not straight down into the tissue. Using two hands can help facilitate the guidance of the tissue through the fascial defect. If pain increases or the reduction is not successful after a few minutes of gentle effort, the attempt must be immediately stopped. Success is often signaled by a distinct feeling of the bulge slipping back into the abdomen, sometimes accompanied by a gurgling sound.
Medical Follow-Up and Options for Permanent Repair
Successful manual reduction provides only temporary relief and does not address the underlying weakness in the abdominal wall. The person must still schedule an appointment with a physician or surgeon promptly to discuss long-term management. Even after a successful reduction, the hernia is likely to recur.
The definitive treatment for an inguinal hernia is surgical repair, which prevents future incarceration and strangulation. Common surgical procedures are herniorrhaphy or hernioplasty, often involving the placement of a synthetic mesh to reinforce the weakened tissue. While awaiting elective surgery, a supportive garment known as a truss may be suggested as a temporary measure to hold the hernia in place. However, a truss only manages the symptoms and does not provide a permanent fix for the defect.