By Olivia Duffield
From PHN Issue 51, Winter 2023
Dear Prison Health News,
Intestinal hernias is a topic you could write an article on. Some points you could cover:
· What causes a hernia?
· How common are they?
· Other than discomfort, are they a problem if there are no complications?
· How often do complications occur?
· Is it possible (or safe) to live indefinitely with a hernia?
– Jon Tillman
Dear Mr. Tillman,
Thank you for this excellent suggestion. Hernias occur because of a tear or a weak spot in the tissue surrounding an organ. The muscle and tendons of the abdominal wall from the ribs to the top of the legs form a corset that holds the intestines in place. Some places in this corset tend to be weaker than others, and those places are typical sites of hernias. Inguinal (groin) hernias are the most common type. Researchers estimate that about 27% of men and 3% of women will develop an inguinal hernia at some point in their lives (NIDDK).
Symptoms of a hernia may include:
· Swelling or a bulge in the groin or scrotum.
· Increased pain at the site of the bulge.
· Pain while lifting.
· Increase in the bulge size over time.
· A dull aching sensation.
· A sense of feeling full or constipation.
Unfortunately, hernias do not get better on their own, and surgery is the only way to repair them. Over time, hernias tend to get bigger as the muscle wall of the belly gets weaker and more intestines bulge through. Lifting heavy objects, coughing, and straining can also make hernias grow in size. However, many people are able to delay surgery for months or even years, and some people may never need surgery for a small hernia. If the hernia is small and you don’t have any symptoms, or if the symptoms don’t bother you much, you and the medical provider in your facility may simply continue to watch for symptoms to occur. Men who delay surgery should watch for symptoms and see a doctor regularly. About 70% of men who delay surgery will develop new or worsening symptoms and will need surgery within 5 years (NIDDK).
In 2017, a class-action lawsuit was brought by a group of people in Florida prisons who were denied hernia repair surgery except in the case of a life-threatening emergency. From Prison Legal News:
“To end this practice, the Florida Justice Institute and the law firm of Kozyak Tropin Throckmorton filed a class-action suit in September 2015. … After two years of litigation, a settlement agreement was approved by the district court on Sept. 11, 2017. It required the FDOC to issue a Health Service Bulletin concerning hernia treatment to include a referral to a surgeon and instructions that the surgeon’s recommendation ‘shall not be unreasonably refused.’ It further required $2.1 million in payments to the class members, with the FDOC paying $150,000 and Corizon responsible for $1.95 million.”
This case, Copeland v. Jones, U.S.D.C. (N.D. Fla.), Case No. 4:15-cv-00452-RHCAS, can hopefully be used in future lawsuits to prevent denial of hernia treatment in prisons in other states.
If the blood flow to the hernia gets cut off, it is called “strangulation.” This is a lifethreatening emergency that occurs when a loop of intestine or a piece of fatty tissue is trapped inside the hernia and is cut off from its blood supply. The risk of a hernia becoming strangulated depends on where the hernia is located. The National Institutes of Health points out the following signs of a strangulated hernia:
· Extreme tenderness or painful redness in the area of the bulge
· Sudden pain that worsens quickly and does not go away
· The inability to have a bowel movement and pass gas
· Nausea and vomiting
· Fever
Risk factors for strangulated hernia include:
· Strenuous activity
· History of abdominal surgery
· Straining during bowel movements
· Chronic coughing
Surgery is the only treatment for strangulated hernias. The operation must take place as soon as possible to prevent permanent damage to the affected bowel.
Prison Health News 