‘Reducible’ is a good thing when it comes to hernias

My son had an ultrasound for a hernia. His results showed an inguinal hernia, 2.2 centimeters and “reducible.” Will he need surgery or a truss? What does “reducible” mean? Is this a risk for strangulation of the bowel? — B.E.

A hernia is a defect in the abdominal wall, through which an organ or part of one protrudes. We are all born with the potential for abdominal wall defects due to the way structures move during embryological development. The holes allow those structures to move. In the case of males, the testicle descends through the inguinal ring, which then normally closes. In your son’s case, it didn’t completely close, leaving a large enough defect for abdominal contents to come through. Hernias can occur at the belly button or at sites of previous surgeries.

“Reducible” is a good thing when it comes to hernias. It means the contents of the abdomen can be pushed back into the abdomen (where they belong) with some gentle but firm pressure from the examiner’s hand. If a hernia is not reducible — meaning, part of the abdominal contents has gone through the abdominal wall and are trapped outside — it is called “incarcerated.” This is dangerous, because with swelling of the abdominal contents, the blood flow to the incarcerated contents can decrease, leading to tissue death. This is “strangulation” and is a surgical emergency.

Surgery is often done to prevent these complications, even though the risk is low (less than 1 percent per year, on average) for inguinal hernias. People who have symptoms from hernias should undergo surgical repair. People with no symptoms may choose to have it repaired; however, others can elect “watchful waiting,” but they need to know the warning signs of an incarceration: a nonreducible hernia and pain.

I seldom recommend a truss, because most people who need it for symptoms should be operated on, and people with no symptoms don’t need it. They are useful in people who are at high risk for surgery.

Contact Dr. Roach at ToYourGoodHealth@med. cornell.edu.