Inguinal Hernia and OW training

[EbbTideMike]

Hello all, I'm completely new to SCUBA and I'm really looking forward to getting started. Unfortunately up until I actually paid my dues for the confined water training, I completely forgot about an issue I have. About 3 years ago, my doctor found a very small inguinal hernia. I went to a surgeon and his thoughts were that it was not worth doing surgery at that point. His reasoning was that there was no noticeable bulge and I'm also in no pain. I guess it was even difficult to detect by feeling around. I was playing ice hockey at the time, so there was always a risk of it getting worse but still little concern. It completely slipped my mind on the medical form as it's been "out of sight out of mind". Even my last physical didn't cause it to surface.

I will be calling my doctor and the surgeon to get their thoughts. I'm not sure surgery will be on the table now that I add SCUBA into the mix or not. Has anyone been in this situation where they have a very minor Hernia and continued diving with doctors orders? Some people probably have minor Hernias and don't realize it. In my case, if it wasn't for my primary physician being extremely thorough, it would have been overlooked. I would have went along never knowing I had this.

If I do need surgery, a delay of about a month isn't so bad.

 

[knotical]

anecdotal: Three or four times in the last forty years, doctors told me I am developing an inguinal hernia. None recommended surgery – yet. Was told that if it ever pops to be prepared to ease it back in, and/or get to an emergency room. Have not avoided any activity (scuba, swimming, hiking, biking, lifting, stoop labor, etc.). Several hundred dives and lots of more strenuous actions later, still no issues. Like you, I rarely think of it.

caveat: Only a physician can properly evaluate you.

my bottom line: I wouldn’t sweat it. Scuba isn’t especially strenuous.

 

[faze]

I'd agree, as long as you have discussed it with your doctor and he is happy then it's simply something to monitor... Suggest you have him sign of on your medical form to cover you and your instructor.

 

[SailNaked]

unfortunately you prob, need a med release,

I think hockey is much more strenous than Scuba, maybe lifting tanks but otherwise i would think the pressure thing works in your favor. no idea.

 

[EbbTideMike]

I'm heading to the doctors on Tuesday. I'll update afterwards. Thanks for the comments.

 

[Darkprincze]

Hey,

just my two cents but it is my understanding that the concern surrounding scuba diving with a hernia is not so much about the strenuous activity making it worse. It is more a concern that a hernia is an air cavity that, in the rare circumstance air could become trapped in it, on expansion at the surface there is a danger that it could become a more serious matter. So possibly worth getting an ok from the doc.

 

[freewillie]

Hey,

just my two cents but it is my understanding that the concern surrounding scuba diving with a hernia is not so much about the strenuous activity making it worse. It is more a concern that a hernia is an air cavity that, in the rare circumstance air could become trapped in it, on expansion at the surface there is a danger that it could become a more serious matter. So possibly worth getting an ok from the doc.

First, and inguinal hernia is a defect in the abdominal wall muscles just under what is referred to as the inguinal ligament. When the patient increases intra-abdominal pressures with a Valsalva (take a deep breath, hold it, the bear down like having a BM) it can force bowel/intestinal loops into and through the defect. If the loop of bowel can be reduced (pushed back into place) then there is no immediate concern. If the bowel cannot be pushed into place and incarcerates (blood supply gets cut off) then you wind up with a segment of dying bowel which becomes a medical emergency and you will need immediate surgery to save your life.

The concern for scuba diving is the lifting. It increases abdominal pressure and increases the risk of bowel entering the hernia. It is unlikely to get stuck and get incarcerated but you never know. You can minimize the risk of herniation by wearing a truss (essentially a large girdle). The need for surgery or the ability to dive with a hernia depends on the size of the defect and size of the hernia. An ultrasound looking for how much bowel enters the hernia during Valsalva would help your doctor make his/her decision. Bottom line is you need talk to your doc for clearance.

Conventional wisdom recommends not diving until the hernia is surgically repaired.

As an open space that communicates to the environment the intestines are not considered a closed space. See the threads on farting in your wetsuit for confirmation!

 

[Duke Dive Medicine]

As an open space that communicates to the environment the intestines are not considered a closed space. See the threads on farting in your wetsuit for confirmation!

... until you're on the tail end of a chamber treatment after having had beans or broccoli or some such thing the night before, and your bladder is beyond capacity, and the operator opens the exhaust valve. Been trying to come up with a word to describe that feeling, without success. In all seriousness though, reverse gut squeeze is a potential concern for divers and is mentioned in the U.S. Navy Diving Manual. If a loop of bowel that pops through an inguinal hernia has gas in it, expansion could be a problem on ascent. Bit of a reach, but still worth mentioning.

 

[freewillie]

... until you're on the tail end of a chamber treatment after having had beans or broccoli or some such thing the night before, and your bladder is beyond capacity, and the operator opens the exhaust valve. Been trying to come up with a word to describe that feeling, without success. In all seriousness though, reverse gut squeeze is a potential concern for divers and is mentioned in the U.S. Navy Diving Manual. If a loop of bowel that pops through an inguinal hernia has gas in it, expansion could be a problem on ascent. Bit of a reach, but still worth mentioning.

True, but the loop needs to be incarcerated first and should produce sx well before the diver starts to ascend. Adhesions would more likely produce partial obstructions and unless the bowel gets closed on two ends (like in an incarcerated hernia) the gas would have a means of decompressing. I have only seen in 15 years one patient who had an incarcerated volvulus and he had prior abdominal surgeries and adhesions. Usually would expect moderate abdominal discomfort and would next expect a diver out of the blue to develop sx during a dive unless something really rare and unusual happens.

 

[Duke Dive Medicine]

It definitely would be rare and unusual, but a diver who periodically has bowel slip down through the inguinal canal could conceivably experience barotrauma if there's air trapped in that loop and he or she ascends in that condition. I've heard of it before; not sure if it was as a hypothetical or a case report (couldn't find anything in a brief lit search).