Dr. Keith Roach

DEAR DR. ROACH: Are there any nonsurgical ways to repair an inguinal hernia, like exercise, diet or walking? I believe I caught mine early on. The mesh does not seem promising. — R.K.
ANSWER: An inguinal hernia is a defect in the abdominal wall. In men, the hernias usually start in the internal inguinal ring, where male structures descended during fetal development. In some people, the inguinal ring doesn’t close all the way, and that potential opening stays asymptomatic for years, sometimes many years.
These small defects sometimes stretch over time, allowing the abdominal contents, such as the intestines, to come through the defect and out of the abdomen. Usually, they will go back into the abdomen where they belong, but they can get stuck outside of the abdomen. Swelling of the area can make the loop of intestines unable to get back in at all, which is when a surgery becomes life-saving.
Because the hernia is an anatomical structure, it absolutely cannot be cured without an anatomical solution — that is, surgery. Imagine you have a seam in a shirt that is partially ripped, leaving you with a hole. You can’t fix it unless you sew it up. But not everyone with an inguinal hernia needs surgery.
Hernias should be repaired if they’re symptomatic; otherwise, many can be watched. A healthy diet and exercise like regular walking is good for everyone, but it won’t help the hernia. Avoiding constipation reduces abdominal pressure and reduces risk of the intestines going through the hernia. Light weightlifting is usually OK, but heavy weightlifting isn’t prudent.
Young and healthy people benefit most from early repair. With the exception of my patients who aren’t good candidates for surgery due to serious medical problems, I usuallly refer my patients to a surgeon to discuss the risks and benefits.
Mesh material and repair techniques are better than they were, and I think mesh has an undeservedly bad reputation (sometimes based on expired or fraudulent mesh material). But I ultimately defer patients to my surgical colleagues regarding choice of surgery. There are certainly mesh-free techniques for those who insist on them.
DEAR DR. ROACH: I am curious about the bee venom gel used to treat arthritis. Can you comment? — S.P.O.
ANSWER: As much as I would like this to be false, there are no medication treatments that can reverse or stop the progression of osteoarthritis. This includes prescription and nonprescription treatments. I understand the appeal that something really dangerous, like bee venom, could be used to treat a serious condition. Unfortunately, the studies I found did not show any benefit in improving symptoms compared to a placebo. Furthermore, there does seem to be a unique form of arthritis in beekeepers, thought to be related to the venom.
Topical treatments that may help include topical diclofenac and capsaicin, but these tend to only work in joints where the cream or gel can permeate, like the hands or knees. The hip joint is too deep for topical treatments to reach.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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