I feel a lot of pain below my belly. It’s like a stone piercing right through my stomach. Sometimes I take warm water to relieve the pain but nothing seems capable of stopping these painful pulses that come in intervals every few minutes,” laments 44-year-old Richard Karugarama. 

He lifts up his shirt to expose his belly. The veins on it are stretched with a red patch similar to that of a skin bruised by friction. 

Karugarama is suffering from hernia, a condition that affects more people than HIV in rural areas.

Dr Osee Sebatunzi, the director of Kibagabaga Hospital, hernia occurs when there is a weakness or hole in the muscular wall that usually keeps abdominal organs in place. This defect allows organs and tissues to push through, or herniate, producing a bulge.

It is a painful condition which left untreated may hinder the patient’s ability to live a normal life. The pain may also adversely affect the patient’s appetite.

Judith Umutesi, Karugarama’s sister, says, "He is uncomfortable and lately we have to force him to eat something at least. Right now he cannot even bend to pick up something from the floor.”

A framed portrait of Karugarama hangs on the wall. He is much younger, late twenties maybe. It is difficult to reconcile the smiling, healthy looking man in the picture with the sad, withered shadow that he is today.

Eric Birikano, a long-time friend of Karugarama says, "It’s difficult to identify him at first sight nowadays.”

Karugarama is scheduled for surgery in a few weekss.

Prevalence of hernia

According to Hernia International, there is an estimated 6.3 million untreated inguinal hernias in sub-Saharan Africa. The lifetime risk for hernia of men is 27 per cent and for women 3 per cent.  

In rural areas, more men suffer from hernia than HIV.

Also, a report from a German-British Mission in Rwanda in February 2013 indicates that 95 operations were carried out on 78 patients within five days in Nyamata and Remera-Rukoma hospitals. A total of 72 inguinal hernias were operated, including 20 in children and 17 inguinoscrotal hernias. 

There was only one case of an incarcerated hernia with chronic abscess formation that required a need for an emergent resection of the small bowel. Ten ventral hernias that include; epigastric, umbilical and incisional hernias as well as 14 hydroceles were operated.  

How hernia manifests 

Dr Sebatunzi says hernias can occur in different locations of the body. These areas include; the groin, where a femoral hernia gives a bulge just below the groin. 

This is more common in women while an inguinal hernia is a bulge in the groin that may reach the scrotum. Inguinal hernia is more common in men.

"Hiatus or hiatal hernia happens in the upper part of the stomach pushing upwards and out of the abdominal cavity and into the chest cavity via an opening in the diaphragm,” he says. 

Causes of hernia

According to the African Journal of integrated health, there is usually no obvious reason for a hernia, except for an incisional hernia being a complication of abdominal surgery. Risk of hernia increases with age and is more common in men than women

A hernia can be congenital (present at birth) or develop in children with a weakness in their abdominal wall.

However, certain activities and medical problems raise pressure on the abdominal wall and can lead to a hernia, including straining on the toilet. For example, because of long-term constipation, long-term cough, enlarged prostate, straining to urinate, being overweight or obese, abdominal fluid, lifting heavy items, poor nutrition, smoking, physical exertion, undescended testicles. 

Health experts estimate that one in every 2,000 to 3,000 live births have this deformity, with up to half of these infants failing to survive.

Preventing hernia

Mayo Clinic indicates that you cannot prevent the congenital defect that makes you susceptible to an inguinal hernia. You can do things to reduce strain on your abdominal muscles and tissues.

Maintain a healthy weight. Talk to your doctor about the best exercise and diet plan for you. 

Emphasize high-fibre foods. Fruits, vegetables and whole grains contain fibre that can help prevent constipation and straining. 

Lift heavy objects carefully or avoid heavy lifting altogether. If you must lift something heavy, always bend from your knees and not your waist. 

Stop smoking. Besides its role in many serious diseases, smoking often causes a chronic cough that can lead to or aggravate an inguinal hernia. 

Avoid relying on a truss. Wearing a supportive garment designed to keep hernias in place (hernia truss) doesn’t correct the underlying problem or help prevent complications. The doctor might recommend a hernia truss for a short time before surgery to help you feel more comfortable, but the truss isn’t a replacement for surgery. 

The ultimate solutions to clear up a hernia are surgical procedures.