Dear Doctor,

I was told that I would never get hernia if I got circumcised, but the condition reappeared eight months after the procedure. Was I misled? James

Dear James,

Circumcision is a process involving removal of the foreskin of the penis. It has many advantages. It improves hygiene of the region, protects against sexually transmitted diseases including HIV, prevents local inflammation as in phimosis and also protects against cancer of this part. However it does not prevent hernia. Somebody has definitely misled you. Hernia occurs due to softening of muscle tone and protrusion of bowels from a small opening, in this case in the groin.

There are several underlying causes of hernia. Weakening of the abdominal muscles as after trauma or some surgery is one of them. It can also be due to obesity. Increase in the abdominal volume due to fat tends to weaken the muscles and pushes out the bowels. Lifting heavy weights, chronic cough, chronic constipation, e.t.c. anything which strains the muscles of the abdomen can result in hernia.

But infection certainly does not cause it. Treatment is only by support or surgery.

Prevention of hernia consists of abdominal exercises to tone up the weak muscles as after surgery or some trauma. One should avoid chronic constipation and cough. If present, it should be treated as soon as possible. Avoid lifting or pushing heavy weights. If obese try to reduce extra weight. If hernia has already developed, one should try to prevent it from increasing. The measures useful for prevention are beneficial here as well. A support put below affected site, particularly while standing for long hours or walking long distances prevents hernia from increasing. Special belts are available for this purpose. Surgery can also be avoided by following these measures of precaution and regular exercise. However one should be cautious as well. There is a potential risk of the intestines getting strangulated in the opening, which is a need for urgent surgery. If anyone having inguinal hernia suddenly develops severe abdominal pain and vomiting with constipation, there is need for urgent medical consultation.