Ischial Hernia

　　The pelvis is a strong bony ring formed by the sacrum, coccyx, and hip bones on both sides through bone joints. The sacrotuberous ligament, sacrospinous ligament, and ischial greater incisure form the ischial greater foramen, and the ischial lesser incisure forms the ischial lesser foramen. The superior boundary and front of the ischial greater foramen are the hip bone, the back is the sacrotuberous ligament, and the inferior boundary is the sacrospinous ligament. Through this foramen, there is the piriformis muscle, above which there are superior gluteal nerves and vessels passing through, and below which there are sciatic nerves, inferior gluteal nerves, pudendal nerves, and vessels passing through. The ischial lesser foramen is in front of the ischial tuberosity, the superior boundary is the ischial spine and sacrospinous ligament, and the back is the sacrotuberous ligament. Through this foramen, there are pudendal nerves and vessels, as well as the obturator internus tendon.

　　When there is a weakened area around the ischial great foramen or small foramen due to paralysis or injury, the organs in the lower abdomen and pelvis can herniate through this area when abdominal pressure is increased.

　　This disease may be complicated by incarceration of abdominal contents, and may cause intestinal strangulation and necrosis.

　　Patients with intestinal strangulation often have fever, persistent abdominal pain, and a mass in the abdomen after gastrointestinal decompression. Laboratory tests show significant leukocytosis, metabolic acidosis, elevated lactic dehydrogenase and amylase. X-ray examination is not sensitive, but it may show coffee bean sign (a single gas-filled cavity separated by a wide and dense band of edematous intestine), pseudotumor sign (intestinal loops filled with fluid, completely closed) or a single loop fixed in three different planes.

　　Intestinal necrosis is caused by ischemic necrosis of the intestine due to adhesion and torsion, which is the most serious complication of intestinal adhesion.

　　Common symptoms include: abdominal discomfort, pressure pain in the ischial foramen area, sciatic nerve pain, etc.

　　1. Pressure pain may occur in the ischial foramen area, and sometimes accompanied by pain in the superior and inferior gluteal or sciatic nerves.

　　2. There is a mass in the gluteal sulcus (i.e., the skin fold under the buttocks), which varies in size with body position. The mass may disappear in the supine position of the pelvis, and there may be a sensation of impact or the appearance of a mass when abdominal pressure is increased.

　　3. Mild abdominal discomfort is common, and symptoms of mechanical intestinal obstruction may occur when the contents are incarcerated.

　　Pay attention to dietary and living habits. Pay attention to physical exercise, moderate diet, regular living, quit smoking and limit alcohol, strengthen physical fitness, avoid the invasion of wind and cold, and avoid or reduce the opportunity for infection and disease.

　　Routine examinations include:Abdominal MRI examination, abdominal fluoroscopy, abdominal film, abdominal CT, etc. When clinical complications occur, white blood cell count and other indicators can increase.

　　1. Abdominal X-ray film:Low-pressure air-filled small intestinal loops and cup-shaped images.

　　2. Ultrasound of the mass:Abnormal intestinal reflex waves can be found.

　　I. Suitable diet for ischial hernia patients

　　1. Drink more water, eat more fruits and vegetables:Patients should increase fluid intake and eat more fruits, vegetables, nuts, seeds, grains, and other beneficial foods.

　　2. Eat more oats:After chopping oat grass, soaking it in warm water for 2 minutes and filtering it, it is a supplement. Drink 1-4 grams a day. To relieve skin itching, wrap oat flakes in fine cotton cloth and hang them under the showerhead, bathe with the water passed through the oat flakes.

　　3. Nutrient supplementation

　　(1) Phosphatidylcholine dosage according to product labeling, taken with meals, it can protect and repair nerves.

　　(2) Comprehensive vitamins and minerals containing vitamin A and thiamine (B1), neural inflammation is often the first sign of malnutrition, and patients with neuritis often lack thiamine. Therefore, supplementing the above vitamins helps prevent the occurrence and development of the disease.

　　(3) Vitamin B complex plus vitamin B1: more than 100 milligrams per day, injection is the best. Patients with neuralgia often lack vitamin B.

　　II. Dietary taboos for ischial hernia patients

　　Avoid stimulants such as coffee and soda. Ischial hernia patients should avoid smoking cigarettes.

　　Surgical removal of the hernia sac and closure of the sacral ischial foramen is the only effective treatment.

　　1. Surgery via the abdominal approach

　　Suitable for strangulated hernia, the advantage of this method is good exposure, no risk of damaging the blood vessels and nerves of the buttocks, and can remove the hernia sac and repair the hernia opening.

　　2. Surgery via the gluteal approach

　　Suitable for reducible hernia, this method has a greater trauma, easily damages the blood vessels and nerves of the buttocks, and cannot be used for strangulated hernia.