# Abstract

 

## Background: Hernia is an abnormal protrusion of an organ or tissue through a defect in its surrounding walls which most commonly involves the abdominal wall, particularly the inguinal region. The treatment options for hernia ranges from simple exercises to modern surgeries. The effect of yoga therapy is not scientifically examined for reversible inguinal hernia and hence this study is undertaken with the aim to test the effect of selected asanas in reversible inguinal hernia. 

## Materials and Methods: A quasi experimental trail of 19 males through consecutive sampling was done with selected asanas for three months and the outcome was measured by a questionnaire focusing on pain, aggravating factors, relieving factors and frequency of occurrence of symptoms of hernia. 

## Results: The pre and post interventional data were compared statistically and found significant reduction of symptoms with *P*≤0.001 in pain, frequency of occurrence and aggravating factors. The relieving factors showed significant increase with *P*≤0.001. 

## Conclusion: Yoga therapy with selected asanas is effective in the treatment of reversible inguinal hernia. # Data analysis and results The pre-intervention and post-intervention assessments were carried out by using the hernia questionnaire designed for this study. This includes the details about intensity of pain, relieving factors, aggravating factors and frequency of occurrence in last two weeks which were used for analysis along with the general information. Schedule method of data collection was used. Data analysis including descriptive analysis and inferential analysis were done by using computerized software (SPSS-11.5) Statistical package for social sciences, Version 11.5 for windows. # Descriptive statistics Descriptive statistics includes measures of central tendency specifically the median and measures of dispersion namely minimum, maximum, first quartile, third quartile and quartile deviation for all the studied dependent variables before and after intervention. # Inferential statistics Inferential statistics of significance testing was done by using Wilcoxon signed-rank test with asymptomatic two tailed z test for paired observations i.e. before and after intervention for all studied variables. # General information Nineteen subjects participated in the study. General information like age, side of bulge, first occurrence of symptoms, activity during first occurrence and effect of rest were also recorded for all participants as applicable. # Age group Age of the subjects ranged from 24 to 46 years, with the mean of 36.26 years and standard deviation of 7.43 years. # Side involved Out of nineteen subjects studied, ten presented with left side hernia, eight with right side hernia and remaining one presented with hernia on both sides. # First occurrence of the problem Out of nineteen studied, eleven subjects were not able to retrieve any detail about first occurrence of the problem. For six subjects, the problem occurred during activity and taking rest relieved it. Remaining two was not clear about the exact activity during occurrence, but they gave the approximate duration of their problem. For all the subjects, there was no history of previous hernia. # Pain Intensity of pain was measured with numeric pain rating scale starting from zero to ten where zero indicates no pain and ten indicates maximum tolerable pain, which was a part of the hernia questionnaire. Pain intensity before intervention ranged from three to eight with median of six and quartile deviation of one. Pain intensity after intervention was from zero to three with median of one and quartile deviation of one \[[Table 1](#), [Figure 1](#)\]. The z value of Wilcoxon signed-rank test which is equal to --3.864 with *P* value\<0.001 denotes that there is statistically significant reduction in pain after intervention. ::::table-wrap

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Data analysis for pain before and after intervention
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![](<>):::: <figure> <p><img src="" /></p> <figcaption>Pre-treatment and post-treatment values of pain, aggravating factors, relieving factors and frequency of occurrence of symptoms. Pain - Maximum score 10; Agg. fac. (aggravating factors) aximum score 5; Rel. fac. (relieving factors) aximum score 3; Freq. (frequency) epending on individual</figcaption> </figure> # Aggravating factors The participants were asked which of the five most common activities exacerbate the problem. The activities are exercise/walking, bowel movement, bladder activity, lifting and coughing/sneezing. Out of nineteen participated, 9 showed the presence of three activities, 6 showed the presence of four activities and remaining 4 showed the presence of all five activities before intervention. After three months of intervention with selected yogasanas, 14 subjects presented with the presence of two activities to increase the problem, 1 presented with one activity and the remaining 4 subjects presented with no activity to increase the problem out of the five commonly found activities. Wilcoxon signed-rank test z value of --3.875 with *P*\<0.001 denotes that there is statistically significant reduction in aggravating factors after yogic practice \[[Table 2](#), [Figure 1](#)\]. ::::table-wrap
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Data analysis for aggravating factors before and after intervention
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![](<>):::: # Reliving factors The symptoms of inguinal hernia may be relieved by three activities which reduce the intra-abdominal pressure viz. sleeping, lying down and sitting which were also asked for its presence. Out of nineteen subjects participated, seven showed the presence of one relieving factor, another seven showed the presence of two relieving factors and the remaining five showed the presence of al three relieving factors before intervention. All nineteen subjects showed the presence of all three relieving factors after intervention \[Table [Table 3](#), [Figure 1](#)\]. ::::table-wrap
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Data analysis for reliving factors before and after intervention
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![](<>):::: The z value of Wilcoxon signed-rank test which is equal to 3.391 with *P*\<0.001 denotes that there is statistically significant increase in relieving factors of inguinal hernia after intervention. # Frequency of occurrence Frequency of occurrence of the hernia i.e. number of times in last two weeks were also analyzed before and after intervention. The median for frequency of occurrence before intervention is twelve times with range from nine to fourteen times per two weeks. Frequency of occurrence reduced from zero to six times with median of two times after practise of yoga. The z value of Wilcoxon signed-rank test which is equal to --3.835 with *P* value\<0.001 denotes that there is statistically significant reduction in frequency of occurrence of symptoms of hernia after intervention \[[Table 4](#), [Figure 1](#)\]. ::::table-wrap
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Data analysis for frequency of occurrence of hernial bulge before and
after intervention
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Extracted trial result:
Outcome: aggravating factors in reversible inguinal hernia (continuous)
Intervention: post-Yoga
Comparator: pre-Yoga
Intervention group size: 19
Comparator group size: 19
Notes: Only median and range is given.