Inguinal Hernia

An inguinal hernia is a bulge that occurs in your groin region, the area between the lower part of your abdomen and your thigh. Inguinal hernias occur because of a weakening of the muscles in the lower abdomen.

Three layers protect the intestines inside the lower abdomen. The first is a thin membrane called the peritoneum. The second is made up of the abdominal muscles, and the third is your skin.

An inguinal hernia forms when your intestines and the peritoneum push through the muscles and appear as a bulge under your skin. Inguinal hernias are dangerous because they tend to keep getting larger and your intestine can get trapped inside the bulge and lose its blood supply. This is called a strangulated inguinal hernia, and surgery may be needed to correct the problem.

Facts about inguinal hernia

Inguinal hernias may occur on one or both sides of the body and are much more common in men than women. An inguinal hernia can appear at any age. Infants may be born with one that doesn’t show up until they become adults. About five out of every 100 children are born with the condition.

An inguinal hernia can also develop over time if you increase pressure on the walls of your abdominal muscles through activities like straining to go to the bathroom, coughing over a long period, being overweight, or lifting heavy weights. If you have a family history of inguinal hernia, you may be at a higher risk for one. Infants born before their due date are also at higher risk.

Types of inguinal hernia

Inguinal hernias come in two types:

• Indirect inguinal hernia. This is the most common type, and a type of hernia that you may be born with. Although it can occur in men and women, it is much more common in men. This is because the male testicle starts inside the abdomen and has to go down through an opening in the groin area to reach the scrotum (the sac that holds the testicles). If this opening does not close at birth, a hernia develops. In women, this type of hernia can occur if reproductive organs or the small intestine slides into the groin area because of a weakness in the abdominal muscles.

• Direct inguinal hernia. This type of hernia is caused by weakening of your abdominal muscles over time and is more likely to be seen in adults. Direct inguinal hernias occur only in men.

Symptoms

The main symptom is a visible bulge in your groin area. In men, an inguinal hernia may extend down into the scrotum and cause an enlarged scrotum. Small hernias may slide back and forth through the opening in the abdomen and not cause any symptoms. Larger hernias may be massaged back into the abdomen. Symptoms of hernias that go back and forth include:

• A bulge that increases in size when you strain and disappears when you lie down

• Sudden pain in your groin or scrotum when exercising or straining

• A feeling of weakness, pressure, burning, or aching in your groin or scrotum

An inguinal hernia that can't be moved back into the abdomen is called an incarcerated hernia. This is a dangerous situation because the part of your intestine inside the hernia can become strangulated, which is a medical emergency. Symptoms of a strangulated inguinal hernia include:

• Severe pain and redness

• Pain that keeps getting worse

• Fever

• Rapid heart rate

• Nausea and vomiting

Diagnosis

Inguinal hernia is most often diagnosed through a medical history and physical examination. Your doctor will ask you questions about hernia symptoms. During the exam, he or she will look for and feel for a bulge in your groin or scrotal area. You may be asked to stand and cough to make the hernia appear. Inguinal hernias in children may only be seen or felt when the child cries.

Treatment

The way to repair an inguinal hernia is usually with a surgical procedure. In adults with small hernias that don’t cause symptoms, treatment may only be to watch it. Adults with symptoms and most children usually have surgery to prevent the possible complication of a strangulated hernia in the future. An incarcerated or strangulated hernia may need emergency surgery.

There are two main types of surgery for inguinal hernia:

• Open repair. An incision is made through the skin in the groin area. The surgeon moves the hernia back inside the abdomen and closes the abdominal wall with stitches. Sometimes, if the opening is large, the surgeon may use a synthetic (manufactured) mesh to strengthen the closure.

• Laparoscopy. This type of surgery uses a few small incisions and a thin scope with a tiny camera. The surgeon works through the scope to repair the hernia. Synthetic mesh may also be used in laparoscopic hernia surgery. Recovery time after laparoscopy may be shorter than for open repair.

Prevention

There is nothing you can do to prevent an indirect inguinal hernia, the type you are born with. Direct hernias that occur over time may be prevented with these precautions:

• Learn how to lift heavy objects properly.

• Avoid and, when needed, treat constipation to prevent straining when having a bowel movement.

• Get treatment for any persistent cough.

• If you are a man with an enlarged prostate and you strain to pass urine, get treated.

• If you are overweight, lose the extra pounds.

Managing inguinal hernia

If you have had surgery for inguinal hernia, it is important to follow all your doctor's instructions and keep your follow-up appointments. Getting out of bed and walking is an important part of recovery and helps prevent complications. You can help to keep an inguinal hernia from coming back after surgery by avoiding heavy lifting and other strenuous activity. Ask your doctor what types of activities are safe and when you can return to work.

If you have a small hernia that is being watched or a repaired hernia, take steps to avoid becoming constipated. Eat lots of fiber, drink plenty of fluids, exercise, and go to the bathroom when you feel the urge.

Call your doctor if your inguinal hernia symptoms get worse, and always call right away if:

• You have a painful bulge that can't be pushed back inside.

• You have increasing pain, swelling, or redness.

• You have nausea, fever, or vomiting along with hernia pain.