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Inguinal Hernia

An inguinal hernia happens when soft tissue bulges through a weakened abdominal wall and into the groin area. Some hernias aren’t painful, but some cause pain that gets worse when lifting heavy objects or coughing. Surgery with hernia mesh is the main treatment for an inguinal hernia.

Last Modified: May 25, 2021
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What Is an Inguinal Hernia?

Inguinal hernias are the most common type of hernia. These hernias occur in the lower abdominal wall in two passages, called inguinal canals, on either side of the groin.

Fat or soft tissue, usually a part of the intestine, bulges through an opening in the abdominal wall.

fact
Men older than age 40 are more likely to get a groin hernia than women are.

Inguinal hernias are more common in men. About 27 percent of men and 3 percent of women will have an inguinal hernia in their lifetime, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

Inguinal hernias don’t get better over time and can get worse if left untreated.

Sometimes a doctor can gently massage a hernia back in place. If the hernia is more serious, doctors have to perform hernia repair surgery.

Inguinal Hernia Symptoms

When hernias first start, they often don’t have symptoms. As inguinal hernias get worse, the first symptoms are pain and a noticeable bulge under the skin in the groin area.

Symptoms are slightly different for men and women, according to Johns Hopkins Medicine. Inguinal hernia pain may be worse for men — especially when lifting or straining.

Inguinal hernia symptoms in men include:
  • A bulge that can be felt or seen that’s more obvious when standing upright
  • Pain in the groin area that gets worse with pushing, straining, bending over, coughing and lifting
  • Pressure or weakness in the groin
  • A feeling of tugging in the scrotum close to the testicles
  • Swelling around the testicles
Inguinal hernia symptoms in women include:
  • Sharp or aching groin pain
  • Burning sensation
  • Visible bulge in the groin, but not all women have bulges
  • Pain and discomfort that increases with physical activity

Emergency Symptoms

If you have symptoms of a strangulated hernia, seek medical attention right away. A strangulated hernia is a life-threatening condition that happens when part of the intestine pushes through the abdominal wall, gets clamped shut and loses blood supply.

Strangulated hernia symptoms include:
  • A bulge that suddenly gets larger
  • Fever
  • Extreme redness or tenderness in the hernia area
  • Severe or sudden pain
  • Signs of intestinal obstruction such as bloating, nausea, vomiting, inability to pass gas and abdominal pain
  • Rapid heart rate

Causes & Risk Factors

Inguinal hernias are caused by a weak area in the connective tissue and muscles of the lower abdominal wall, specifically in the inguinal canal.

Some people are born with a defect in the abdominal wall that leads to a hernia later in life. Others develop weakened abdominal walls later in life.

Potential risk factors for developing an inguinal hernia, include:
  • Obesity
  • Repeated heavy lifting
  • Standing or walking for many hours for work
  • Chronic coughing
  • Straining to defecate or urinate
  • Chronic constipation
  • Fluid buildup in the abdomen (ascites)
  • Peritoneal dialysis
  • Connective tissue disorders (some cancers cancer, lupus, scleroderma and other disorders)
  • Connective tissue that is weaker than normal
  • Genes that increase risk of inguinal hernia
  • Pregnancy
  • Being white, male and older

Types of Inguinal Hernias

There are two types of inguinal hernias: Indirect and direct.

Indirect Inguinal Hernia

Birth defects in the lower abdominal wall cause indirect inguinal hernias.

Before babies are born they have openings inside the abdomen that lead to the inguinal canals on either side of the groin. Normally, these openings close before birth. When they don’t close, contents of the abdomen may bulge through, causing a hernia.

Some people with the birth defect don’t have a hernia until many years later. Premature babies are at increased risk from indirect inguinal hernias.

Direct Inguinal Hernia

Direct inguinal hernias develop later in life. They are caused by a weak area in the inguinal canal wall that slowly forms over time or by repeated straining or heavy lifting. Contents of the abdomen bulge out of the weak spot and cause a hernia.

Women and children don’t often suffer from direct inguinal hernias. These hernias primarily occur in adult men.

Incarcerated or Strangulated Hernias

When indirect or direct hernias become stuck in the groin and cannot be pushed back, they become incarcerated. Incarcerated hernias can become strangulated hernias that cut off the blood supply to the small intestine.

Strangulated hernias are medical emergencies.

Diagnosing an Inguinal Hernia

Medical providers diagnose inguinal hernias by performing physical examinations and abdominal imaging tests such as ultrasounds, X-rays, CT scans or MRIs.

Often, doctors can diagnose inguinal hernias in men from just a physical examination. Women may require imaging tests to confirm the presence of a hernia, according to a 2020 article by Dr. Amer Shakil and colleagues from the University of Texas Southwestern Medical Center.

Treatment

The type of treatment for an inguinal hernia depends on whether or not it’s causing symptoms and how serious the symptoms are.

Hernias don’t just go away on their own and may get worse over time without treatment. Hernia complications include painful pressure on surrounding tissues, swelling and incarceration or strangulation of the hernia.

Hundreds of thousands of people have surgery to treat their hernias each year. Most people recover quickly and can return to normal activities.

“Overall, inguinal hernias are associated with a good prognosis.”
Drs. Mohamad Hammoud and Jeffrey Gerken
Source: StatPearls

Inguinal Hernia Surgery

Patients with symptomatic hernias require inguinal hernia surgery. The type of surgery a doctor recommends depends on the patient’s age and general health as well as the size of the hernia.

Hernia repair surgery may be done with or without hernia mesh. Most doctors use mesh because there is less chance the hernia will come back. However, some people may suffer hernia mesh failure that causes complications. This requires revision surgery to remove and replace failed mesh.

The two main types of surgery are open and laparoscopic.

Open Hernia Surgery

To perform open hernia surgery, doctors manually make a cut in the groin to repair the hernia. At this point, the doctor may use a patient’s own tissue and stitches or surgical mesh to repair the weak spot in the abdominal wall.

Patients typically receive local anesthesia for open hernia repair surgery, though some may receive spinal blocks or general anesthesia.

Laparoscopic Hernia Surgery

Laparoscopic hernia surgery is a minimally invasive technique where the surgeon makes several small cuts in your lower abdomen. They insert special tools through these small cuts to repair the hernia with a piece of mesh.

Patients most often receive general anesthesia for this procedure. It’s usually more expensive and takes longer than open repair, but recovery time may be shorter because the surgeon cuts through fewer muscles.

Inguinal Hernia Surgery Complications

In general, inguinal hernia surgery is quite safe, according to the National Institute of Diabetes and Digestive and Kidney Diseases. But some people may have complications after surgery.

Surgery complications include:
  • Difficulty urinating
  • Infection
  • Buildup of fluid or blood at the surgery site
  • Severe or chronic pain
  • Hernia recurrence, which may require one or more surgery to repair
  • Rarely, damage to blood vessels or organs
  • Hernia mesh failure (bowel blockages, mesh migration, nerve entrapment, mesh infection and other symptoms)

A few types of hernia mesh have been recalled after causing problems. Some people who suffered complications after their mesh failed filed hernia mesh lawsuits against manufacturers claiming the mesh was defective.

Lawsuit Information
Learn more about the lawsuits being filed after some patients experienced hernia mesh failure and suffered serious side effects.
View Lawsuits

Do’s and Don’ts After Inguinal Hernia Surgery

Most people who have hernia surgery can go home the same day. The average inguinal surgery recovery time is about three to six weeks.

After three weeks patients may return to light activities and after six weeks, they may do more strenuous exercise.

These are general guidelines and each person is different. Talk to your doctor about your specific recovery plan.

What to do after inguinal hernia surgery:
  • DO follow all your doctor’s instructions for a good recovery
  • DO rest whenever you feel tired
  • DO take gentle walks to help blood flow and speed up healing
  • DO drink plenty of water
  • DO ask your doctor about a mild stool softener or mild laxative to avoid straining and constipation
What not to do after inguinal hernia surgery:
  • DON’T overexert yourself
  • DON’T do strenuous exercise for at least six weeks
  • DON’T drive for at least two weeks or have sexual intercourse for at least three weeks
  • DON’T do anything that causes pain
  • DON’T ignore symptoms such as fever, swelling around the incision site, pain that doesn’t go away with medication, or inability to pass gas or stools — contact your doctor

Inguinal Hernia Treatment without Surgery

If the hernia is relatively minor and isn’t causing symptoms, doctors may recommend watchful waiting. This means the doctor will keep an eye on the hernia to see if it gets worse before pursuing more treatment.

For some hernias with minor symptoms, a doctor may be able to gently massage the bulge back into the abdominal wall.

Doctors may recommend compression underwear or belts to support weakened muscles and relieve the discomfort of a hernia

Prevention

Birth defects that cause indirect inguinal hernias can’t be prevented, but adults can take steps to reduce their risk for developing an inguinal hernia later in life. These steps involve limiting the strain on abdominal muscles.

Tips for preventing inguinal hernias include:
  • Talk to your doctor about developing a diet and exercise plan that helps you maintain a healthy weight.
  • Eat plenty of vegetables, fruits and whole grains with fiber that can help prevent constipation and straining.
  • Be careful when lifting heavy objects and bend from your knees not your waist.
  • Do exercises that keep abdominal muscles strong.
  • Quit smoking because it can cause a chronic cough that increases the risk of developing an inguinal hernia.
Please seek the advice of a medical professional before making health care decisions.