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.
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.
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.
- 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
- 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
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.
- A bulge that suddenly gets larger
- 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.
- 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
- 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.
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.”
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.
- Difficulty urinating
- 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.
Recurrence was the most common complication before the hernia mesh’s invention. Research is mixed on how long a mesh hernia repair will last. A 2022 study followed 100 patients for ten years after a ventral abdominal hernia repair.
No recurrence was recorded after three years, while about 10% had a recurrence after roughly eight years. Two patients had a central breakdown of the mesh at about seven years. Mesh had stretched across the defect by an average of 21%. Mechanical testing showed that the mesh lost its elasticity at low forces.
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.
- 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
- 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
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.
- 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.
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