An inguinal hernia occurs when part of the abdominal cavity pushes into a part of the body called the inguinal canal. The abdominal cavity is the large hollow space in the body that contains many important organs, such as the stomach and liver.
There are two inguinal canals in the body, one on either side of the groin. Different structures of the body pass through the inguinal canal, depending on the person’s gender.
In men, the spermatic cord passes through the canal and connects to the testicles. In women, round ligaments that support the uterus pass through the canal.
An inguinal hernia usually affects either the small intestine or the fatty tissue in the abdomen.
An indirect inguinal hernia happens because a person has a pre-existing weakness, or they may be born with it. A direct inguinal hernia occurs only in adults. It develops over time due to repeated stress on the abdominal muscles.
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), around 25 percent of males will develop an inguinal hernia at some point in their lives, but only 2 percent of women.
Direct inguinal hernias tend to occur later in life as the abdominal muscles weaken with age. However, inguinal hernias can happen at any age. Indirect hernias tend to be found in young children and people under the age of 30 years.
People are more likely to develop an inguinal hernia if other members of their family have had a hernia. Smoking cigarettes also increases the risk.
The abdominal muscles often weaken with age. An individual cannot prevent this, but maintaining a healthy weight and avoiding cigarette use can help prevent inguinal hernias from occurring or reoccurring.
Avoiding heavy lifting and using the legs when lifting objects (as opposed to the back) can help to reduce stress on the abdominal wall.
Preventing constipation and not straining when using the bathroom can also help inguinal hernias from worsening or reoccurring.
The most common symptom to appear first is a small bulge in the groin. This bulge can be on one or both sides of the groin. It often goes away when lying down.
Other symptoms may include:
- a swollen scrotum
- weakness, heaviness, or pain in the groin
- a burning or pinching sensation in the groin
It is common for pain to improve with rest and get worse when lifting something heavy, coughing, or straining.
Two main complications can occur with an inguinal hernia:
An incarcerated bowel is stuck in the inguinal canal. It is not possible for a healthcare provider to ease the stuck portion of bowel or fat back into the abdominal cavity.
Without treatment, an incarcerated inguinal hernia can become a strangulated hernia. When this happens, blood flow to the tissue can be cut off. This can cause the small intestine to die. It is an emergency and a life-threatening situation.
Symptoms of either incarceration or strangulation include:
- extreme pain at the site of the bulge that does not improve with rest or other measures
- nausea, vomiting, or fever
- inability to move the bowels or pass gas
Anyone who has these symptoms should seek emergency care immediately. A hernia that is strangulated will need emergency surgical repair.
If someone suspects that they have a hernia, they should see their healthcare provider. The doctor will carry out a physical exam and take a family and medical history.
Usually, this is enough to diagnose a hernia.
A doctor will sometimes order additional testing to rule out other medical conditions or complications.
Tests that can help to confirm the diagnosis include:
The only treatment for an inguinal hernia is surgical repair of the abdominal wall.
A doctor will decide whether surgery is necessary, depending on how severe the symptoms are.
If there is no severe pain or other medical problem related to the hernia, the doctor may suggest a “watch and wait” approach. In this case, they will ask the person to report any worsening or new symptoms as soon as they occur.
If the doctor recommends surgery, there are two different approaches:
Open surgery: The surgeon makes an incision in the abdomen and pushes the hernia back into the abdomen. They then repair the hole.
Laparoscopic surgery: The surgeon makes several small incisions and inserts instruments into the abdomen. They then use those instruments to repair the hernia.
The doctor will usually use a mesh to repair the site, but sometimes they use stitches.
Each procedure has advantages and disadvantages.
Both types of surgery may not be suitable for some people. The surgeon will help the person to make the best decision.
Recovery will depend on the type of procedure and the severity and size of the hernia.
There may be some discomfort or pain in the days following surgery, but the recovery time after laparoscopic surgery tends to be easier and shorter than recovery from open surgery.
A person can usually go home on the same day after surgery, but they should have an adult with them for at least 24 hours. They should arrange for someone to drive them home.
The individual should talk to their doctor about their options for managing pain.
After surgery, the person should check for any unwanted changes that might indicate that an infection is developing.
- worsening pain around the incision
The doctor will let the person know when they will be able to return to work. It will depend on the individual. If the person’s job does not involve lifting, they can probably return after 1–2 weeks, according to a review published in 2012, but other health factors may also play a role.
They will also give specific instructions based on each case. This usually includes avoiding heavy lifting and physical activity for a few weeks.
Pain and numbness may develop around the groin if the surgeon damages a nerve during the procedure. One in 10 people will continue to experience persistent pain after surgery.
Treatment with pain relief medication or drugs to block the nerve may help. Sometimes, further surgery is necessary.
Hernias are relatively common, especially for older men, and surgery is a routine procedure.
Doctors in the United States carry out around 800,000 repairs every year, although surgery is not always necessary.
People should speak with their doctor about any concerns and discuss all the available options with them.
If the individual and their doctor decide that surgery is not the best option, the person should follow up with the doctor as they recommend. They must be ready to report any symptoms that are new or getting worse.
There are several different types of hernias, depending on what part of the body it affects:
Incisional: A part of the body extends through a surgical wound that has not yet fully closed.
Femoral: The intestines or abdominal fat pushes into the femoral canal, which is at the top of the inner thigh or in the groin. These types of hernia are less common than inguinal hernias and tend to happen more often in women. To learn more about a femoral hernia, click here.
Umbilical: The bowel or fatty tissue extends through the belly button, usually in babies. Click here to learn more.
Hiatal: The stomach pushes through the hiatus, a small opening in the diaphragm at the top of the abdomen. Click here to find out more.