Inguinal hernia

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at May 31, 2016
StartDiseasesInguinal hernia

Inguinal hernias are a bulge in the abdominal wall, pushing through the inguinal canal. Inguinal hernias are more common in males, as some men are born with a weakness of the inguinal canal. Inguinal hernias are sometimes present in newborns and children. This type of hernia is also called a groin hernia.

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Definition & Facts

Inguinal hernias are fairly common and occur when the muscle of the abdomen becomes weak or torn. The tear will allow either the omentum, which is the membrane lining the abdominal cavity, or part of the intestine to protrude through the muscle. There are over 500,000 diagnoses every year of inguinal hernia in the United States.

Inguinal hernias can be quite painful, especially when bending to lift a heavy object or even when just sneezing or coughing. While an inguinal hernia isn't dangerous in of itself, it will not heal on its own and can lead to life-threatening complications if left untreated.

Symptoms & Complaints

Inguinal hernias don't always cause symptoms, and many patients never even know they have a hernia until their physician discovers it when performing a routine physical examination. However, the bulge created by an inguinal hernia is typically very noticeable. The protrusion is usually more obvious when the patient is standing upright, especially when straining. Inguinal hernia symptoms can include: 

Sometimes the omentum or a part of the intestines can become trapped, or incarcerated in the abdominal wall. This can lead to a strangulated hernia where the blood supply to the intestines is blocked. If left untreated, a strangulated inguinal hernia can be life-threatening. Symptoms of strangulated inguinal hernia can include: 

Causes

In men, inguinal hernias occur in the inguinal canal, where the spermatic cord enters the scrotum. In women, hernias can occur where the uterus connects to the pubic bone. Inguinal hernias sometimes have no apparent cause. In male fetuses, the testicles develop inside the abdomen and travel down into the scrotum through the inguinal canal. In some abnormal cases, the inguinal canal doesn't close completely after birth, setting the stage for an inguinal hernia.

Due to the lack of testicles, there is much less chance of this problem in females. However, weaknesses in the abdominal wall can also occur anytime after giving birth, from an injury, or from a surgical procedure. Regardless of a preexisting weakness, placing extreme pressure on the abdomen from heavy lifting, being excessively overweight, or pregnancy can cause an inguinal hernia.

Other causes can include excessive straining during bowel movements or urination and coughing or sneezing. Fluid building up in the abdomen, known as ascites, can also cause a hernia. Inguinal hernias can develop late in life as the result of muscles weakness or deterioration from the natural aging process. 

Diagnosis & Tests

In most cases, a digital physical exam, an examination the doctor performs with the fingers, is all that is required to diagnose an inguinal hernia. During the exam, the physician will ask about signs and symptoms, such as when the pain is most noticeable, and check for a bulge or protrusion in the groin area.

Because standing upright and coughing will usually make an inguinal hernia more conspicuous, the doctor will have the patient cough and strain while standing upright while the doctor applies pressure to the area with his or her fingertips.

Except in cases that aren't obvious, tests such as X-rays, CT scans, MRIs, and ultrasounds are not typically needed. However, a urinalysis, or urine test, may be done to rule out the possibility of a urinary tract infection.

Treatment & Therapy

If the hernia isn't too large and isn't causing a great deal of discomfort, the physician may suggest a watchful waiting approach. Conversely, if the inguinal hernia is large, causing a great deal of pain or showing any signs of strangulation or other dangerous complications, the doctor will recommend hernia repair surgery.

There are two types of surgical procedures for hernias: open hernia repair and laparoscopic surgery. Open hernia repair requires a surgeon to makes an incision in the groin and push the omentum or intestine back inside the abdomen. The surgeon then stitches the muscle back together. The area is sometimes reinforced with a synthetic mesh. Recovery from open-hernia repair can take up to six weeks.

Laparoscopic surgery is a minimally-invasive procedure where the surgeon performs the operation through small incisions in the abdomen. A tiny camera, called a laparoscope, is inserted into one of the incisions. Using the camera as a guide, the surgeon inserts instruments through a second incision to make the repair using synthetic mesh.

Because laparoscopic surgery is less invasive, patients experience quicker healing with less pain. However, laparoscopy cannot be used for the following scenarios: to fix very large hernias, if the intestine has descended into the scrotum, or on patients who have had pelvic surgery

Prevention & Prophylaxis

While congenital defects that result in a person being susceptible to an inguinal hernia can't be prevented, there are things that can be done to reduce strain on the abdominal tissues. Steps that can be taken to reduce the risk of inguinal hernia include: