Inguinal Hernia

A hernia is a bulge formed when the internal organs of your abdominal cavity are pushed through a weakened spot in your abdominal wall. Hernias most commonly occur between the area of your rib cage and the groin.

An inguinal hernia is a bulge that forms when a part of your small intestine or fatty tissue protrudes through a weak spot in the groin (area between the upper thigh and lower abdomen) or scrotum (muscular sac containing male testes). Inguinal hernias occur more commonly in men than women. There are two types of inguinal hernia:

Indirect inguinal Hernia

Most inguinal hernias are caused when the walls of the abdominal muscles fail to close before birth. It commonly occurs in males because of the way the reproductive system develops. Before birth, the testicles are formed within the abdomen and slowly descend into the scrotum through the inguinal canal. The inguinal canal is closed after birth, preventing the testicles from moving back into the abdomen, but leaving enough space for the spermatic cord to pass through. Weakness in this region can lead to the formation of a hernia. The risk of indirect inguinal hernia is higher in premature infants as the baby does not get enough time in the womb for the closing of the inguinal canal.

Direct inguinal Hernia

The abdominal wall may become weaker in later life due to tissue degeneration and result in an inguinal hernia. Pressure on the weak spot due to coughing, straining, or lifting heavy objects can cause a bulge in the groin. Being overweight or undergoing a prior surgery is also a risk factor for inguinal hernia.

Signs & Symptoms

Inguinal hernias generally do not cause any symptoms, but may be revealed when your doctor conducts a routine medical exam. The bulge formed is more prominent when you stand, cough or strain, and may disappear while lying down as it slips back into the abdomen. Other symptoms include:

  • Pain or discomfort in the groin
  • Heavy sensation in the groin
  • Burning or aching bulge
  • Pain and swelling around the testicles in men

The hernia can be easily pushed into the abdomen while lying down. Inability to push the hernia back into the abdomen may cause the hernia to become incarcerated (trapped). An incarcerated hernia may strangulate thereby disconnecting blood supply to the trapped part of your intestine. This is a dangerous situation and may require emergency medical help. Symptoms of a strangulated inguinal hernia include:

  • Fever
  • Increased heart rate
  • Sudden quick intensifying pain
  • Reddish or bluish discoloration of the bulge
  • Nausea and vomiting

In children, inguinal hernia is visible only when the child stands for a long time, while coughing, crying or straining during bowel movements.

Screening & Diagnosis

A physical examination is generally required for the diagnosis of an inguinal hernia. Your doctor will enquire about your symptoms and examine the bulge in your groin. A cough test may be ordered to check for protrusion when pressure is applied, which can confirm presence of direct or indirect inguinal hernia.

Imaging tests such as X-rays, magnetic resonance imaging (MRI) or computer tomography (CT) scan may be ordered to determine if the intestine or other internal organs has protruded into the bulge.

Your doctor may suggest blood and stool tests to confirm any trapped tissue. White blood cell and red blood cell counts indicate if the bulge is inflamed or infected, or if there is death of tissue or bleeding. Stool tests may also help to determine if the intestine has been trapped.  

Your doctor may also suggest special tests for diagnosis which include:

  • Biopsy: Your doctor may remove a sample from the herniated site and check for the presence of cancer.
  • Herniagram: Your doctor will inject a radio-opaque liquid into the abdominal cavity which will fill in the hole of the cavity. The liquid filled bulged area will show up on X-ray images, and confirm the presence of a hernia.

Treatment

Small inguinal hernias that do not cause any symptoms are usually not treated; your doctor may follow a wait-and-watch approach. Surgery is recommended for inguinal hernias that show symptoms, are enlarged and entrapped. Inguinal hernias in children are generally operated on as they have a high risk of becoming strangulated. Treatment can be through either open hernia repair or laparoscopic surgery.

Open hernia repair: This procedure is also called herniorrhaphy. You may be given either general anesthesia or local anesthesia in your spine or abdomen. Your surgeon will make an incision in the groin and push back the bulged intestine into your abdomen. The muscles of the abdominal wall will be stitched. A hernioplasty may be performed, where a synthetic mesh or screen is stitched to support the weakened part of the abdominal wall.

Laparoscopy: This procedure is performed under general anesthesia. Your surgeon will make several small incisions on your abdomen, through which a laparoscope and other special instruments will be inserted. The video camera attached to the laparoscope will send magnified images to a monitor, which will guide the surgeon during surgery. Your surgeon will push the bulge into your abdomen and either stitch the abdominal wall (herniorrhaphy) or use mesh to support the weakened wall (hernioplasty).   

Laparoscopy is advised for patients with a recurring hernia who have had a prior traditional hernia repair. People with bilateral inguinal hernias (hernia on both sides of the pelvis) are also advised to undergo laparoscopic repair. However, the minimally invasive procedure is not preferred for patients with very large hernias or who have had a prior pelvic surgery.

  • The University of Milan
  • Oxford University Hospitals
  • The University of Milan
  • Oxford University Hospitals
  • The University of Milan