What is chronic groin pain after inguinal hernia repair?

Chronic groin pain is defined as pain that is present for more than 3 months after the inguinal hernia surgery. Chronic groin pain can occur in more than 15% of patients who have this surgery.

What is an inguinal hernia?

A hernia is a condition in which part of an internal organ or tissue bulges through a muscle. In an inguinal hernia, the intestines or fat from the abdomen push through the lower abdominal wall into the inguinal, or groin, area.

An inguinal hernia is usually not dangerous. However, it can be painful, especially when lifting, bending, straining with a bowel movement, or coughing. If a hernia bulges out and cannot be pushed back, or reduced, this is an emergency and you should seek immediate medical attention.

Inguinal hernias include the following:

  • Indirect inguinal hernias: This is caused by a birth defect in the abdominal wall.
  • Direct inguinal hernias: These are most often caused by a weakness in the muscles of the abdominal wall that develops over time, or by straining or heavy lifting.
  • Incarcerated hernia: Incarceration occurs when part of the fat or intestine from inside the abdomen gets stuck in the groin or scrotum and cannot go back into the abdomen.
  • Strangulated hernia: A strangulated hernia is an incarcerated hernia that has not been treated. The blood supply to the intestine can be cut off, causing “strangulation” of the intestine. This is a very serious condition that must be treated immediately.

What are the symptoms of an inguinal hernia?

Symptoms of an inguinal hernia can include:

  • A bulge on one or both sides of the groin that disappears when lying down
  • Pain in the groin, especially when lifting, coughing or exercising
  • A feeling of weakness, heaviness or burning in the groin
  • A swollen scrotum

How is an inguinal hernia treated?

An inguinal hernia is usually treated with surgery. There are two main types of inguinal hernia surgery:

  • Open hernia repair: An incision, or cut, is made in the groin. The surgeon then pushes the hernia back into the abdomen and strengthens the abdominal wall with mesh and stitches.
  • Laparoscopic (minimally invasive) hernia repair: The surgeon makes small cuts in the lower abdomen and inserts a laparoscope (a thin tube with a tiny video camera attached). The laparoscope sends images to a video monitor, allowing the surgeon to repair the hernia.

What happens after inguinal hernia repair surgery?

Patients who have surgery usually need medication for several weeks to treat pain. Patients are also advised to not lift anything heavy or engage in vigorous activity.

Minimally invasive hernia surgery usually has a shorter recovery time. However, it may not be an option for patients with large hernias or for those who have had previous abdominal surgery.

What are the risks of inguinal hernia repair surgery?

Inguinal hernia repair is a very common surgery. However, like all surgeries, it has some risks, including infection, bleeding, and pain that is not relieved by medication. Long-term complications are rare, but can include nerve damage. In addition, the hernia can recur (come back), which would require a second surgery.

What are the symptoms of chronic groin pain after surgery?

The symptoms of chronic groin pain after surgery include:

  • Sharp or radiating (spreading) pain;
  • A burning sensation in the area of the surgery;
  • Foreign body sensation (feeling like there is something strange in the body);
  • Pain in the testicles;
  • Pain when walking;
  • Pain with sexual intercourse.

How is chronic groin pain after inguinal hernia repair treated?

Management of chronic groin pain can be challenging and requires a team of health care professionals working together.

There are several treatment options for chronic groin pain after inguinal hernia repair, including:

  • Pain medications
  • Nerve block (injection of a local anesthetic)
  • Nerve ablation (an electric current heats up a small area of nerve tissue to stop it from sending pain signals)
  • Peripheral nerve field stimulation (electrodes are placed on the nerves to stop the pain)

Surgery is an option for patients who have had a thorough consultation and examination by a surgeon. Surgery can be performed through an open incision (over the previous surgery) or laparoscopically. During the surgery, the surgeon may partially or completely remove the hernia mesh that was placed in the earlier surgery.

Depending on the nature of the groin pain, some patients will benefit from a neurectomy. This is a procedure in which one or more of the peripheral nerves around the previous surgery are cut.

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