What is a hernia?
A hernia is a common condition that occurs when part of an internal organ or tissue bulges through a muscle. Hernias can occur around the belly button, through a surgical scar, in the diaphragm, or in the groin (the area between the abdomen and the thigh on both sides of the body).
What is an inguinal hernia?
An inguinal hernia occurs when the intestines or fat from the abdomen bulge through the lower abdominal wall into the inguinal, or groin, area.
There are 2 types of inguinal hernias:
- Indirect inguinal hernias: This type of hernia is caused by a birth defect in the abdominal wall that is congenital (present at birth).
- Direct inguinal hernias: This type of hernia usually occurs in adult males. These are most often caused by a weakness in the muscles of the abdominal wall that develops over time, or are due to straining or heavy lifting.
Hernias can be on one or both sides of the abdomen. Direct inguinal hernias are more common later in life because the abdominal wall weakens with age.
An inguinal hernia is usually not dangerous. However, it can be painful, especially when lifting, bending, straining with a bowel movement, or coughing. Direct inguinal hernias usually occur in adult males whose abdominal muscles have weakened.
Who gets an inguinal hernia?
Adult males over age 40 are much more likely to develop direct inguinal hernias than females. About 25% of males, and only about 2% of females, will develop an inguinal hernia in their lifetime.
A family history of having an inguinal hernia, smoking, and men who have had previous abdominal surgery are at greater risk for developing an inguinal hernia.
What is an incarcerated or strangulated inguinal hernia?
Incarceration or strangulation of inguinal hernias is rare, but serious complications can develop if a hernia is left untreated.
- 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: Strangulation can occur when an incarcerated hernia is not treated. The blood supply to the intestine can be cut off, causing “strangulation” of the intestine. This is a very serious condition. You should seek immediate medical attention if you suspect you have an incarcerated or strangulated inguinal hernia.
Symptoms and Causes
What are the symptoms of an inguinal hernia?
Inguinal hernias may be painless or cause no symptoms, especially when they first appear. Symptoms that can develop 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 (the sac-like a part of the male genitalia underneath the penis).
Diagnosis and Tests
How is an inguinal hernia diagnosed?
If you suspect you or your child has an inguinal hernia, you should seek medical attention. If it is not treated, an inguinal hernia can develop into a serious condition.
Your healthcare provider may ask about family history, as inguinal hernias tend to run in families. He or she may then perform a physical examination to feel for a hernia bulge. You may be asked to cough or strain to see if the hernia comes out.
An abdominal X-ray or CT scan may be ordered to look for a hernia and determine if it is strangulated or incarcerated.
Management and Treatment
Do all inguinal hernias require surgery?
Sometimes a healthcare provider can push or “reduce” a small inguinal hernia back into the abdomen with gentle massage. If this does not work, surgery may be needed.
An inguinal hernia does not get better or go away on its own. If you are diagnosed with an inguinal hernia, your physician will likely recommend surgery.
How is an inguinal hernia repaired?
Inguinal hernia repair is a common surgical procedure. Inguinal hernia surgery is also called herniorrhaphy or hernioplasty. There are 3 types of inguinal hernia repair:
- Open hernia repair: A surgical procedure in which 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. This surgery may be done under local anesthesia for the abdominal area, or general anesthesia in which you will be put to sleep.
- Minimally invasive or laparoscopic hernia repair: A less invasive surgical procedure in which the surgeon makes small, half-inch 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 and the surgeon to repairs the hernia through the small incisions.
- Robotic hernia repair: Like laparoscopic surgery, robotic surgery uses a laparoscope, and is performed in the same manner (small incisions, a tiny camera and projecting the inside of the abdomen onto television screens).
Robotic surgery differs from laparoscopic surgery in that the surgeon is seated at a console in the operating room, and handles the surgical instruments from the console. While robotic surgery can be used for some smaller hernias, or weak areas, it can now also be used to reconstruct the abdominal wall.
What are the risks of inguinal hernia repair surgery?
The risks of inguinal hernia repair include:
- Pain that is not relieved by medication
Long-term complications are rare, but can include nerve damage or a return of the hernia, which requires a second surgery.
Outlook / Prognosis
What can be expected in the recovery after inguinal hernia repair surgery?
Recovery from both minimally invasive and open surgery usually requires medication for several weeks to treat postoperative pain. You will also be 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 those who have had previous abdominal surgery.
Infants and children usually have a quicker recovery than adults from inguinal hernia repair surgery.
What is the prognosis (outlook) for someone who has had inguinal hernia repair?
Patients who have had inguinal hernia repair generally do very well. Following surgery, you may be advised to maintain a healthy weight and avoid heavy lifting or straining during bowel movements. These steps can help to prevent your inguinal hernia from returning.