Inguinal Hernia (Groin Hernia)
What is an inguinal hernia?
An inguinal hernia is sometimes called a groin hernia. (“Inguinal” means “in the groin.”) It’s the most common type of groin hernia. An inguinal hernia occurs in the inguinal canal, which is a passageway that runs down either side of your pelvis into your sex organs. A less common type of groin hernia is the femoral hernia, which happens in the smaller femoral canal that runs underneath it.
A hernia occurs when tissue from one body cavity bulges through an opening in your muscle wall into another. Different types of hernias happen in different body compartments. Inguinal hernia is the most common type of hernia. It takes place when abdominal tissue, such as belly fat or a loop of intestines, bulges through an opening in your lower abdominal wall. This is the wall that separates your abdomen from your groin.
Other types of hernias that can come through your abdominal muscles include:
- Ventral hernia: When abdominal tissue pushes through your front abdominal wall.
- Hiatal hernia: When part of your stomach pushes up through an opening in your diaphragm into your chest cavity.
What is the difference between a direct inguinal hernia and an indirect inguinal hernia?
- Direct inguinal hernia: A direct inguinal hernia penetrates directly through the wall of your inguinal canal. This type of hernia occurs in adults over time, from a combination of weakening abdominal muscles and chronic pressure on the muscle wall.
- Indirect inguinal hernia: An indirect inguinal hernia enters your inguinal canal through the top. This usually occurs because of a birth defect. In some babies, the opening to their canal doesn’t close all the way during development in the womb.
Who does inguinal hernia affect?
For reasons of anatomy, inguinal hernias usually affect people assigned male at birth (AMAB), by a ratio of 10:1. Your testicle begins above your lower abdominal wall and descends through your inguinal canal into your scrotum. The place where your testicle passes through is more susceptible to a hernia because it’s a preexisting opening, which is more easily reopened. And, sometimes, it doesn’t close all the way during development in the first place.
In people assigned female at birth (AFAB), their inguinal canal is narrower and begins under their abdominal wall. It carries the round ligament that supports their uterus, and this tough ligament helps to reinforce their muscle wall. However, women with connective tissue diseases may be more susceptible to hernias where connective tissue attaches their uterus to their inguinal canal. Congenital indirect inguinal hernias may also affect babies who are AFAB.
How common are inguinal hernias?
Up to 75% of all hernias are inguinal hernias. Around 25% of those AMAB will have an inguinal hernia during their lifetime, compared to 2% of those AFAB. Direct (acquired) inguinal hernias are more common in middle-aged and older men. Indirect inguinal hernias affect up to 4.5% of children, including 2% of babies AMAB and 1% of babies AFAB. Premature babies are up to 30% more likely to get one.
How serious is an inguinal hernia?
Hernias aren’t always serious, but serious complications can develop. Hernias do tend to worsen over time. As the opening becomes weaker and wider, more tissue can push through it. The more tissue pushes through, the more likely it is to become trapped. This can be painful, and in extreme cases, can be dangerous. Once trapped, a piece of your intestine could become pinched and blocked, or the tissue could become cut off from your blood supply.
If your hernia already causes you discomfort, your healthcare provider will probably recommend fixing it in surgery before it becomes worse. If you don’t have symptoms yet, they may just wait and watch it for a while, but most inguinal hernias will become symptomatic with time.
Pediatricians generally recommend treating children with inguinal hernias immediately, as their risk of complications is greater. This is also true for those AFAB.
Symptoms and Causes
What are the symptoms of an inguinal hernia?
Not all inguinal hernias have symptoms. Sometimes, symptoms come and go. A hernia may slide in and out of the opening, or you may only feel it during certain activities. In children, you may see a lump in their groin area that appears bigger when they cry. It may go away when they sleep. An indirect inguinal hernia may not be palpable (able to be felt) to the touch because it may be tucked behind muscle fibers.
You might notice:
- A bulge in your groin area on either side of your pubic bone. It can go into your scrotum or labia.
- A feeling of pressure or heaviness in your groin.
- Pain in your groin, especially when straining, lifting, coughing or bending over.
- A burning or pinching sensation that may radiate through your pelvis or down your leg.
What is the main cause of inguinal hernia?
An inguinal hernia occurs when there’s a weakness or opening in your lower abdominal wall that allows abdominal tissue to push through. Many things can contribute to this, including:
- An opening or weak spot that’s present at birth.
- Congenital differences in the strength of your connective tissue (collagen).
- An opening or weak spot from previous abdominal surgery.
- Chronic coughing or sneezing.
- Chronic straining to pee or poop.
- Frequent strenuous exercise or manual labor.
- Years of pregnancy and carrying small children.
- Jobs that require standing for many hours at a time.
- Intrabdominal pressure from chronic obesity.
- Normal age-related tissue degeneration.
What are the possible complications of an inguinal hernia?
- Enlargement over time. The pressure of an existing hernia on weakened tissues can have a snowball effect, making things worse. In those AMAB, an enlarged testicular hernia that moves down into your scrotum can cause painful swelling.
- Incarceration. An incarcerated hernia is one that can’t be “reduced” — physically moved back into place. A trapped hernia is more likely to become pinched as it grows bigger, causing pain and other complications.
- Small bowel obstruction. If part of your small intestine is herniated and becomes trapped and pinched, it can cause a blockage. It may stop you from being able to poop or pass gas, causing severe abdominal pain, nausea and vomiting.
- Strangulation. A strangulated hernia has been cut off from blood supply. This can lead to inflammation and infection of the tissue, and eventually tissue death (gangrene). Strangulation is a medical emergency.
Diagnosis and Tests
What should I do if I think my child or I might have an inguinal hernia?
Seek medical attention for any signs of a hernia, or any kind of lump or fussiness in your child. An inguinal hernia in a child is usually treated as soon as possible. Even if your hernia isn’t bothering you, it’s important to have it diagnosed and to rule out other possible causes of groin pain, lumps or scrotal swelling. Other possible causes include:
- Femoral hernia.
- Femoral artery aneurysm.
- Athletic pubagalia.
- Undescended testicle.
- Retractile testicle.
- Swollen lymph node.
- Scrotal masses.
- Tumors, both malignant and benign.
How is an inguinal hernia diagnosed?
A physical examination is usually enough to diagnose an inguinal hernia. Your healthcare provider will try to see and feel the hernia. They may ask you to cough or to bear down as though you were pooping to make the hernia emerge. They’ll also want to know if the hernia can be massaged back into place, or if it’s stuck (incarcerated).
If they can’t see the hernia from the outside, they may order an imaging test to see it from the inside. An ultrasound will usually do the trick, but in rare cases, they may need to use something more specific, such as a CT scan.
Management and Treatment
What is the best treatment for inguinal hernia?
Healthcare providers recommend surgery for most inguinal hernias, and for all in children and those AFAB. Most inguinal hernias will eventually cause symptoms, and children and women are more at risk of dangerous complications. For adults AMAB with small hernias that aren’t causing symptoms, healthcare providers may take a wait-and-watch approach. But most will need treatment eventually.
If you have health conditions that make surgery less safe for you, you and your healthcare provider will need to weigh the risks and benefits together. Your healthcare provider may be able to massage your hernia back into place (reduction). In this case, they might suggest that you wear a belt or truss to hold the hernia in while you’re doing certain activities. This may stop it from continuing to grow.
What will happen if an inguinal hernia is left untreated?
Inguinal hernias don’t improve by themselves. They usually worsen. You won’t necessarily have complications, but the risk does increase over time. The risk is highest for children because they’re still growing and their hernias will enlarge at a faster rate. Children also tend to have indirect hernias, which are more likely to go into their scrotum. An inguinal hernia in a child shouldn’t be left untreated.
Groin hernias in those AFAB are rarer but tend to be more serious. A woman with an inguinal hernia is likely to also have a hidden femoral hernia behind it, which will only be found through surgery. Femoral hernias have a higher risk of complications, and 50% of hidden femoral hernias in people AFAB require emergency surgery.
How are inguinal hernias repaired in surgery?
The object of hernia repair surgery is to move the hernia contents back into your abdominal cavity and close the gap. This is also called herniorrhaphy. Sometimes, surgeons reinforce the weak spot with tissue from another part of your body, or with a fine synthetic mesh. This is called hernioplasty.
Hernia repair is one of the most common surgical procedures performed worldwide and can often be done on an outpatient basis. It can be performed under general, regional or local anesthesia. You can discuss the pros and cons of these different methods with your anesthesiologist.
- General anesthesia puts you to sleep for the procedure. You won’t have any awareness or sensation.
- Regional anesthesia numbs your body from your waist down.
- Local anesthesia numbs only the part of your body being operated on, in this case, your groin.
Most hernia repairs can be managed by minimally invasive surgery methods, but hernias that are more complicated may require open surgery. Around 5% of hernia repair surgeries are emergencies. The type of surgery you have will depend on your condition, prior surgical history, and the experience and judgment of your surgeon.
- Laparoscopic surgery is a minimally invasive technique. Your surgeon makes several small, half-inch incisions in your abdomen, which heal relatively fast. Through one “keyhole,” they insert a laparoscope, a thin tube with a video camera attached. They’ll make the repairs through the other holes using long, thin instruments and guided by the video camera.
- Robotic hernia repair also uses a laparoscope. The difference is that the surgeon is seated at a console in the operating room and handles the surgical instruments from the console.
- Open surgery is the traditional method for hernia repair. Your surgeon makes one long cut across your pelvis to open up your pelvic cavity.
If you have a pinched or strangulated bowel, your surgeon may have to remove the affected section (bowel resection). You might have to have a temporary ostomy while your bowel heals from surgery. Your bowel will be reconnected and your ostomy closed in a second surgery later on.
What are the possible complications of hernia repair surgery?
All surgeries have a low risk of certain general complications. These occur in 1% of hernia repairs and include:
- Injury to nearby organs, blood vessels or nerves.
- Wound-healing problems.
- Reactions to the anesthesia.
- Blood clots.
Risks associated with inguinal hernia repair in particular include:
- Urinary retention. Some people have difficulty urinating after surgery. This is temporary. Your healthcare provider may have to drain your bladder for you.
- Chronic pain. Long-term chronic groin pain after inguinal hernia repair occurs in 10% of people. It may be due to nerve damage or a reaction to the synthetic mesh if you had hernioplasty.
How can I reduce my risk of getting an inguinal hernia?
There’s no way to prevent a congenital inguinal hernia (one you’re born with), but you can reduce your risk of acquiring a direct inguinal hernia by reducing wear and tear on your lower abdominal wall. For example:
- Lift heavy objects from your legs, not your stomach or back.
- If you lift weights, have an expert check your technique.
- Seek treatment for conditions that cause chronic coughing or sneezing.
- Seek treatment for chronic constipation. Diet and lifestyle changes often help.
- Reduce weight in your abdomen.
- Exercise to build core strength and keep your abdominal muscles fit.
Outlook / Prognosis
What is the prognosis after hernia repair?
You may need pain medication for a few weeks after surgery. You’ll be advised not to strain or lift anything while you’re recovering. Your healthcare provider may also recommend longer-term lifestyle changes to help prevent your hernia from returning. Up to 10% of adults may see their hernias return with time, requiring another operation. Hernias usually don’t recur in children.
How should I manage an active inguinal hernia?
If you’re living with an inguinal hernia and not having it repaired, you’ll need to take care not to let it get worse. You may want to avoid certain exercises or activities that strain your abdominal muscles. You may want to consider reducing your weight, quitting smoking or changing your diet to improve your bowel function and prevent straining on the toilet. Talk to your healthcare provider about hernia care.
When should I call my healthcare provider about my hernia?
Contact your healthcare provider right away if you experience any of these complications before or after surgery:
- Fever or chills.
- Nausea and vomiting.
- Difficulty urinating.
- Difficulty pooping.
- Increasing pain, swelling or redness.
- Your hernia looks bigger or can’t be pushed back inside.
A note from Cleveland Clinic
An inguinal hernia is one of the most common conditions to affect all people, including 25% of all men. Inguinal hernia repair is equally common, and many different techniques have been developed and refined to manage it. If you or your child are diagnosed with an inguinal hernia, it’s best to treat it right away before it becomes more complicated. You can feel confident that you’ll be in experienced hands.
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