Understanding Inguinal Hernia

Whether you’re newly diagnosed, suspect you may have a hernia, or are seeking more in-depth knowledge about this condition, this resource will provide a wealth of information to help you understand and navigate the complexities of inguinal hernias.

King Edward VII’s Hospital’s Consultant General Surgeon, Mr Husam Ebied has offered some expert advice on this subject. With this comprehensive guide, you’ll be better equipped to understand inguinal hernias, interpret their symptoms and potential treatment pathways. This knowledge can assist in having informed discussions with your healthcare provider, empowering you to make the best decisions for your health.

What is inguinal hernia?

An inguinal hernia is a condition that occurs when tissue, such as part of the intestine or intraperitoneal fat protrudes through a weak spot in the abdominal muscles. The resulting bulge can be painful, especially when you cough, bend over, or lift a heavy object.

Inguinal hernias are located in the lower abdomen, in the groin area. They are more common in men because of the way male anatomy develops, but women can also get them.

There are two types of inguinal hernias:

Indirect inguinal hernia

These are congenital hernias that are present at birth and are more common in males. They occur when the inguinal canal, which normally closes before birth in females and shortly after birth in males, doesn’t close completely. This leaves a weak area in the abdominal wall.

Direct inguinal hernia

This type typically occurs in adult males. It is caused by degeneration of the abdominal muscles, which can happen due to ageing, strenuous physical activity or repetitive straining.

What does an inguinal hernia feel like? Inguinal hernia symptoms

Inguinal hernia symptoms can vary depending on the size of the hernia and other individual factors. It’s also important to note that some hernias may cause no symptoms at all, especially at first. However, here are some common symptoms of an inguinal hernia:

• Visible Bulge
  The most noticeable symptom of an inguinal hernia is often a bulge in the groin or scrotum (in men). The bulge may become more apparent when standing upright, especially if you cough or strain.
• Pain or Discomfort
  This can occur in the groin area, particularly when lifting heavy objects, bending over, or straining. The pain can be sharp and sudden or a dull ache that gets worse towards the end of the day.
• Sensation of Heaviness or Dragging
  People with an inguinal hernia often describe a sensation of heaviness, dragging, or pressure in the groin area.
• Burning or Aching Sensation
  There can be a burning or aching sensation at the site of the bulge. This symptom can be especially noticeable when you’re active.
• Swelling or Pain in the Testicles
  In men, an inguinal hernia may descend into the scrotum, causing swelling or pain.
• Weakness or Pressure in the Groin
  There may be a feeling of weakness or pressure in the groin, which may not be associated with noticeable pain but can still be uncomfortable.
• Gurgling Sensation
  Some people may experience a gurgling sensation, which can be due to the movement of intestines within the hernia.

It’s important to note that not all inguinal hernias cause symptoms. Some people discover they have a hernia during a routine physical examination or a medical test for an unrelated condition.

If a hernia is small, it may not cause any discomfort at all. But even small, painless hernias have a risk of becoming a medical emergency if the intestine or another piece of tissue becomes trapped (incarcerated) and the blood supply is cut off (strangulation).

Strangulated hernias are less common but they can cause severe pain and symptoms like nausea, vomiting, and a sudden increase in pain. If you suspect you have an inguinal hernia, it is important to seek medical attention promptly.

Where are inguinal hernias located?

Inguinal hernias are located in the lower abdomen, specifically in the groin area. This area is where the thigh meets the torso on each side of the body.

There are two types of inguinal hernias, each of which is located in a slightly different place:

Indirect Inguinal Hernia

This is the most common type of inguinal hernia. It occurs in the internal inguinal ring, an opening in the abdominal wall that is present at birth. Normally, this opening closes before or shortly after birth, but if it doesn’t close completely, fatty tissue or a part of the intestine can push through the weak spot in the inguinal canal, creating a hernia.

Direct Inguinal Hernia

This type of hernia is generally associated with ageing and the weakening of the abdominal muscles. It occurs in an area slightly to the inside of the site of an indirect hernia, in a place where the abdominal wall naturally has a slightly thinner muscle.

In men, an inguinal hernia may extend into the scrotum, causing it to become enlarged. In women, the inguinal canal contains a ligament that helps hold the uterus in place, and hernias may occur near the ligament. Regardless of the specific type or location, all inguinal hernias occur in the lower abdomen near the inguinal canal.

What causes inguinal hernia?

Inguinal hernias occur when tissue, such as part of your intestine, pushes through a weak spot in your abdominal wall. The exact causes of this can vary. Here’s a more detailed look at what can lead to an inguinal hernia:

• Increased Pressure in the Abdomen
  Any condition or activity that increases pressure in the abdominal cavity can lead to an inguinal hernia. This could be due to lifting heavy objects, straining during bowel movements (such as with constipation), straining to urinate, chronic coughing or sneezing, or being overweight or obese.
• Weakness in the Abdominal Wall
  Certain people are born with a weakened abdominal wall or experience weakening of the wall over time. This weakening can be due to ageing, an injury, a surgical incision, or conditions that may affect collagen synthesis and cause connective tissue disorders. The weak spot in the abdominal muscle wall allows for the abdominal contents to protrude, forming a hernia.
• Pregnancy
  Pregnancy can also cause an inguinal hernia. The growing uterus increases pressure in a woman’s abdominal cavity, and the hormones produced during pregnancy can also soften and stretch tissues, making them more vulnerable to protrusion.
• Premature Birth and Low Birth Weight
  Being born prematurely or at a low birth weight increases the risk of having an inguinal hernia.
• Family History
  There seems to be a genetic component to the development of hernias, as they often run in families.
• Chronic Diseases
  Certain chronic diseases, like cystic fibrosis, can cause a persistent, heavy cough that leads to increased pressure in the abdominal cavity and, potentially, a hernia.
• Congenital Defect
  Indirect inguinal hernias are often associated with a congenital defect (a defect present from birth), such as the incomplete closure of the inguinal canal.

It’s important to note that while these factors can increase the risk of developing an inguinal hernia, anyone can develop this condition. This includes people of all ages and both genders, although they are more common in men.

How common is an inguinal hernia?

Inguinal hernias are the most common type of hernia. They account for about 70% of all hernias, according to the British Hernia Centre. In terms of population, inguinal hernias are significantly more common in men than in women. The incidence of inguinal hernias increases with age. For instance, men over the age of 40 are more likely to develop this type of hernia.

How serious is an inguinal hernia?

An inguinal hernia itself isn’t necessarily dangerous immediately, but it doesn’t improve on its own and can lead to life-threatening complications if not managed properly. Hernia presentation is variable from being asymptomatic to presenting with the complications below

• Inguinal hernias may become stuck, or incarcerated, meaning the contents of the hernia that bulge through the abdominal wall cannot be massaged back inside the abdominal wall.
• If a hernia becomes stuck outside the abdominal wall, it may become strangulated, meaning the blood flow to the hernia is cut off. Lack of blood flow can cause the death of tissues inside the hernia.
• If a hernia that contains part of the small intestine becomes stuck and strangulated, this can lead to intestinal obstruction and death of the strangulated part of the intestine.

For these reasons, doctors often recommend surgery to repair inguinal hernias that are causing symptoms or growing larger. Hernia repair is a common surgical procedure. Though any surgical procedure carries some risk, most inguinal hernia repairs go smoothly and patients recover well.

Find out more about surgical hernia repair here.

Can an inguinal hernia cause abdominal pain?

Yes, an inguinal hernia can cause abdominal pain or discomfort. This is because an inguinal hernia occurs when tissue, such as a part of your intestine, pushes through a weak spot in your abdominal wall.

Can you exercise with an inguinal hernia?

Whether you can exercise with an inguinal hernia largely depends on the size of the hernia, the nature of the exercise, and the severity of your symptoms. It’s crucial to first discuss your exercise plan with your healthcare provider or a physical therapist, as some activities could potentially worsen a hernia.

What exercise can I do with an inguinal hernia?

In general, light physical activities such as walking or gentle cycling might be safe, as long as they don’t exacerbate your symptoms or cause discomfort. However, strenuous physical activity, particularly exercises that increase abdominal pressure, should typically be avoided. This includes heavy weightlifting, intense core workouts, or any exercise that causes straining, as these could potentially cause the hernia to enlarge or lead to complications such as incarceration or strangulation.

In all cases, if you have an inguinal hernia and wish to engage in physical activity, it’s essential to discuss this with your healthcare provider. They can provide you with guidelines tailored to your individual circumstances, and monitor your condition to ensure your activities do not lead to complications.

Can an inguinal hernia heal itself?

No, an inguinal hernia cannot heal itself. Once a portion of tissue pushes through the abdominal wall and creates a hernia, it will not go away on its own. While the associated symptoms (like discomfort or pain) can potentially vary over time, the physical defect in the abdominal wall remains.

In some cases, the hernia may be manually reducible, which means the bulging tissue can be gently pushed back into the abdomen. However, this is not a cure. The underlying weak spot in the abdominal wall is still present, and the tissue is likely to bulge out again, especially during activities that increase pressure in the abdomen, such as lifting or straining.

Moreover, there’s always a risk that the herniated tissue could become trapped (incarcerated) or have its blood supply cut off (strangulated), both of which are surgical emergencies.

Because of these risks, doctors often recommend surgery to repair inguinal hernias, especially if they’re causing symptoms or growing larger. Surgical repair involves pushing the protruding tissue back into place and reinforcing the weakened area of the abdominal wall, often with a synthetic mesh.

Inguinal hernia treatment

How to cure inguinal hernia? As inguinal hernias don’t heal themselves, surgery is usually advised.

The primary treatment for an inguinal hernia is surgery, and there are two main types:

Open Hernia Repair (Herniorrhaphy or Hernioplasty)

In this procedure, a surgeon makes an incision in your groin and pushes the protruding tissue back into your abdomen. After that, the surgeon sews the weakened area, often reinforcing it with a synthetic mesh (hernioplasty). The incision is then closed with stitches, staples, or surgical glue.

Laparoscopic Hernia Repair

This is a minimally invasive procedure where a surgeon operates through several small incisions in your abdomen. Gas is used to inflate your abdomen to make the internal organs more visible. A small tube equipped with a tiny camera (laparoscope) is inserted into one incision. Guided by the camera, the surgeon inserts tiny instruments through other incisions to repair the hernia using synthetic mesh.

Find out more about surgical hernia repair here.

More information

• If you think you have inguinal hernia, speak to your GP about possible treatments. (Don’t have a GP?)
• King Edward VII’s Hernia Centre is a fully equipped unit, staffed by experts with access to the most up to date tests and treatments.
• Mr Husam Ebied is an expert in hernia surgery and can provide expert treatment, advice and guidance. Make an enquiry.