What Is an Inguinal Hernia?

An inguinal hernia occurs when a section of the intestine bulges through a weak spot in the inguinal canal. The inguinal canal is a passageway through the abdominal wall near the groin.

The first sign of an inguinal hernia is usually an unexplained bulge in the groin area. This type of hernia can be present at birth or develop over time.

Causes

An inguinal hernia is caused by a weakness in the muscle of the groin. It can be present at birth due to a small muscle defect or can develop over time.

Repetitive straining to have a bowel movement can cause a hernia, as can straining to urinate, as often happens with prostate problems. A chronic cough, from lung disease or from smoking, can also contribute to a hernia.

Obesity can increase the chances of developing a hernia, too. For some patients, losing weight may prevent a hernia from forming or growing in size, while exercise can make hernias temporarily bulge to an even larger size.

Symptoms

It can be difficult to determine if a hernia is a femoral hernia or an inguinal hernia. They are only differentiated by their location relative to the inguinal ligament:

• A hernia in the groin area that is above the inguinal ligament is an inguinal hernia;
• Below the ligament, it is a femoral hernia.

It often takes a specialist to determine what type of hernia is present, and the exact nature of the hernia may not be known until surgery begins.

An inguinal hernia may be small enough that only the peritoneum, or the lining of the abdominal cavity, pushes through the muscle wall. In more severe cases, portions of the intestines may move through the hole in the muscle, creating the bulging area that hernias are known for.

Risk Factors

Inguinal hernias are eight to 10 times more likely to occur in men than women.

Those who are also at higher risk include:

• People with a family history of inguinal hernias
• Men who have had a prostatectomy
• People who have a lower body mass index (BMI) (?)
• People who have connective tissue disorders, such as scleroderma

Although they are present at birth in up to 5% of all children. Women can also develop inguinal hernias, but pregnant women have a higher risk of having a hernia develop than a woman who is not pregnant.

Treatment

An inguinal hernia will not heal by itself and does require surgery to be repaired. Initially, the hernia may only be a small lump in the groin but can grow much larger over time.

It may also appear to grow and shrink with different activities. Increased abdominal pressure during activities, such as straining to have a bowel movement or sneezing, may push more of the intestines into the herniated area, making the hernia appear to grow temporarily.

Lifting heavy objects, working out, and exercises that use the abdominal muscles can make the hernia bulge.

When Is It an Emergency?

A hernia that gets stuck in the “out” position is referred to as an "incarcerated hernia." This is a common complication of inguinal hernias, and while an incarcerated hernia is not an emergency, it should be addressed, and medical care should be sought.

An incarcerated hernia is an emergency when it becomes a “strangulated hernia,” where the tissue that bulges outside of the muscle is being starved of its blood supply. This can cause the death of the tissue that is bulging through the hernia.

A strangulated hernia can be identified by the deep red or purple color of the bulging tissue. It may be accompanied by severe pain, but it is not always painful. Nausea, vomiting, diarrhea and abdominal swelling may also be present.

Surgery

Inguinal hernia surgery is typically performed using general anesthesia and can be done on an inpatient or outpatient basis. The surgery is performed by a general surgeon or a colon-rectal specialist.

1. Once anesthesia is given, surgery begins with an incision on either side of the hernia.
2. A laparoscope is inserted into one incision, and the other incision is used for additional surgical instruments.
3. The surgeon then isolates the portion of the abdominal lining that is pushing through the muscle. This tissue is called the “hernia sac.”
4. The surgeon returns the hernia sac to its proper position inside the body, then begins to repair the muscle defect.

• ‍If the defect in the muscle is small, it may be sutured closed. The sutures will remain in place permanently, preventing the hernia from returning. For large defects, the surgeon may feel that suturing is not adequate. In this case, a mesh graft will be used to cover the hole. The mesh is permanent and prevents the hernia from returning, even though the defect remains open.‍

• If the suture method is used with larger muscle defects (approximately the size of a quarter or larger), the chance of reoccurrence is increased. The use of mesh in larger hernias is the standard of treatment, but it may not be appropriate if the patient has a history of rejecting surgical implants or a condition that prevents the use of mesh. Once the mesh is in place or the muscle has been sewn, the laparoscope is removed and the incision can be closed. The incision can be closed in one of several ways: it can be closed with sutures that are removed at a follow-up visit with the surgeon, a special form of glue that is used to hold the incision closed without sutures or small sticky bandages called "steri-strips."