standard-title Groin Hernia

Groin Hernia

Groin Hernia (Inguinal Hernia)

About Condition

Inguinal Hernia

An inguinal hernia occurs when soft tissue — usually part of the membrane lining the abdominal cavity (omentum) or part of the intestine — protrudes through a weak point in the abdominal muscles. The resulting bulge can be painful, especially when you cough, bend over or lift a heavy object.

An inguinal hernia isn’t necessarily dangerous by itself. It doesn’t get better or go away on its own, however, and it can lead to life-threatening complications. For this reason, your doctor is likely to recommend surgery to fix an inguinal hernia that’s painful or becoming larger. Inguinal hernia repair is a common surgical procedure.

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Signs and Symptoms

Some inguinal hernias don’t cause any symptoms. You might not know you have one until your doctor discovers it during a routine medical exam. Often, however, you can see and feel the bulge created by the hernia. The bulge is usually more obvious when you stand upright, especially if you cough or strain.

Inguinal hernia signs and symptoms include:

  • A bulge in the area on either side of your pubic bone
  • A burning, gurgling or aching sensation at the bulge
  • Pain or discomfort in your groin, especially when bending over, coughing or lifting
  • A heavy or dragging sensation in your groin
  • Weakness or pressure in your groin
  • Occasionally, pain and swelling around the testicles when the protruding intestine descends into the scrotum

You should be able to gently and easily push the hernia back into your abdomen when you’re lying down. If not, applying an ice pack to the area may reduce the swelling enough so that the hernia slides in easily. Lying with your pelvis higher than your head also may help.

Incarcerated hernia

If you aren’t able to push the hernia in, the omentum or a loop of intestine can be trapped (incarcerated) in the abdominal wall. An incarcerated hernia can lead to a strangulated hernia, which cuts off the blood supply to your intestine. Surgery is needed to repair the hernia and restore blood supply to the bowel. A strangulated hernia can be life-threatening if it isn’t treated.

Signs and symptoms of strangulated hernia include:

  • Nausea, vomiting or both
  • Fever
  • Rapid heart rate
  • Sudden pain that quickly intensifies
  • A hernia bulge that turns red, purple or dark

If any of these signs or symptoms occurs, call your doctor right away.

Signs and symptoms in children

Inguinal hernias in newborns and children result from a weakness in the abdominal wall that’s present at birth. Sometimes the hernia may be visible only when an infant is crying, coughing or straining during a bowel movement. In an older child, a hernia is likely to be more apparent when the child coughs, strains during a bowel movement or stands for a long period of time.

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Risk Factors

Risk factors for an inguinal hernia include:

  • Being male. You’re far more likely to develop an inguinal hernia if you’re male. Also, the vast majority of newborns and children who develop inguinal hernias are boys.
  • Family history. Your risk of inguinal hernia increases if you have a close relative, such as a parent or sibling, who has the condition.
  • Certain medical conditions. People who have cystic fibrosis, a life-threatening condition that causes severe lung damage and often a chronic cough, are more likely to develop an inguinal hernia.
  • Chronic cough. A chronic cough, such as from smoking, increases your risk of inguinal hernia.
  • Chronic constipation. Straining during bowel movements is a common cause of inguinal hernias.
  • Excess weight. Being moderately to severely overweight puts extra pressure on your abdomen.
  • Pregnancy. This can both weaken the abdominal muscles and cause increased pressure inside your abdomen.
  • Certain occupations. Having a job that requires standing for long periods or doing heavy physical labor increases your risk of developing an inguinal hernia.
  • Premature birth. Infants who are born early are more likely to have inguinal hernias.
  • History of hernias. If you’ve had one inguinal hernia, it’s much more likely that you’ll eventually develop another — usually on the opposite side.

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Diagnostic Process

A physical exam is usually all that’s needed to diagnose an inguinal hernia. Your doctor is likely to ask about your signs and symptoms and to check for a bulge in the groin area. Because standing and coughing can make a hernia more prominent, you may be asked to stand up and cough or strain as part of the exam.

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Treatment

If your hernia is small and isn’t bothering you, your doctor may recommend a watch-and-wait approach. Enlarging or painful hernias usually require surgery to relieve discomfort and prevent serious complications.

There are two general types of hernia operations — open hernia repair and laparoscopic repair.

Herniorrhaphy

In this procedure, also called an open hernia repair, the surgeon makes an incision in your groin and pushes the protruding omentum or intestine back into your abdomen. The surgeon then sews together the weakened or torn muscle. The weak area often is reinforced and supported with a synthetic mesh (hernioplasty).

After the surgery, you’ll be encouraged to move about as soon as possible, but it may be four to six weeks before you’re fully able to resume your normal activities.

Laparoscopy

In this minimally invasive procedure, the surgeon operates through several small incisions in your abdomen. A small tube equipped with a tiny camera (laparoscope) is inserted into one incision. Guided by the camera, the surgeon inserts tiny instruments through another incision to repair the hernia using synthetic mesh.

Most people who have laparoscopic repair experience less discomfort and scarring after surgery and a quicker return to normal activities. Laparoscopy may be a good choice for people whose hernias recur after traditional hernia surgery because it allows the surgeon to avoid scar tissue from the earlier repair. Laparoscopy also may be a good choice for people with hernias on both sides of the body (bilateral inguinal hernias).

Some studies indicate that a laparoscopic repair may have an increased risk of complications and of recurrence following surgery. These risks can be reduced if the procedure is performed by a surgeon with extensive experience in laparoscopic hernia repairs.

Laparoscopic hernia repair may not be for you if:

  • You have a very large hernia
  • Your intestine is pushed down into the scrotum
  • You’ve had previous pelvic surgery, such as prostate surgery (prostatectomy)
  • You can’t receive general anesthesia

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