Inguinal Hernia

An inguinal hernia presents as a bulge in the upper thigh or groin on either side of the pubic bone. It occurs when an abdominal organ, usually the small intestine, protrudes through a weakness in the abdominal wall or in the inguinal canal. Inguinal hernias are by far the most common hernias, occurring more frequently in men than in women.

The danger of an inguinal hernia, or any type of hernia, is that it may become incarcerated or strangulated, causing life-threatening problems. The existence of a hernia should never be ignored. It should always be evaluated by a physician. If an inguinal hernia is becoming larger or more painful, surgical repair is usually necessary.

Causes of an Inguinal Hernia

Inguinal hernias are sometimes apparent in infancy and result from a congenital weakness in the abdominal wall. In other cases, inguinal hernias may result from one of the following:

  • Increased pressure within the abdomen due to accumulation of fluid
  • Straining during bowel movements or urination
  • Heavy lifting
  • Pregnancy
  • Excessive weight gain
  • Chronic coughing or sneezing
  • Abdominal injury or post-surgical complications

Symptoms of an Inguinal Hernia

In many cases, the inguinal hernia causes no symptoms and is only found by the doctor upon physical examination. Sometimes other symptoms are present, including:

  • Noticeable bulge in the upper thigh, groin, labia or scrotum
  • Heaviness or aching in the groin area which is relieved when lying down
  • Tugging or burning sensation in the femoral area
  • Discomfort or pain in the groin, especially during sneezing, coughing or heavy lifting
  • Sudden pain in the area, sometimes accompanied by nausea or vomiting

Sudden pain may indicate that the hernia has become blocked or strangulated. This complication occurs more frequently in infants and small children. This is an emergency situation and requires immediate care since it means blood flow is impeded and when blood flow to an area is impeded, tissue dies.

Diagnosis of an Inguinal Hernia

Diagnosis of an inguinal hernia is usually made through physical examination only, though other tests may be done to rule out other causes for symptoms. In overly obese patients, where a physical examination is inconclusive, an X-Ray, CT scan or MRI may be needed for a definitive diagnosis. A urinalysis may be performed in order to discount the possibility of a urinary tract infection or kidney stone. Other tests may be done to rule out prostate problems, colon disease, aneurysm, swollen lymph nodes or other causes of lower abdominal pain.

Types of Inguinal Hernias

Reducible

Reducible inguinal hernias are minimally painful. With only moderate manipulation, they can be pushed back behind the abdominal wall.

Irreducible

An irreducible inguinal hernia occurs when intestinal tissue protrudes enough to become lodged in the opening. When this occurs, the patient usually experiences more pain and surgery may be required.

Incarcerated or Obstructed

When intestinal tissue becomes stuck, or incarcerated, the patient experiences extreme pain and and vomiting. At this point, surgery is necessary.

Strangulated

An inguinal hernia is referred to as strangulated when intestinal tissue becomes so tightly trapped that blood flow to the protrusion is cut off, causing tissue to die. If left untreated, this may result in gangrene, or tissue decay. When a hernia is strangulated, the patient experiences extreme pain, nausea and vomiting. This is a medical emergency and must be treated immediately.

Treatment of an Inguinal Hernia

In the case of a minor inguinal hernia where there is no pain, there may be no treatment required. Where there is pain or where the hernia is enlarging, surgery is usually necessary. Many doctors recommend surgery to repair a hernia as a prophylactic measure to prevent later incarceration or strangulation.

During surgery, mesh in the form of a synthetic patch is used to repair the weakness in the abdominal wall. Some patients have a history of rejecting synthetic products. When surgical mesh is not used in the repair of an inguinal hernia, there is a higher rate of recurrence of the hernia. Post-surgically, it is important that issues which may have led to or exacerbated the development of the hernia, such as obesity or chronic coughing, be addressed.

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