An inguinal hernia occurs when tissue protrudes through a weak spot in the abdominal muscles, specifically in the groin area.
It is one of the most common types of hernias, affecting both men and women, but is more prevalent in men. Inguinal hernias can cause discomfort, pain, and complications if left untreated.
Causes and Risk Factors
The main cause of an inguinal hernia is a weakening of the muscles in the groin area that allows abdominal contents to bulge through. Several factors contribute to this weakening, including:
- Genetics: Some individuals may inherit a predisposition to weak abdominal muscles, making them more susceptible to developing inguinal hernias.
- Age: As individuals age, their abdominal muscles may weaken, increasing the risk of hernias.
- Gender: Men are more likely to develop inguinal hernias than women due to the natural anatomical structure of the inguinal canal.
- Chronic Strain: Activities or conditions that increase pressure on the abdomen, such as heavy lifting, persistent coughing, or straining during bowel movements, can weaken the muscles and contribute to hernia formation.
- Pregnancy: In women, pregnancy can increase abdominal pressure and weaken the muscles, making them more susceptible to hernias.
- Smoking: This can reduce tissue strength and also lead to a chronic cough making people vulnerable to developing a hernia
Symptoms
The symptoms of an inguinal hernia can vary depending on the size and severity of the hernia. Common symptoms may include:
- Bulge: The most prominent symptom of an inguinal hernia is a visible bulge in the groin area, which may become more noticeable when standing, coughing, or straining.
- Pain or Discomfort: Discomfort or aching sensation in the groin, particularly when lifting heavy objects, coughing, or bending over.
- Pressure or Heaviness: A feeling of pressure or heaviness in the groin area, especially after prolonged standing or physical activity.
- Swelling: Swelling or enlargement of the scrotum in men or the labia in women, particularly if the hernia extends into the genital area.
- Symptoms of Incarceration or Strangulation: In rare cases, an inguinal hernia can become trapped (incarcerated) or have its blood supply cut off (strangulated), leading to severe pain, nausea, vomiting, and a red or tender bulge. These are medical emergencies and require immediate attention.
Diagnosis
Diagnosing an inguinal hernia typically involves a physical examination and may include additional imaging tests. Common diagnostic methods may include:
- Physical Examination: A healthcare provider may perform a physical examination to feel for a bulge in the groin area and assess its size, location, and reducibility (whether it can be pushed back into the abdomen).
- Ultrasound: An ultrasound scan may be used to visualize the hernia and surrounding structures to confirm the diagnosis and assess for any complications.
- CT: This is used rarely if the diagnosis is in doubt or if the anatomy needs clarification (e.g. in a recurrent hernia)
Treatment
Treatment for an inguinal hernia typically involves surgical repair to reinforce the weakened abdominal wall and prevent recurrence. Treatment options may include:
- Watchful Waiting: In cases where the hernia is small and asymptomatic, a healthcare provider may recommend watchful waiting and monitoring for any changes in size or symptoms.
- Laparoscopic Surgery: In some cases, minimally invasive laparoscopic surgery may be performed, involving small incisions and the use of a camera and specialized instruments to repair the hernia.
- Robotic Surgery: Minimally invasive surgery using small (8mm) incisions and attached to robotic instruments (controlled by the surgeon) can be appropriate in some patients with inguinal hernia. Most patients are served well by either the laparoscopic or open approach.
- Open Surgery: Traditional open surgery may be necessary for larger or more complex hernias, involving an incision in the groin area to access and repair the hernia with mesh.