Diseases & Conditions

Inguinal hernia

Inguinal hernias occur when soft tissue — usually part of the intestine — protrudes through a weak point or tear in your lower abdominal wall. The resulting bulge can be painful — especially when you cough, bend over or lift a heavy object.

Not necessarily dangerous in themselves, inguinal hernias can lead to life-threatening complications. For this reason, your doctor is likely to recommend surgical repair of an inguinal hernia that's painful or becoming larger.

Today's hernia surgery isn't the same that your father may have had — with a large abdominal incision, a long hospital stay and weeks of immobility. Instead, many inguinal hernias now can be successfully repaired with a technique that uses several small incisions, leading to a faster, less painful recovery.

Some inguinal hernias don't cause any symptoms, and you may 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 protruding intestine. 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
• Pain or discomfort in your groin, especially when bending over, coughing or lifting
• A heavy or dragging sensation in your groin
• Occasionally, in men, pain and swelling in the scrotum around the testicles when the protruding intestine descends into the scrotum

Signs and symptoms in children
About five in every 100 children have inguinal hernias. 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.

When to see a doctor
See your doctor if you have a painful or noticeable bulge in the area on either side of your pubic bone. The bulge is likely to be more noticeable when you're standing upright, and you usually can feel it if you put your hand directly over the affected area.

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.

If you still aren't able to push the hernia in, the herniated intestine may have become trapped (incarcerated) in the abdominal wall — a serious condition that may require immediate medical attention. This condition may be accompanied by nausea, vomiting or a fever, and a hernia bulge that turns red, purple or dark. If any of these signs or symptoms occur, call your doctor right away.

Some inguinal hernias have no apparent cause. But many occur as a result of:

• Increased pressure within the abdomen
• A pre-existing weak spot in the abdominal wall
• A combination of the two

In many people, the abdominal wall weakness that leads to an inguinal hernia occurs at birth when the abdominal lining (peritoneum) doesn't close properly. Other inguinal hernias develop later in life when muscles weaken or deteriorate due to factors such as aging, strenuous physical activity or coughing that accompanies smoking.

In men, the weak spot usually occurs along the inguinal canal. This is the area where the spermatic cord, which contains the vas deferens, the tube that carries sperm, enters the scrotum.

In women, the inguinal canal carries a ligament that helps hold the uterus in place, and hernias sometimes occur where connective tissue from the uterus attaches to tissue surrounding the pubic bone.

More common in men
Men are more likely to have an inherent weakness along the inguinal canal because of the way males develop in the womb. In the male fetus, the testicles form within the abdomen and then move down the inguinal canal into the scrotum. Shortly after birth, the inguinal canal closes almost completely, leaving just enough room for the spermatic cord to pass through, but not large enough to allow the testicles to move back into the abdomen.

Sometimes, however, the canal doesn't close properly, leaving a weakened area. There's less chance that the inguinal canal won't close after birth in female babies. In fact, women are more likely to develop hernias in the femoral canal, an opening near the inguinal canal where the femoral artery, vein and nerve pass through.

Weaknesses can also occur in the abdominal wall later in life, especially after an injury or certain operations in the abdominal cavity.

Whether or not you have a pre-existing weakness, extra pressure in your abdomen can cause a hernia. This pressure may result from:

• Straining during bowel movements or urination
• Heavy lifting
• Fluid in the abdomen (ascites)
• Pregnancy
• Excess weight

Even chronic coughing or sneezing can cause abdominal muscles to tear.

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 coughing can make a hernia more prominent, you may be asked to cough or strain as part of the exam.

Most inguinal hernias enlarge over time if they're not repaired surgically. Large hernias can put pressure on surrounding tissues — in men they may extend into the scrotum, causing pain and swelling.

But the most serious complication of an inguinal hernia occurs when a loop of intestine becomes trapped in the weak point in the abdominal wall (incarcerated hernia). This may obstruct the bowel, leading to severe pain, nausea, vomiting and the inability to have a bowel movement or pass gas.

It can also diminish blood flow to the trapped portion of the intestine — a condition called strangulation — that may lead to the death of the affected bowel tissues. A strangulated hernia is life-threatening and requires immediate surgery.