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Inguinal Hernia

In a direct inguinal hernia, a portion of the intestine pushes through a weak spot in the abdominal wall and may result in a visible bulge in the groin.

What is it?

A hernia (sometimes referred to as a rupture) is a protrusion of soft tissue, such as a portion of the intestine, through a weak spot in a muscle, usually in the abdominal wall. The most common type—the inguinal hernia—occurs where the abdomen meets the thigh in the groin region. Men are more susceptible to this type of hernia because of a residual weakness along the path (inguinal canal) where the testicles descended into the scrotum prior to birth. But any weakness in the abdominal wall—whether due to injury, strain, aging, or a congenital defect—can promote the formation of one of the two types of inguinal hernia.

In a direct inguinal hernia (the more common of the two), the abdominal organs push through a weak spot in the abdominal wall to create a visible bulge in the groin area. In an indirect inguinal hernia, which occurs almost exclusively in men, the tissue protrudes farther down through the inguinal canal, entering the scrotum. In either case, if the hernia can be pushed back into the abdominal cavity, it is said to be "reducible," which, while not an immediate health threat, eventually requires surgical repair.

If it cannot be pushed back, the hernia is "nonreducible" (or incarcerated), a condition that may lead to dangerous complications including the obstruction of the flow of the intestinal contents or obstruction of intestinal blood supply (strangulation), leading to tissue death. Intestinal obstruction produces nausea, vomiting, loss of appetite, and abdominal pain and usually requires prompt surgery. A strangulated hernia is extremely painful and requires immediate emergency surgery.

What Causes It?

  • Congenital or age-related weakness in the abdominal wall.
  • Increase in abdominal cavity pressure owing to heavy lifting, straining, obesity, or pregnancy.

Prevention

  • When lifting heavy objects, bend your knees, keeping the object close to your chest. Lift using your leg muscles and keep your back straight. Don't strain or hold your breath while lifting.

Diagnosis

  • Patient history and physical examination are usually all that are required. Observation of a protrusion in the groin when the patient strains or coughs during examination indicates diagnosis of an inguinal hernia.

How to Treat It

  • In simple cases, the preferred treatment is herniorrhaphy, in which soft tissue is pushed back into the abdominal cavity, the weak spot is sewn closed, and a piece of nylon mesh is sutured into place to reinforce the abdominal wall. New muscle eventually grows over the mesh. This is now one of the safest and most common of all major operations. Formerly, it required hospitalization, several days of bed rest, and weeks of restricted activity. Thanks to improved techniques, the procedure is now usually done on an outpatient basis under local anesthesia, and the patient can usually return to a normal schedule within a week.
  • Although it requires a general anesthetic, laparoscopic surgery (using a lighted tube inserted through a small hole in the abdominal wall) may cause less postoperative pain.
  • Strangulated hernias require surgical removal of the affected portion of intestine and several days in the hospital.
  • An externally worn truss, once a common remedy, is generally no longer recommended, as it does nothing to address the risk of intestinal strangulation or other associated problems. However, a truss may be useful for those who are too frail to withstand an operation.

When to Call a Doctor

  • See a doctor if you develop the symptoms of inguinal hernia.
  • EMERGENCY Severe lower abdominal pain warrants immediate medical care; it may be a sign of intestinal obstruction or strangulation.