The first sign of an inguinal hernia is usually an unexplained bulge in the groin area. This type of hernia can be present at birth or develop over time.
This article looks at the causes, symptoms, and risk factors of an inguinal hernia, and how they are treated.
Symptoms
Symptoms of an inguinal hernia may include:
A bulge in your groin to the left or right of your pubic boneA feeling of heaviness or pressurePain when lifting something, bending over, or strainingPain when coughingPain that radiates from your pelvis to your leg
Inguinal hernias don’t always have symptoms. When they do, the symptoms may be present at some times and not at others.
Inguinal hernias can differ in size. Initially, the hernia may only be a small lump in the groin but can grow much larger over time. Some hernias may be so small that only the peritoneum—the lining of the abdominal cavity—protrudes from the muscle wall. In severe cases, portions of the intestines may push through the hole in the muscle.
An inguinal hernia may also appear to grow and shrink with different activities. Increased abdominal pressure during activities, such as straining to have a bowel movement or sneezing, may push more of the intestines into the herniated area, making the hernia appear to grow temporarily. Lifting heavy objects, working out, and exercises that use the abdominal muscles can also make the hernia bulge.
Causes
An inguinal hernia is caused by a weakness in the muscle of the groin. It can be present at birth due to a small muscle defect or can develop over time.
Repetitive straining to have a bowel movement can cause a hernia. So can straining to urinate, as often happens with prostate problems. A chronic cough, from lung disease or from smoking, can also contribute to a hernia.
Obesity can increase the chances of developing a hernia, too. For some people, losing weight may prevent a hernia from forming or growing in size, while exercise can make hernias temporarily bulge to an even larger size.
Types
An inguinal hernia is a hernia located above the inguinal ligament. It can be hard to tell from a femoral hernia, which is a hernia located below the inguinal ligament.
Sometimes a specialist is needed to confirm which type of hernia you have. In fact, it is possible you may not know which type of hernia you have until surgery.
Healthcare providers use different terms to describe the location of a hernia and its status and severity:
Direct: With a direct hernia, the bulge is in the back of the inguinal canal. Indirect: With an indirect hernia, the bulge is in the inguinal ring. Incarcerated: A hernia that gets stuck in the “out” position is called an “incarcerated hernia. " This is a common complication of inguinal hernias. An incarcerated hernia is not an emergency, but it should be addressed, and medical care should be sought. Strangulated: A strangulated hernia means blood flow has been cut off to the incarcerated tissue. It can be identified by the deep red or purple color of the bulging tissue. It may be accompanied by severe pain, but it is not always painful. Nausea, vomiting, diarrhea, and abdominal swelling may also be present.
Risk Factors
Inguinal hernias are eight to 10 times more likely to occur in males than females. Pregnant females have a higher risk of developing a hernia than females who are not pregnant.
Those who are also at higher risk include:
People with a family history of inguinal hernias Males who have had a prostatectomy People who have connective tissue disorders, such as scleroderma
Inguinal hernias are present at birth in up to 5% of all children.
Treatment
An inguinal hernia will not heal by itself and requires surgery to be repaired.
Hernia Surgery
Inguinal hernia surgery is typically performed using general anesthesia. It can be done on an inpatient or outpatient basis. The surgery is performed by a general surgeon or a colorectal specialist.
Once anesthesia is given, surgery begins with an incision on either side of the hernia. A laparoscope is inserted into one incision, and the other incision is used for additional surgical instruments.
The surgeon isolates the “hernia sac,” the portion of the abdominal lining that is pushing through the muscle. The surgeon returns the hernia sac to its proper position inside the body, then repairs the muscle defect.
If the defect in the muscle is small, it may be sutured closed. The sutures will remain in place permanently, preventing the hernia from returning.
For large defects, suturing may not be adequate. In this case, a mesh graft will be used to cover the hole. The mesh is permanent and prevents the hernia from returning, even though the defect remains open.
When defects the size of a quarter or larger are sutured, there is an increased chance of recurrence. The use of mesh in larger hernias is the standard of treatment, but it may not be appropriate if the person has a history of rejecting surgical implants or a condition that prevents the use of mesh.
Once the mesh is in place or the muscle has been sewn, the laparoscope is removed and the incision can be closed. This is done in one of several ways:
With sutures that are removed at a follow-up visitWith a special form of glue that holds the incision closed without suturesWith small sticky bandages called “steri-strips”
Recovery
Most people are able to return to their normal activity within two to four weeks after hernia surgery. The area will be tender, especially for the first week. During this time, the incision should be protected during any activity that increases abdominal pressure. To do this, apply firm but gentle pressure on the incision line.
Activities during which the incision should be protected include:
Moving from a lying position to a seated position or from a seated position to standing Sneezing Coughing Crying Bearing down during a bowel movement Vomiting Lifting heavy objects (which should be avoided during the recovery process)
Summary
An inguinal hernia happens when part of the intestine protrudes through a weak spot in the muscle. It usually appears as a bulge in the groin.
Males are more likely to get inguinal hernias than females. Some inguinal hernias can be present at birth.
The only way to repair an inguinal hernia is with surgery. The surgery is usually done with a laparoscope. Recovery time is typically around two to four weeks.
A Word From Verywell
If you have a hernia, the first step to treatment is to have a consultation with a surgeon who regularly repairs inguinal hernias. Surgery may or may not be recommended, depending on symptoms, your health, and any risk factors that may be present.
For those with minor symptoms, the risk of surgery may outweigh the benefits of the procedure. Others may feel the procedure is absolutely necessary for cosmetic reasons rather than symptom management.
