An inguinal hernia is a fairly common condition in which the small intestine or intra-abdominal fat protrudes through the lower abdominal muscles. A hernia, in its general definition, is a piece of tissue or organ that bulges through the muscle that normally contains it. In the case of an inguinal hernia, the abdominal contents push into the inguinal canal. The canal is much larger in men than in women, which perhaps accounts for the higher incidence of this type of hernia in men.
The inguinal canal is a tube-like passageway that holds the spermatic cord in men and the round ligament to the uterus in women. When abdominal contents pass into the canal, it presents as a protrusion at the groin area. There are two types of inguinal hernia, indirect and direct.
Indirect inguinal hernias are more common than direct inguinal hernias and occur when the abdominal contents slide through a weakness in abdominal wall. This congenital condition is most common with premature babies who more at risk of the inguinal ring not fully closing. In males, the ring is open to allow the testes and spermatic cord to descend into the scrotum, but if the ring does not fully close, it may leave a weakness that the small intestine or abdominal fat can push through. In a female indirect hernia, the female reproductive organs slide through the weakness in the abdominal wall and into the canal, to present in the groin.
Direct inguinal hernias occur only in men and are associated with aging. As the tissue loses strength and degenerates over time, abdominal muscles lose their integrity. The resulting weakness in these muscles creates an opportunity for fat or small intestine to slip into the groin. This condition is developed gradually due to continuous muscle strain. A direct hernia can be aggravated through heavy lifting, constipation related stress, chronic coughing, sudden muscle pulls or twists, or weight gain.
A person with this type of hernia may experience a bulge on one or both sides of the groin, or the area between the thigh and abdomen. The bulge will likely flatten out when lying down and may grow with time. Other symptoms include aching, burning, or pressure in the groin and pain with physical strain. A hernia may also present as a swollen scrotum in males.
Normally, a hernia can be pushed or massaged back into place. In the event of an incarcerated hernia, however, the tissue or organ becomes stuck and will likely require surgery to prevent a strangulated hernia. A strangulated hernia occurs when the blood supply to the herniated tissue or organ is cut off and is considered a serious medical condition. If left untreated, the tissue or organ may become infected and possibly die, and will need to be removed. A strangulated hernia presents symptoms of acute pain and redness at the site of the bulge, increased heart rate, fever, and, in advanced cases, vomiting and infection.
After diagnosing an inguinal hernia, a doctor will test to see if the hernia can be gently pushed back into place or if it requires surgery. In infants and children, the hernia is always operated upon to prevent risk of incarceration. The two types of surgery are open hernia repair, also called herniorrhaphy, and laparoscopy. In a herniorrhaphy, the doctor makes an incision at the groin, relocates the herniated tissue, and reinforces the weak muscle with stitches and synthetic mesh.
In a laparoscopy, the doctor makes small incisions in the lower abdomen and inserts a lighted viewing device called a laparoscope that produces an image of the patient’s insides on a monitor. The doctor then inserts instruments through the other incisions to push the hernia back and reinforce the muscles. This operation generally has a shorter recovery time, but may not be possible if the patient has a history of pelvic surgery or a very large hernia. After the operation, patients are restricted from physical strain for several weeks and can expect some pain or discomfort.