An inguinal hernia is a fairly common condition in which the small intestine or intra-abdominal fat protrudes from 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 explains the higher incidence of this type of hernia in men.
The inguinal canal is a tube-shaped passageway that supports the spermatic cord in men and the round ligament to the uterus in women. When the abdominal contents pass into the canal, it presents as a bulge in 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 abdominal contents slip through a weakness in the abdominal wall. This congenital condition is more common in premature babies who are more at risk of the inguinal ring not closing completely. In men, the ring is open to allow the testicles and spermatic cord to descend into the scrotum, but if the ring doesn't close completely, it can leave a weakness that the small intestine or abdominal fat can pass through. In a female indirect inguinal hernia, the female reproductive organs slip 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, the 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 develops gradually due to continuous muscle tension. A direct inguinal hernia can be aggravated by heavy lifting, stress related to constipation, chronic cough, sudden muscle pulls or twists, or weight gain.
A person with an inguinal hernia may experience a bulge in one or both sides of the groin, or the area between the thigh and the abdomen. The lump will likely flatten out when you are lying down and may grow larger over time. Other symptoms include pain, burning, or pressure in the groin and pain with physical tension. A hernia can also present as a swollen scrotum in men.
Normally, a hernia can be pushed or massaged back into place. However, in the case of an incarcerated inguinal hernia, 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 can become infected and possibly die, and will need to be removed. A strangulated hernia presents symptoms of sharp 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 perform a 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 on to prevent the 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 in the groin, repositions 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 inside of the patient on a monitor. The doctor then inserts instruments through the other incisions to push the hernia back and strengthen 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 tension for several weeks and can expect some pain or discomfort.