Inguinal hernia

A hernia is a lump that results from a part of the intestine (bowel) slipping through a weakness in the abdominal wall. The most common hernias are inguinal hernias (groin hernias)

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A hernia occurs when an organ protrudes through an abnormal opening or weakness outside its normal position. A common abdominal hernia is an inguinal hernia. In this situation, part of the bowel or abdominal contents protrudes out through the weakness in the groin called the inguinal ring. The Inguinal ring allows the spermatic cord to leave the abdomen and supply the testes. Inguinal hernias are therefore much more common in men than in women. Groin hernias in women tend to be femoral hernias.

What are the types of inguinal hernias?

There are two types of inguinal hernia – direct and indirect. Indirect inguinal hernias tend to occur in babies, especially premature babies, or young children. This is a mild genetic birth defect. 

Direct inguinal hernias tend to occur in men much later in life. Risk factors for direct inguinal hernias include obesity, excessive coughing due to smoking or lung disease, chronic bronchitis or an occupation involving heavy lifting. It can be difficult to determine whether an inguinal hernia is direct or indirect until surgery itself. Generally this does not matter as treatment is very similar.

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What are the symptoms and signs of inguinal hernias?

Usually the patient will notice a lump in the groin area. The lump may be intermittent, only occurring if standing up and disappearing on lying down. Coughing may make the lump larger or more painful. The patient or doctor may be able to push the lump back into the abdomen. This is known as reducibility but the hernia may still cause pain.

The real concern occurs when the hernia cannot be pushed back into the abdomen and so becomes irreducible or incarcerated. If the hernia becomes stuck outside, then the bowel may become obstructed leading to complete bowel obstruction if left untreated.

The most serious complication is a "strangulated" hernia. In this case the hernia has become stuck and the narrow ring through which is has passed has become so tight that it is constricting the blood supply to the bowel or bowel contents in the hernia. Severe pain is common. The bowel in the hernia may die from lack of blood leading to serious peritonitis and infection.

How are inguinal hernias treated?

The diagnosis is usually apparent on examination of the groin. Occasionally, ultrasound or CT scan may be required if there is doubt. If the inguinal hernia is causing no pain and can easily be pushed back, then no treatment may be recommended. This is especially the case if the patient is elderly and medically unfit. A surgical support or truss can keep the hernia in the abdomen by direct pressure.

Most patients have either discomfort or wish to avoid the potential complications of obstruction or strangulation. The most effective treatment is surgical. This can be performed either as keyhole or laparoscopic surgery or open through a traditional incision. The hernia contents are reduced back into the abdomen and the hernia orifice is closed either by stitches or by using a mesh. This can be performed under general or local anaesthesia.

The results of surgery are good but inguinal hernias do recur in about 10% of cases. This is particularly true if the underlying cause of obesity, smoking and chronic lung disease has not been addressed.

Last updated 03/06/2016

Consultant Gastroenterologis at The Shrewsbury and Telford Hospital NHS Trust and Specialises in Gastrointestinal and Liver services
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