inguinal hernia

DEFINITION

An inguinal hernia occurs when soft tissue — usually part of the membrane lining the abdominal cavity (omentum) or part of the intestine — protrudes through a weak point in the abdominal muscles. The resulting bulge can be painful, especially when you cough, bend over or lift a heavy object.

An inguinal hernia isn’t necessarily dangerous by itself. It doesn’t get better or go away on its own, however, and it can lead to life-threatening complications. For this reason, your doctor is likely to recommend surgery to fix an inguinal hernia that’s painful or becoming larger. Inguinal hernia repair is a common surgical procedure.

CAUSES

Some inguinal hernias have no apparent cause. Others occur as a result of:

• Increased pressure within the abdomen
• A pre-existing weak spot in the abdominal wall
• A combination of increased pressure within the abdomen and a pre-existing weak spot in the abdominal wall
• Straining during bowel movements or urination
• Heavy lifting
• Fluid in the abdomen (ascites)
• Pregnancy
• Excess weight
• Chronic coughing or sneezing

In many people, the abdominal wall weakness that leads to an inguinal hernia occurs at birth when the abdominal lining (peritoneum) doesn’t close properly. Other inguinal hernias develop later in life when muscles weaken or deteriorate due to factors such as aging, strenuous physical activity or coughing that accompanies smoking.

In men, the weak spot usually occurs in the inguinal canal, where the spermatic cord enters the scrotum. In women, the inguinal canal carries a ligament that helps hold the uterus in place, and hernias sometimes occur where connective tissue from the uterus attaches to tissue surrounding the pubic bone.

More common in men

Men are more likely to have an inherent weakness along the inguinal canal because of the way males develop before birth.

In male babies, the testicles form within the abdomen and then move down the inguinal canal into the scrotum. Shortly after birth, the inguinal canal closes almost completely — leaving just enough room for the spermatic cord to pass through but not enough to allow the testicles to move back into the abdomen. Sometimes, the canal doesn’t close properly, leaving a weakened area.

In female babies, there’s less chance that the inguinal canal won’t close after birth.

Weaknesses can also occur in the abdominal wall later in life, especially after an injury or a surgical operation in the abdominal cavity. Whether or not you have a pre-existing weakness, extra pressure in your abdomen from straining, heavy lifting, pregnancy or excess weight can cause a hernia.

SYMPTOMS

Some inguinal hernias don’t cause any symptoms. You might not know you have one until your doctor discovers it during a routine medical exam. Often, however, you can see and feel the bulge created by the hernia. The bulge is usually more obvious when you stand upright, especially if you cough or strain.

Inguinal hernia signs and symptoms include:

• A bulge in the area on either side of your pubic bone
• A burning, gurgling or aching sensation at the bulge
• Pain or discomfort in your groin, especially when bending over, coughing or lifting
• A heavy or dragging sensation in your groin
• Weakness or pressure in your groin
• Occasionally, pain and swelling around the testicles when the protruding intestine descends into the scrotum

You should be able to gently and easily push the hernia back into your abdomen when you’re lying down. If not, applying an ice pack to the area may reduce the swelling enough so that the hernia slides in easily. Lying with your pelvis higher than your head also may help.

Incarcerated hernia

If you aren’t able to push the hernia in, the omentum or a loop of intestine can be trapped (incarcerated) in the abdominal wall. An incarcerated hernia can lead to a strangulated hernia, which cuts off the blood supply to your intestine. Surgery is needed to repair the hernia and restore blood supply to the bowel. A strangulated hernia can be life-threatening if it isn’t treated.

Signs and symptoms of strangulated hernia include:

• Nausea, vomiting or both
• Fever
• Rapid heart rate
• Sudden pain that quickly intensifies
• A hernia bulge that turns red, purple or dark
• If any of these signs or symptoms occurs, call your doctor right away.

Signs and symptoms in children

Inguinal hernias in newborns and children result from a weakness in the abdominal wall that’s present at birth. Sometimes the hernia may be visible only when an infant is crying, coughing or straining during a bowel movement. In an older child, a hernia is likely to be more apparent when the child coughs, strains during a bowel movement or stands for a long period of time.

When to see a doctor

See your doctor if you have a painful or noticeable bulge in your groin on either side of your pubic bone. The bulge is likely to be more noticeable when you’re standing upright, and you usually can feel it if you put your hand directly over the affected area. Seek immediate medical care if a hernia bulge turns red, purple or dark.