Definition and Overview

A hernia is a medical condition characterised by the protrusion of internal organs through the wall of the cavity that is supposed to keep them in their right places.

Inguinal hernias are the most common type and are responsible for about 70% of all adult hernias. They occur in the inguinal canal, a part of the abdominal wall where a man’s testicles descend before birth resulting in a bulge in the scrotum or groin. Although the condition can occur on both sides of the pubic area (bilateral inguinal hernia), most cases only affect one side with left inguinal hernias being more common than right inguinal hernias. Inguinal hernias are further classified as either direct or indirect. Direct inguinal hernias occur due to the weakening of the inguinal region and are more common in men over the age of 40. An indirect inguinal hernia, on the other hand, is the result of the weakening of the internal inguinal ring.

Groin hernias can also occur in women but they are very uncommon accounting to just one in every 20 groin hernias. Inguinal hernias in women occur when tissue pushes through the wall of the femoral canal. This also results in a bulge near the groin or thigh and produces pain that extends to the upper thigh.

Causes of Condition

The two main causes of inguinal hernias are:

  • An inguinal canal that failed to close before birth

  • Age-related weakening of the abdominal muscles

Various factors can contribute to the development of hernias, including:

  • Heavy lifting

  • Increased abdominal pressure

  • Obesity

  • Pregnancy

  • Previous history of an inguinal hernia

  • Repetitive straining during urination and bowel movement

  • The presence of fluid in the abdomen

Key Symptoms

Inguinal hernia symptoms are very noticeable and should prompt patients to seek medical attention. These symptoms include:

  • The gradual or sudden appearance of a bulge in the scrotum or groin. Their sudden appearance can be caused by lifting heavy objects, straining, and coughing.

  • Inguinal hernia pain that worsens when the patient lifts objects or bends

  • Swollen scrotum

  • Burning sensation in the inner thigh or scrotum

  • Discomfort in the affected area that is often relieved by lying down

  • In infants, a hernia often bulges when the child moves or cries

  • Nausea and vomiting – These symptoms are often observed in patients suffering from strangulated hernias that cut off blood supply to a part of the intestine.

  • Severe cramping of the groin area

Who to See and Types of Available Treatments

Patients with an inguinal hernia that cannot be pushed back into the abdomen using gentle pressure as well as those that suffer from the symptoms of a strangulated hernia must be taken to the doctor immediately. An inguinal hernia can be treated by an internist, a family medicine doctor, an emergency room doctor, a paediatrician, or a surgeon.

Patients who complain of the symptoms mentioned above undergo a thorough physical exam as well as various tests. This allows doctors to make an accurate diagnosis and rule out other medical conditions such as kidney stones or urinary tract infection that also causes pain in the groin area. These tests include an ultrasound, computed tomography (CT) scan, and urine tests.

Asymptomatic inguinal hernias, or those that are small and painless, do not require any form of treatment because they do not pose any risk to the patient. However, inguinal hernia surgery is recommended if diagnostic tests suggest the risk of strangulation that can cut the blood supply to the intestine. The procedure can be performed using any of the following techniques:

  • Tension repair – This used to be the standard in the treatment of inguinal hernias. It involves making an incision in the abdomen that allows the surgeon to push the protruding tissue inside the abdominal cavity. It is called tension repair because sutures are used to put tension on both sides of the defect to ensure that it remains closed. However, simple suturing often recreates tension that caused the hernia in the first place. As such, other methods of repair have been introduced.

  • Tension-free inguinal hernia repair – This technique, which is now considered the gold standard of hernia repair, uses a piece of mesh to bridge the hernia defect instead of using sutures. The surgical mesh used helps in reinforcing the abdominal wall. Over time, it incorporates into the muscle layer, eliminating the need for another surgery to have it removed.

  • Laparoscopic tension-free inguinal hernia repair – Due to the advancements in the field of surgery, many types of surgical procedures can now be performed using minimally invasive techniques. With this method, the surgeon creates up to four small incisions on the abdomen where endoscope and other special surgical instruments are inserted. During the procedure, the space under the inguinal canal is dissected and organs found in the hernia sac are brought back to their proper places. The weakened area is then reinforced with a piece of mesh. Due to the minimally invasive nature of this procedure, patients enjoy shorter recovery time. The risk of scarring and infection is also minimal.

References:

  • Simons MP, Aufenacker T, Bay-Nielsen M, et al. (August 2009). "European Hernia Society guidelines on the treatment of inguinal hernia in adult patients". Hernia. 13

  • Trudie A Goers; Washington University School of Medicine Department of Surgery; Klingensmith, Mary E; Li Ern Chen; Sean C Glasgow (2008). The Washington manual of surgery. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 0-7817-7447-0.

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