Overview
An inguinal hernia occurs when tissue, such as part of the intestine, protrudes through a weak spot in the abdominal muscles. This can cause a bulge in the groin area, which may be painful, especially when coughing, bending over, or lifting a heavy object. Inguinal hernias can develop due to preexisting weak spots in the abdominal wall, straining during bowel movements or urination, strenuous activity, pregnancy, or chronic coughing or sneezing. While many hernias do not cause pain, a painful or enlarging inguinal hernia typically requires surgery to fix. A strangulated hernia, which occurs when the contents of the hernia become trapped and obstruct the bowel, is a life-threatening complication that requires immediate medical attention.
Understanding the disease
Symptoms
The symptoms of an inguinal hernia may include:
- A bulge in the area on either side of your pubic bone, which becomes more noticeable when you cough or strain
- A burning 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
- Nausea, vomiting, or both
- Fever
- Sudden pain that quickly intensifies
- A hernia bulge that turns red, purple, or dark
- Inability to move your bowels or pass gas It's important to seek immediate medical care if you experience a hernia bulge that turns red, purple, or dark or notice any other signs of a strangulated hernia. If you have a painful or noticeable bulge in your groin, you should see your doctor.
Risk Factors
Risk factors for developing an inguinal hernia include:
- Being male: Men are eight times more likely to develop an inguinal hernia than women.
- Being older: Muscles weaken as you age.
- Being white.
- Family history: Having a close relative, such as a parent or sibling, with the condition.
- Chronic cough, such as from smoking.
- Chronic constipation: Constipation causes straining during bowel movements.
- Pregnancy: Weakened abdominal muscles and increased pressure during pregnancy can contribute to hernias.
- Premature birth and low birth weight: Inguinal hernias are more common in babies born prematurely or with low birth weight.
- Previous inguinal hernia or hernia repair: People who have had a previous hernia are at higher risk of developing another one.
Development
Inguinal hernias can develop due to weaknesses in the abdominal wall muscles, which may occur prior to birth, during aging, or as a result of strenuous physical activity, chronic coughing, or following abdominal surgery. The weak spot in the abdominal wall can be found in different locations, such as the inguinal canal in men or the area where connective tissue from the uterus attaches to the surrounding tissue in women. The risk factors for developing an inguinal hernia include being male, older, white, having a family history, smoking, experiencing chronic constipation, being pregnant, or having a history of inguinal hernias. Complications can arise from pressure on surrounding tissues, including incarcerated hernias and strangulation, which require immediate surgical intervention.
Assessment and Diagnosis
Triage
You should see a doctor if you suspect an inguinal hernia, especially if you experience any of the following symptoms:
- A painful or noticeable bulge in your groin on either side of your pubic bone.
- Nausea, vomiting, or a combination of both.
- Fever.
- Sudden pain that quickly intensifies.
- A hernia bulge that turns red, purple, or dark.
- Inability to move your bowels or pass gas. These signs and symptoms may indicate a strangulated hernia, which requires immediate medical attention as it can be life-threatening if left untreated.
Diagnosis
Inguinal hernia can be diagnosed through a physical examination. During the examination, a healthcare provider will check for a bulge in the groin area, and may ask the patient to stand and cough or strain to make the hernia more prominent. In some cases, imaging tests such as an abdominal ultrasound, CT scan, or MRI may be ordered to assist in the diagnosis.
Management and Treatment
Complications
Potential complications of inguinal hernia include pressure on surrounding tissues, incarcerated hernia, and strangulation. Pressure on surrounding tissues can lead to enlarged hernias and pain, while incarcerated hernia can cause bowel obstruction and severe pain. Strangulation is a life-threatening condition that requires immediate surgery, as it can lead to the death of affected bowel tissue due to the cutting off of blood flow.
Home Remedies
It is important to consult a healthcare professional for proper diagnosis and treatment recommendations for an inguinal hernia.
Treatment
Treatment for an inguinal hernia typically involves surgery, but the type of surgery and approach can vary. The two main types of hernia operations are open hernia repair and minimally invasive hernia repair. In open hernia repair, the surgeon makes an incision in your groin and pushes the protruding tissue back into your abdomen. The weakened area is then sewn, often reinforced with synthetic mesh. Open hernia repair may be done with local anesthesia and sedation or general anesthesia. Minimally invasive hernia repair is performed through several small incisions in your abdomen, often using laparoscopic or robotic instruments. The surgeon inserts a laparoscope and other instruments to repair the hernia with synthetic mesh. This approach often results in less discomfort, scarring, and a quicker return to normal activities. In addition to surgery, there are some non-surgical options to help manage inguinal hernia symptoms:
- Topical anesthetic creams: Lidocaine (Xylocaine) creams may help relieve pain.
- Botox injection: OnabotulinumtoxinA (Botox) injections can be used to paralyze the anal sphincter muscle and relax spasms.
- Blood pressure medication: Nifedipine or diltiazem can be applied to the skin or taken orally to help relax the anal sphincter. These medications may be used when nitroglycerin is not effective or causes significant side effects. It's important to consult with a healthcare provider to determine the best treatment approach based on the individual's specific condition and medical history.