Inguinal Hernia National Digestive Diseases Information Clearinghouse What is inguinal hernia? What are the types and An inguinal hernia is a condition in which causes of inguinal hernia? intra-abdominal fat or part of the small The two types of inguinal hernia have differ­ intestine, also called the small bowel, bulges U.S. Department ent causes. of Health and through a weak area in the lower abdominal Human Services muscles. An inguinal hernia occurs in the Indirect inguinal hernia. Indirect inguinal groin—the area between the abdomen and hernias are congenital hernias and are much NATIONAL thigh. This type of hernia is called inguinal more common in males than females because INSTITUTES OF HEALTH because fat or part of the intestine slides of the way males develop in the womb. In through a weak area at the inguinal ring, the a male fetus, the spermatic cord and both opening to the inguinal canal. An inguinal testicles—starting from an intra-abdominal hernia appears as a bulge on one or both location—normally descend through the sides of the groin. An inguinal hernia can inguinal canal into the scrotum, the sac that occur any time from infancy to adulthood holds the testicles. Sometimes the entrance and is much more common in males than of the inguinal canal at the inguinal ring does females. Inguinal hernias tend to become not close as it should just after birth, leav­ larger with time. ing a weakness in the abdominal wall. Fat or part of the small intestine slides through the weakness into the inguinal canal, caus­ ing a hernia. In females, an indirect inguinal Small intestine hernia is caused by the female organs or the small intestine sliding into the groin through a weakness in the abdominal wall. Internal Indirect hernias are the most common type inguinal ring of inguinal hernia. Premature infants are External especially at risk for indirect inguinal hernias inguinal ring because there is less time for the inguinal Pubic canal to close. Penis bone Spermatic Direct inguinal hernia. Direct inguinal her­ cord nias are caused by connective tissue degener­ ation of the abdominal muscles, which causes Testes weakening of the muscles during the adult years. Direct inguinal hernias occur only in males. The hernia involves fat or the small An inguinal hernia showing the small intestine descending through the inguinal canal. intestine sliding through the weak muscles What are “incarcerated” into the groin. A direct hernia develops gradually because of continuous stress on and “strangulated” inguinal the muscles. One or more of the following hernias? factors can cause pressure on the abdominal An incarcerated inguinal hernia is a hernia muscles and may worsen the hernia: that becomes stuck in the groin or scro­ tum and cannot be massaged back into the • sudden twists, pulls, or muscle strains abdomen. An incarcerated hernia is caused • lifting heavy objects by swelling and can lead to a strangulated • straining on the toilet because of hernia, in which the blood supply to the constipation incarcerated small intestine is jeopardized. A strangulated hernia is a serious condition • weight gain and requires immediate medical attention. • chronic coughing Symptoms of a strangulated hernia include Indirect and direct inguinal hernias usually • extreme tenderness and redness in the slide back and forth spontaneously through area of the bulge the inguinal canal and can often be moved • sudden pain that worsens in a short back into the abdomen with gentle massage. period of time What are the symptoms of • fever inguinal hernia? • rapid heart rate Symptoms of inguinal hernia include Left untreated, nausea, vomiting, and severe infection can occur. If surgery is not per­ • a small bulge in one or both sides of formed right away, the condition can become the groin that may increase in size and life threatening, and the affected intestine disappear when lying down; in males, may die. Then that portion of the intestine it can present as a swollen or enlarged must be removed. scrotum • discomfort or sharp pain—especially How is inguinal hernia when straining, lifting, or exercising— diagnosed? that improves when resting To diagnose inguinal hernia, the doctor takes • a feeling of weakness or pressure in the a thorough medical history and conducts a groin physical examination. The person may be • a burning, gurgling, or aching feeling at asked to stand and cough so the doctor can the bulge feel the hernia as it moves into the groin or scrotum. The doctor checks to see if the hernia can be gently massaged back into its proper position in the abdomen. 2 Inguinal Hernia How is inguinal hernia best option if the hernia is very large or the treated? person has had pelvic surgery. In adults, inguinal hernias that enlarge, Most adults experience discomfort after sur­ cause symptoms, or become incarcerated are gery and require pain medication. Vigorous treated surgically. In infants and children, activity and heavy lifting are restricted for inguinal hernias are always operated on to several weeks. The doctor will discuss when prevent incarceration from occurring. Sur­ a person may safely return to work. Infants gery is usually done on an outpatient basis. and children also experience some discom­ Recovery time varies depending on the size fort but usually resume normal activities of the hernia, the technique used, and the after several days. age and health of the patient. The two main types of surgery for hernias are as follows: What are the complications • “Open” hernia repair. In open hernia of surgery for inguinal repair, also called herniorrhaphy, a hernia? person is given local anesthesia in the Surgery to repair an inguinal hernia is quite abdomen or spine to numb the area, safe and complications are uncommon. general anesthesia to sedate or help the Knowing possible risks allows patients to person sleep, or a combination of the report postoperative symptoms to their doc­ two. Then the surgeon makes an inci­ tor as soon as they occur. sion in the groin, moves the hernia back into the abdomen, and reinforces the • Risk of general anesthesia. Before muscle wall with stitches. Usually the surgery, the anesthesiologist—a doctor area of muscle weakness is reinforced who administers anesthesia—reviews with a synthetic mesh or screen to pro­ the risks of anesthesia with the patient vide additional support—an operation and asks about medical history and called hernioplasty. allergies to medications. Complications • Laparoscopy. Laparoscopic surgery is most likely occur in older people and performed using general anesthesia. those with other medical conditions. The surgeon makes several small inci­ Common complications include nausea, sions in the lower abdomen and inserts vomiting, urinary retention, sore throat, a laparoscope—a thin tube with a tiny and headache. More serious problems video camera attached to one end. The include heart attack, stroke, pneumonia, camera sends a magnified image from and blood clots in the legs. inside the body to a monitor, giving the Getting out of bed after surgery and surgeon a close-up view of the hernia moving as soon as the doctor allows will and surrounding tissue. While viewing help reduce the risk of complications the monitor, the surgeon uses instru­ such as pneumonia and blood clots. ments to carefully repair the hernia using synthetic mesh. • Hernia recurrence. A hernia can recur up to several years after repair. Recur­ People who undergo laparoscopic surgery rence is the most common complica­ generally experience a somewhat shorter tion of inguinal hernia repair, causing recovery time. However, the doctor may patients to undergo a second operation. determine laparoscopic surgery is not the Hernia recurrence occurs less often when a hernioplasty is performed. 3 Inguinal Hernia • Bleeding. Bleeding inside the incision is Points to Remember another complication of inguinal hernia • An inguinal hernia is a condition in repair. It can cause severe swelling and which intra-abdominal fat or part of bluish discoloration of the skin around the small intestine, also called the small the incision. Surgery may be necessary bowel, bulges through a weak area in to open the incision and stop the bleed­ the lower abdominal muscles. An ingui­ ing. Bleeding is unusual and occurs in nal hernia occurs in the groin—the area less than 2 percent of patients.1 between the abdomen and thigh. • Wound infection. The risk of wound • An inguinal hernia can occur any time infection is small—less than 2 percent— from infancy to adulthood and is much and is more likely to occur in older more common in males than females. adults and people who undergo more complex hernia repair.2 The person • Direct and indirect hernias are the two may experience a fever, discharge types of inguinal hernia, and they have from the incision, and redness, swelling, different causes. or tenderness around the incision. Post­ • Symptoms of an inguinal hernia usually operative infection requires antibiotics appear gradually and include a bulge in and, occasionally, another procedure the groin, discomfort or sharp pain, a requiring local anesthesia to make a feeling of weakness or pressure in the small opening in the incision and drain groin, and a burning, gurgling, or aching the infection. feeling at the bulge. • Painful scar. Sometimes people expe­ • An incarcerated inguinal hernia is a her­ rience sharp, tingling pain in a spe­ nia that becomes stuck in the groin or cific area near the incision after it has scrotum and cannot be massaged back healed. The pain usually resolves with into the abdomen. time. Medicine may be injected in the area if the pain continues. • A strangulated hernia, in which the blood supply to the incarcerated small • Injury to internal organs. Although intestine is jeopardized, is a serious con­ extremely rare, injury to the intestine, dition and requires immediate medical bladder, kidneys, nerves and blood ves­ attention.