Inguinal Hernia

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Introduction

What is an inguinal hernia?

A hernia is a protrusion of tissue from one area of the body through the wall that is supposed to contain it. Hernias can be present at birth due to incomplete closure of a structure, or they may develop later due to increased pressure pushing against a weakened area of muscle or its fibrous sheath (fascia). Inguinal hernias, which occur in about five in 100 children, more frequently in boys than girls, are the most common type of hernias (Source: PubMedHealth).

Inguinal hernias can be direct or indirect. Indirect hernias, which are present at birth, result from incomplete closure of the inguinal canal. In males, the testicles descend from their original intra-abdominal position into the scrotum through the inguinal canal. Direct inguinal hernias result from weakening of the lower abdominal muscles.

Inguinal hernias may or may not be painful, and they are typically seen as a bulge in the groin, labia or scrotum that gets larger over time. Inguinal hernias are often reducible, meaning their contents can be pushed back into the abdomen temporarily. Treatment typically requires surgery to reduce the hernia contents and to close and reinforce the opening.

Swelling can lead to entrapment, or “incarceration,” of the hernia contents, which can include fatty tissue, intestine, and other abdominal or pelvic organs. This can ultimately reduce the blood supply to the incarcerated tissues, resulting in tissue “strangulation.” Tissue strangulation is typically accompanied by intense pain, and it is a medical emergency that requires immediate treatment to prevent tissue necrosis (tissue death).

Intestinal strangulation is a potentially life-threatening medical emergency that requires immediate treatment to reduce the risk of bowel loss. Seek immediate medical care (call 911) if you, or someone you are with, have symptoms such as profuse sweating; severe abdominal pain; increased swelling of a known hernia; a painful new bulge or mass; severe nausea and vomiting; an inability to have bowel movements or pass gas; decreased or absent urine output; or high fever (higher than 101 degrees Fahrenheit).

Seek prompt medical care for bulges of the groin, scrotum or labia, especially if they increase in size or are painful, or if you have been treated for an inguinal hernia but symptoms recur.

Symptoms

What are the symptoms of an inguinal hernia?

Some inguinal hernias occur without symptoms. A bulge may be noticed in the groin, scrotum or labia. It may increase in size when abdominal pressure is increased, as occurs with coughing or heavy lifting. The area may be painful.

Common symptoms of inguinal hernias

Common symptoms of inguinal hernias include:

  • Bulging area or lump in the groin
  • Enlargement of the lump when abdominal pressure is increased
  • Lump that is reducible with gentle pressure
  • Painful lump
  • Pain radiating down the leg
  • Redness of the skin over a lump
  • Swelling of the labia or scrotum

Serious symptoms that might indicate a life-threatening condition

In some cases, an inguinal hernia can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

  • Change in bowel habits, such as an inability to have bowel movements or pass gas
  • High fever (higher than 101 degrees Fahrenheit)
  • Increased swelling of a known hernia
  • Not producing any urine, or an infant who does not produce the usual amount of wet diapers
  • Painful new bulge or mass
  • Severe abdominal pain
  • Severe nausea and vomiting
Causes

What causes inguinal hernias?

Inguinal hernias may be present at birth or they may develop over time. Hernias present at birth are called congenital hernias, and are also referred to as indirect hernias. They are a result of incomplete closure of the inguinal canal, the canal through which the testicles descend from their original intra-abdominal position into the scrotum. Direct inguinal hernias develop later in life as a result of weakening of the lower abdominal muscles.

There is a tendency for inguinal hernias to run in some families.

What are the risk factors for inguinal hernias?

A number of factors increase the risk of developing an inguinal hernia. Experiencing one or more of these risk factors does not necessarily mean you will develop an inguinal hernia. Risk factors for an inguinal hernia include:

  • Chronic constipation
  • Chronic cough
  • Enlargement of the prostate or other conditions that can result in straining to urinate
  • Family history of hernias
  • Lifting or pushing heavy objects
  • Low birth weight
  • Male gender
  • Nutritional deficiencies
  • Obesity
  • Overexertion
  • Premature birth
  • Smoking
  • Steroid use
  • Undescended testes

Reducing your risk of inguinal hernia

You may be able to lower your risk of inguinal hernia by:

  • Avoiding lifting or pushing heavy objects
  • Avoiding overexertion
  • Avoiding straining to urinate
  • Eating a healthy diet
  • Maintaining a healthy weight
  • Managing constipation and avoiding straining to have a bowel movement
  • Quitting smoking
Treatments

How are inguinal hernias treated?

As with many diseases and conditions, treatment of inguinal hernias begins with maintaining a program of regular medical care throughout the course of your life. Regular medical care allows your health care professional to provide early screening for many conditions. And with regular medical care, your health care professional can more promptly evaluate symptoms and your risks for inguinal hernia.

The only cure for inguinal hernia is surgery, and it is typically performed when the hernia increases in size or becomes uncomfortable. During surgery, the protruding tissues and organs are pushed back into the abdominal cavity, the stretched portion of the peritoneum (the membrane lining the abdominal cavity) that protrudes is removed, and the peritoneal defect is closed. The opening in the abdominal wall is also closed, and it is often reinforced with mesh to reduce the risk of recurrence.

Small hernias may simply be monitored, and the use of wearable “trusses” can provide support for the area of herniation.

What are the potential complications of inguinal hernia?

Complications of untreated inguinal hernias can be serious, even life threatening in some cases. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of inguinal hernias include:

  • Adverse effects of surgical repair
  • Bowel obstruction
  • Intestinal strangulation
  • Necrosis (death) of tissues and gangrene, which may require removal of the dead tissues
  • Nerve damage
  • Shock
  • Testicular injury
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Jan 5
  1. Hernia. PubMed Health, a service of the NLM from the NIH. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001956/.
  2. Inguinal hernia. National Digestive Diseases Information Clearinghouse (NDDIC). http://digestive.niddk.nih.gov/ddiseases/pubs/inguinalhernia/
  3. Bope ET, Kellerman RD (Eds.) Conn’s Current Therapy. Philadelphia: Saunders, 2013.
  4. Domino FJ (Ed.) Five Minute Clinical Consult. Philadelphia: Lippincott Williams & Wilkins, 2013.
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