What Is It?

In a hernia, part of an organ protrudes through an abnormal opening or in an abnormal way. An inguinal (groin) hernia occurs when a portion of the intestine bulges through a weak spot in the abdominal wall at the inguinal canal. The inguinal canal is a natural passageway through the abdominal wall near the groin. Inguinal hernias are up to 10 times more common in males than in females. About one in four men will develop a hernia at some point in life.

There are two types of inguinal hernias:

• Indirect inguinal hernia — This type of hernia occurs when the internal opening of the inguinal canal, which usually closes around the time of birth, remains open. This allows a portion of the intestine to slip through the inguinal canal. Indirect inguinal hernias often are diagnosed within the first year of life, but may not show up until adulthood. This condition affects between 1 percent and 5 percent of normal newborns and up to 10 percent of premature infants.



• Direct inguinal hernia — This type of hernia occurs when a portion of the intestine protrudes through a weakness in the abdominal muscles along the wall of the inguinal canal. Direct inguinal hernias are common in adults, but rarely occur in children.

In adults, direct and indirect inguinal hernias look and feel about the same. They can occur on one or both sides of the groin. Your doctor may not know which type of hernia you have until surgery is performed. However, both types of hernias are treated in a similar manner.

A type of hernia called a femoral hernia can appear similar to an inguinal hernia. Femoral hernias are much more common in women than in men. They may cause a lump that appears just below the groin and extends into the upper portion of the thigh. In a femoral hernia, a portion of the intestine protrudes through the passage that is normally used by large blood vessels (the femoral artery and vein) when they pass between the abdomen and the leg. Femoral hernias are most common in older, overweight women.

At first, an inguinal hernia either may not cause any symptoms or may cause only a feeling of heaviness in the groin. Symptoms are most likely to appear after prolonged standing, or with activities that increase pressure inside the abdomen, such as heavy lifting, persistent coughing, or straining while urinating or moving the bowels.

As the hernia grows, it eventually causes an abnormal bulge under the skin near the groin. This bulge may become increasingly more uncomfortable or tender to the touch. As the hernia increases in size, a portion of herniated intestine may become trapped (incarcerated) and unable to slide back into the abdomen. If this happens, there is a danger that the trapped intestine may twist and die (strangulate) because its blood supply is cut off. This causes severe pain and requires immediate treatment.

Your doctor will review your symptoms and your medical history. He or she will ask you when you first noticed the lump in your groin, whether it has become larger, and whether it hurts.

Doctors can diagnose most inguinal hernias simply by examining the area. Your doctor will look for an abnormal protrusion near your groin and also will feel the area to check for a mass. Often, the protruding hernia can be pushed back temporarily into the abdomen with careful pressure. Your doctor also may ask you to cough or strain, which may make the hernia easier to feel or see.

In some cases, your doctor may need to confirm the diagnosis with an ultrasound or magnetic resonance imaging (MRI) scan. In these procedures, painless sound or magnetic waves will be used to distinguish a hernia from other causes of a mass in the groin area, such as an enlarged lymph node (swollen gland).

An inguinal hernia will not heal on its own. It is likely to become larger and cause increased discomfort until it is repaired. Hernias that are not repaired can cause bowel obstruction or strangulation.

Indirect hernias in children cannot be prevented. To reduce the risk of inguinal hernia as an adult, you can:

• Maintain a normal body weight.
• Exercise regularly to strengthen abdominal muscles.
• Avoid straining while defecating or urinating.
• Avoid lifting heavy objects.

Not all hernias need to be treated. However, most hernias that cause symptoms or are becoming larger should be repaired by a surgeon. While awaiting surgery, some patients may wear a device called a truss, which puts pressure on the hernia and keeps it under control. In patients who are poor candidates for surgery because of poor health or advanced age, a truss may be used permanently.

There are two basic types of hernia repair: open surgery or laparoscopic surgery. Both usually are done on an outpatient basis and take about one hour to complete.

• Open surgery — About 95 percent of all inguinal hernias are repaired by open surgery with the patient under local anesthetic. After an incision is made in the groin, the surgeon pushes the herniated tissue back into place and repairs the hernia opening with stitches. In many cases, a small piece of synthetic mesh material is used to reinforce the area to prevent the hernia from recurring.



• Laparoscopic surgery — In laparoscopic hernia repair, a surgeon makes three small incisions in the abdominal wall, and the abdomen is inflated with a harmless gas. A laparoscope, a tubelike instrument with a small video camera, and surgical instruments are then inserted through the incisions. While viewing a monitor, the surgeon pushes the herniated intestine back into place and repairs the hernia opening with surgical staples. Although this type of surgery seems attractive to many patients, it is relatively new, and many surgeons are not convinced that it offers many benefits over the traditional, open technique. However, some experts believe that laparoscopic surgery produces less discomfort, and leads to a quicker return to usual activities. If you are interested in laparoscopic surgery, be sure to discuss the advantages and disadvantages with your doctor.

Contact your doctor if you develop a lump, tenderness or a persistent feeling of heaviness in your groin area. In babies and young children, call your doctor promptly if you notice a lump in the child’s groin or scrotum.

Hernia surgery is very safe and usually quite effective. Depending on the location and size of the hernia and what technique is used, up to 10 percent of hernias may develop again at some point in the future.

After open surgery, the patient usually is able to resume normal activities within one to two weeks. For laparoscopic surgery, full recovery generally takes one week or less. After any hernia surgery, the patient should avoid heavy lifting for six to eight weeks (or as the doctor directs) to allow muscle and tissues to heal completely.

Diseases and Conditions Center

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.