As we get older, our muscles weaken, and so does our chance of developing a hernia. A hernia is generally caused by a combination of pressure and weakness of muscle, in which the pressure pushes an organ or tissue into the weak spot. Depending on where the spot is, the hernia can either be very serious or not at all.
From my experience of seeing patients with hernias, many barely know what a hernia is, much less think they will develop one in their lifetime. In my next few articles, I will do a few hernia-related ones to shed light on this topic. For this piece, let’s discuss the inguinal hernia, one of the most common and overlooked hernia in men and women.
What is an inguinal hernia?
An inguinal hernia occurs when the intestine or bladder protrudes through the abdominal wall or into the inguinal canal. It accounts for 96% of groin hernias. For reference, the inguinal canal is located at the base of the abdomen around the groin. While both men and women have inguinal canals, inguinal hernias tend to affect men more because of a natural weakness in the area.
What you get is a bulge in the groin area which can be painful, especially when you bend over, cough or lift a heavy object. While an inguinal hernia may not be dangerous, it does not improve on its own and can lead to complications over time. I recommend hernia surgery to fix the bump.
What are the symptoms of an inguinal hernia?
Do look out for the following:
- A bulge on either side of your pubic bone which becomes more obvious when you stand upright, cough or strain
- A burning sensation at the bulge
- Discomfort and general discomfort in your groin especially when you bend over, cough or lift
- For men, there may be pain and swelling around the testicles
What causes an inguinal hernia?
While some inguinal hernias have no cause, they are thought to form due to weak spots within the abdominal and groin muscles. I’ve found that there are a few risk factors that cause extra pressure on those areas, including:
- Pregnancy
- Strenuous activity, such as heavy lifting
- Straining during bowel movements (which, by the way, can lead to piles!)
- Being overweight or obese
- Chronic coughing
I’d like to add that these are general causes but they can contribute to specific types of inguinal hernias.
What are the types of inguinal hernias?
Direct inguinal hernia
A direct inguinal hernia is often caused by a weakness in our muscles as we age or due to pressure, so that’s where the heavy lifting comes in. It is a lot more prevalent in men.
Indirect inguinal hernia
Unlike a direct inguinal hernia, an indirect one is not caused by weakened abdominal muscles or certain activities. Rather, it’s occurs before birth when the inguinal ring (an area of abdominal muscle tissue) fails to close up when the baby is still in the mother’s womb. This allows a part of the intestine to push through. Indirect inguinal hernias are 9 times more likely to develop in men.
Incarcerated inguinal hernia
When tissue gets stuck in the groin and is not reducible, that’s what we call an incarcerated inguinal hernia. Such hernias cannot be pushed back.
Strangulated inguinal hernia
A strangulated inguinal hernia happens when the intestine in an incarcerated hernia has its blood flow cut off. This becomes a serious medical emergency.
Do all inguinal hernias require surgery?
Surgery is the only form of hernia repair, but inguinal hernia repair may not always be necessary. This usually only applies for smaller hernias that are not strangulated, causing bowel obstruction or significant pain.
However, should you require surgery or decide to opt for one, rest assured that hernia surgery is very common and is very successful when performed by an experienced surgeon. I recommend laparoscopic inguinal herniorrhaphy, where smaller incisions instead of a larger cut across the abdomen are made.
The goal of inguinal hernia surgery is to push the protruding abdominal tissue back into where it belongs in the abdominal cavity, and repair the abdominal wall defect. I then put mesh to reinforce the abdominal wall.
How do I prevent an inguinal hernia?
To reduce your risk of an inguinal hernia or prevent it from progressing, you should:
- Maintain a healthy weight
- Eat a diet high in fibre
- Quit smoking, because smoking causes damage to your tissues and causes you to cough a lot as well, which raises of risk of developing a hernia
- Be careful when lifting heavy objects. Always bend at the knees and lift from your legs, not from your lower back.
Have any questions? Send them my way!
References
- Ramanan, B., Maloley, B. J., & Fitzgibbons, R. J., Jr (2014). Inguinal hernia: follow or repair?. Advances in surgery, 48, 1–11. https://doi.org/10.1016/j.yasu.2014.05.017
- Sarosi, G. A., Wei, Y., Gibbs, J. O., Reda, D. J., McCarthy, M., Fitzgibbons, R. J., & Barkun, J. S. (2011). A clinician’s guide to patient selection for watchful waiting management of inguinal hernia. Annals of surgery, 253(3), 605–610. https://doi.org/10.1097/SLA.0b013e31820b04e9
