Inguinal Hernia

Inguinal hernias are the most common type of hernia. These hernias occur in the lower abdominal wall in two passages, called inguinal canals, on either side of the groin.

Fat or soft tissue, usually a part of the intestine, bulges through an opening in the abdominal wall.

Inguinal hernias are more common in men. About 27 percent of men and 3 percent of women will have an inguinal hernia in their lifetime, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

Inguinal hernias don’t get better over time and can get worse if left untreated.

Sometimes a doctor can gently massage a hernia back in place. If the hernia is more serious, doctors have to perform hernia repair surgery.

When hernias first start, they often don’t have symptoms. As inguinal hernias get worse, the first symptoms are pain and a noticeable bulge under the skin in the groin area.

Symptoms are slightly different for men and women, according to Johns Hopkins Medicine. Inguinal hernia pain may be worse for men — especially when lifting or straining.

Emergency Symptoms

If you have symptoms of a strangulated hernia, seek medical attention right away. A strangulated hernia is a life-threatening condition that happens when part of the intestine pushes through the abdominal wall, gets clamped shut and loses blood supply.

Inguinal hernias are caused by a weak area in the connective tissue and muscles of the lower abdominal wall, specifically in the inguinal canal.

Some people are born with a defect in the abdominal wall that leads to a hernia later in life. Others develop weakened abdominal walls later in life.

There are two types of inguinal hernias: Indirect and direct.

Indirect Inguinal Hernia

Birth defects in the lower abdominal wall cause indirect inguinal hernias.

Before babies are born they have openings inside the abdomen that lead to the inguinal canals on either side of the groin. Normally, these openings close before birth. When they don’t close, contents of the abdomen may bulge through, causing a hernia.

Some people with the birth defect don’t have a hernia until many years later. Premature babies are at increased risk from indirect inguinal hernias.

Direct Inguinal Hernia

Direct inguinal hernias develop later in life. They are caused by a weak area in the inguinal canal wall that slowly forms over time or by repeated straining or heavy lifting. Contents of the abdomen bulge out of the weak spot and cause a hernia.

Women and children don’t often suffer from direct inguinal hernias. These hernias primarily occur in adult men.

Incarcerated or Strangulated Hernias

When indirect or direct hernias become stuck in the groin and cannot be pushed back, they become incarcerated. Incarcerated hernias can become strangulated hernias that cut off the blood supply to the small intestine.

Strangulated hernias are medical emergencies.

Medical providers diagnose inguinal hernias by performing physical examinations and abdominal imaging tests such as ultrasounds, X-rays, CT scans or MRIs.

Often, doctors can diagnose inguinal hernias in men from just a physical examination. Women may require imaging tests to confirm the presence of a hernia, according to a 2020 article by Dr. Amer Shakil and colleagues from the University of Texas Southwestern Medical Center.

The type of treatment for an inguinal hernia depends on whether or not it’s causing symptoms and how serious the symptoms are.

Hernias don’t just go away on their own and may get worse over time without treatment. Hernia complications include painful pressure on surrounding tissues, swelling and incarceration or strangulation of the hernia.

Hundreds of thousands of people have surgery to treat their hernias each year. Most people recover quickly and can return to normal activities.

Inguinal Hernia Surgery

Patients with symptomatic hernias require inguinal hernia surgery. The type of surgery a doctor recommends depends on the patient’s age and general health as well as the size of the hernia.

Hernia repair surgery may be done with or without hernia mesh. Most doctors use mesh because there is less chance the hernia will come back. However, some people may suffer hernia mesh failure that causes complications. This requires revision surgery to remove and replace failed mesh.

The two main types of surgery are open and laparoscopic.

Open Hernia Surgery

To perform open hernia surgery, doctors manually make a cut in the groin to repair the hernia. At this point, the doctor may use a patient’s own tissue and stitches or surgical mesh to repair the weak spot in the abdominal wall.

Patients typically receive local anesthesia for open hernia repair surgery, though some may receive spinal blocks or general anesthesia.

Laparoscopic Hernia Surgery

Laparoscopic hernia surgery is a minimally invasive technique where the surgeon makes several small cuts in your lower abdomen. They insert special tools through these small cuts to repair the hernia with a piece of mesh.

Patients most often receive general anesthesia for this procedure. It’s usually more expensive and takes longer than open repair, but recovery time may be shorter because the surgeon cuts through fewer muscles.

Inguinal Hernia Surgery Complications

In general, inguinal hernia surgery is quite safe, according to the National Institute of Diabetes and Digestive and Kidney Diseases. But some people may have complications after surgery.

A few types of hernia mesh have been recalled after causing problems. Some people who suffered complications after their mesh failed filed hernia mesh lawsuits against manufacturers claiming the mesh was defective.

Recurrence was the most common complication before the hernia mesh’s invention. Research is mixed on how long a mesh hernia repair will last. A 2022 study followed 100 patients for ten years after a ventral abdominal hernia repair.

No recurrence was recorded after three years, while about 10% had a recurrence after roughly eight years. Two patients had a central breakdown of the mesh at about seven years. Mesh had stretched across the defect by an average of 21%. Mechanical testing showed that the mesh lost its elasticity at low forces.

Do’s and Don’ts After Inguinal Hernia Surgery

Most people who have hernia surgery can go home the same day. The average inguinal surgery recovery time is about three to six weeks.

After three weeks patients may return to light activities and after six weeks, they may do more strenuous exercise.

These are general guidelines and each person is different. Talk to your doctor about your specific recovery plan.

Inguinal Hernia Treatment without Surgery

If the hernia is relatively minor and isn’t causing symptoms, doctors may recommend watchful waiting. This means the doctor will keep an eye on the hernia to see if it gets worse before pursuing more treatment.

For some hernias with minor symptoms, a doctor may be able to gently massage the bulge back into the abdominal wall.

Doctors may recommend compression underwear or belts to support weakened muscles and relieve the discomfort of a hernia

Birth defects that cause indirect inguinal hernias can’t be prevented, but adults can take steps to reduce their risk for developing an inguinal hernia later in life. These steps involve limiting the strain on abdominal muscles.