Inguinal Hernia

Condition Basics

What is an inguinal hernia?

An inguinal hernia (say "IN-gwuh-nul HER-nee-uh") happens when tissue bulges through a weak spot in your groin area. You may see or feel a tender bulge in the groin or scrotum. You may also have pain, pressure or burning, or a feeling that something has "given way."

What causes it?

Most inguinal hernias happen because an opening in the muscle wall does not close as it should before birth, leaving a weak area in the belly muscle. Pressure on that area can cause tissue to push through the belly and bulge out.

Belly muscles that are torn or weakened can also cause the condition.

What are the symptoms of an inguinal hernia?

The main symptom of an inguinal hernia is a bulge in the groin or scrotum. It often feels like a round lump and may be uncomfortable or painful. The bulge may form over a period of weeks or months. Or it may appear suddenly after an activity that strains the groin.

How is it diagnosed?

A doctor can usually tell if you have an inguinal hernia based on your symptoms and a physical exam. The bulge of a hernia is usually easy to feel.

How is an inguinal hernia treated?

Only surgery can repair an inguinal hernia. But if your hernia does not bother you and it causes no other problems, you may not need treatment right now. Hernias in babies and young children can be more dangerous and generally need to be repaired with surgery right away.

Prevention

Most inguinal hernias cannot be prevented, especially in infants and children. Adults may be able to prevent a few hernias or prevent a hernia from recurring by using some common self-care steps.

• Avoid becoming overweight.

  Being overweight creates greater abdominal pressure and increases your risk for developing an inguinal hernia. Stay at a healthy weight through diet and exercise.

• Avoid rapid weight loss (such as in crash dieting).

  Rapid weight-loss programs may be lacking in protein and vitamins that are needed for muscle strength, causing weakness in the muscles of the abdomen.

• Stop smoking.

  Chronic coughing from smoking increases the risk for developing a hernia.

• Avoid constipation and straining.

  Constipation and straining during bowel movements and urination causes increased pressure inside the abdomen.

• Lift carefully.

  Use good body mechanics when you lift heavy objects. Lift with your legs, not with your back.

Symptoms

The main symptom of an inguinal hernia is a bulge in the groin or scrotum. It often feels like a round lump. The bulge may form over a period of weeks or months. Or it may appear suddenly after you've been lifting heavy weights, coughing, bending, straining, or laughing. The hernia may be uncomfortable or painful. Some cause no pain.

A hernia also may cause swelling and a feeling of heaviness, tugging, or burning in the area of the hernia. These symptoms may get better when you lie down.

In babies, a hernia may bulge when the child cries or moves around.

Strangulated hernias, which happen when part of the intestine gets trapped in the hernia, are more common in babies and children than in adults. They can cause nausea and vomiting and severe pain. A baby with a strangulated hernia may cry and refuse to eat.

What Happens

Inguinal hernias typically flatten or disappear when they are pushed gently back into place or when you lie down. Over time, hernias tend to increase in size as the abdominal muscle wall becomes weaker and more tissue bulges through.

If you can't push your hernia back into your belly, it is incarcerated. A hernia gets incarcerated when tissue moves into the sac of the hernia and fills it up. This is not necessarily an emergency.

But if a loop of the intestine is trapped very tightly in the hernia, the blood supply to that part of the intestine can be cut off (strangulated), causing tissue to die. In a man, if tissue is trapped, the testicle and its blood vessels can also be damaged.

A strangulated hernia is a medical emergency that requires immediate surgery.

When to Call

Call a doctor now if:

• Your child has an inguinal hernia that can't be pushed back into the belly with gentle pressure.
• You or your child has an inguinal hernia and symptoms of strangulation, such as nausea, vomiting, fever, tenderness, and severe cramping pain in the groin area. These symptoms mean that the intestine has lost blood supply.

Call a doctor if:

• Your infant has a definite lump in the groin area.
• You or your child has a tender bulge in the groin or scrotum, even if the bulge disappears when lying down.
• You or your child has increasing groin discomfort or pain. The discomfort may be increased by bending or lifting. It may extend into the scrotum.

Talk with your doctor before wearing a corset or truss for a hernia. These devices are not recommended for treating hernias. They sometimes can do more harm than good.

Watchful waiting

Watchful waiting is a wait-and-see approach. If you aren't sure if you have a groin muscle strain or a hernia, watchful waiting with home treatment for 1 to 2 weeks is okay to try. If you have pain that is increasing or severe, an obvious lump, or evidence of bowel blockage or urinary symptoms, call your doctor to be checked.

Watchful waiting is not okay for infants and children who have inguinal hernias.

You and your doctor can decide whether you should have surgery to fix your hernia or if you can wait. If your hernia doesn't bother you, you can probably wait to have surgery.

Exams and Tests

Your doctor can usually diagnose an inguinal hernia by asking questions about your health and doing a physical exam. Tests such as ultrasound and CT scans are not usually needed. In most cases, a doctor can find an inguinal hernia during the physical exam.

Other tests may be needed if you need to have surgery. These tests check the status of any current health problems, such as lung, heart, or bleeding problems.

Treatment Overview

Only surgery can repair an inguinal hernia. But if the hernia does not bother you and it causes no other problems, you may not need treatment right now.

Many people with hernias have surgery to repair them when more symptoms develop. It is very uncommon for a hernia to become strangulated, a serious problem that happens when part of your intestine gets trapped inside the hernia.

Some people wait to have surgery. Waiting to have surgery does not increase the chance that part of your intestine or belly tissue will get stuck in your hernia. Waiting will also not increase your risk for problems.

The two types of surgeries to repair inguinal hernias are:

• Open inguinal hernia repair.
• Laparoscopic inguinal hernia repair.

Hernias in babies and young children can be more dangerous and often need to be repaired with surgery right away because of the increased risk of incarceration and strangulation.

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Self-Care

• Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• Use proper lifting techniques, and avoid heavy lifting if you can. To lift things more safely, bend your knees and let your arms and legs do the work. Keep your back straight, and do not bend over at the waist. Keep the load as close to your body as you can. Move your feet instead of turning or twisting your body.
• Lose weight if you are overweight.
• Include fruits, vegetables, legumes, and whole grains in your diet each day. These foods are high in fiber and will make it easier to avoid straining during bowel movements.
• Do not smoke. Smoking can cause coughing, which can cause your hernia to bulge. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.

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