Inguinal hernia

A hernia is the protrusion of an organ or tissue through the structure that usually contains it. With an inguinal hernia, a loop of intestine pushes through an opening in the abdominal wall into the inguinal canal (a passageway in the lower abdomen that opens into the groin).


Causes/associated factors
An inguinal hernia may develop when the inguinal canal area of the lower abdominal muscle weakens or tears. Some people are born with a weakness in this area and others acquire the condition later. People who have inguinal hernias usually have a family history of groin hernias. Also, men are 25 times more likely to develop this type of hernia than women. Sometimes, the weakness is caused by pressure in the abdomen from:
obesity
pregnancy
excessive coughing or sneezing
heavy lifting
straining during a bowel movement
enlargement or blockage of the prostate (a male gland located at the base of the bladder)

Signs/symptoms
Symptoms may include:
abdominal pain
discomfort in the upper thigh or groin (a dragging sensation, for example)
pain or discomfort that's aggravated by bending or lifting
a lump or bulge in the groin area (the lump may disappear when you lie down)
a lump that gets bigger when you cough, bend, lift or strain
constipation

Diagnosis
An inguinal hernia is typically diagnosed based on a physical exam. Blood tests and X-rays may help the doctor determine if your intestine is blocked. Ultrasound (using sound waves to create an image of internal body parts) may be used to differentiate a hernia from other potential causes of groin swelling.

Treatment
If you have mild symptoms or the hernia isn't causing problems, the doctor may be able to simply push the hernia back into place. No further treatment may be needed. Some hernias will even slip back into place on their own. Although the lump or bulge in the inguinal canal may resolve without treatment, the condition that allowed it to happen may not. This is why symptoms of a hernia can recur repeatedly. Some people are able to avoid problems by limiting the amount of lifting they do.
Surgery
If the hernia is incarcerated (can't be returned to the abdominal cavity) or you have complications or pain that interferes with normal activity, your doctor may recommend surgery. If the condition is severe, you may need immediate surgery.

The surgical repair of a tear in the abdominal muscle wall is called herniorrhaphy. If a weak part of the muscle wall needs to be reinforced (using material such as mesh or wire), the procedure is called hernioplasty. If the hernia condition has caused blockage of stool passage or obstruction of blood flow to the intestine, the doctor may need to do a bowel resection to remove part of your intestine. Hernia surgery may be done under local, regional or general anesthesia. The procedure may be done with a traditional incision or through a laparascope (a thin, flexible tube equipped with a camera lens and light used to see the inside of a hollow organ or cavity). Depending on the severity of the condition and your medical history, the procedure may be done in an outpatient or hospital setting.

Surgical risks
Risks from the inguinal herniorrhaphy surgery include:

infection
urinary retention
recurrence of hernia
injury to the testicular blood vessels or nerves (Testicular atrophy, or decrease in size, is considered a rare complication.)
rarely, excessive blood loss
rarely, osteitis (bone inflammation)
Surgical risk increases when you're obese, over age 60, have chronic health conditions, such as lung disease or prostate conditions, or have a history of excessive alcohol use or smoking.


Complications
If an inguinal hernia is left untreated for too long, the doctor may not be able to move it back into place. If the blood supply to the intestine is cut off, the hernia has become strangulated. This can lead to gangrene (death of tissue) of that section of the intestine. A strangulated intestine is a life-threatening medical emergency.

Pregnancy-specific information
The increase in abdominal pressure during pregnancy can contribute to the appearance and progression of a hernia in the groin area. Inguinal hernia is not considered a common problem in pregnancy, however.

Senior-specific information
Aging increases the risk of developing an inguinal hernia. Elderly women tend to have a higher incidence of femoral (upper thigh) hernias than the general population. Anyone who has a strangulated inguinal hernia would need emergency surgical repair, regardless of age. Surgical risk depends on your overall health status, and healing may take longer for older adults. If the initial surgery is not successful, repeat operations done close together pose a much higher risk.

Prevention
It may not be possible to prevent an inguinal hernia. You can reduce your risk, however.
If you are overweight, lose the extra pounds.
Exercise regularly to maintain good muscle tone.
Avoid lifting, pulling or pushing excessively heavy objects, especially when you're out of shape.
Stop smoking. You'll cough less and enjoy a variety of other health benefits.
If you have a chronic cough, consult your doctor.
Prevent constipation and straining during bowel movements by eating more fiber and drinking plenty of fluids.
Jock straps or groin-support devices may be a good idea at certain times. Consult your doctor for advice.