What is Inguinal Hernia?

Hernia is a common condition in which part of an internal organ or tissue bulges through a muscle.

An inguinal hernia is a type of hernia in which the intestines or fat from the abdomen bulge through the lower abdominal wall into the groin area, which is the area between the abdomen and thigh.

1. What are the types of Inguinal Hernia?

There are two types of inguinal hernias; the direct inguinal hernia and indirect inguinal hernia. They have different causes.

Indirect inguinal hernia- is caused by a defect in the abdominal wall. The defect may be present at birth (congenital).
Direct inguinal hernia- usually occurs in adult males. It is most often caused by a weakness in the muscles of the abdominal wall that develops over time, or are due to straining or heavy lifting.

2. Symptoms of Inguinal hernia

Many persons are unaware of the inguinal hernia and it is only detected on the routine physical examination. If inguinal hernia is causing problems, you will experience one or more of the following symptoms:

A small bulge in one or both sides of the groin. It typically increases in size on standing and disappear when lying down. It becomes prominent on coughing and straining as the pressure increases inside the abdomen
Swollen or enlarged scrotum in males
Groin discomfort, pain or gurgling sensation
Heavy or dragging sensation in your groin

3. Causes of Inguinal hernia

Inguinal hernia basically occurs when there is a weakness in the muscles of abdominal wall. The muscle weakness may be congenital or may occur in older age. Any condition that increases the abdominal pressure (such as long standing constipation, coughing or heavy weight lifting) will cause the part of intestines to bulge out from the weakened muscle. Inguinal hernia is common in males because the spermatic cord crosses the abdomen and enters the scrotum from the inguinal area thus creating a potential weak spot.

4. Risk Factors of Inguinal hernia

Lifting heavy objects
Chronic constipation and straining
Obesity
Chronic coughing
Pregnancy
Previous hernia repair or abdominal surgery
Trauma

5. Prevention of Inguinal Hernia

The risk of inguinal hernia can be reduced by decreasing the intra-abdominal pressure. It can be achieved by:

Maintaining a healthy weight
Preventing constipation by consuming high-fiber foods
Avoiding heavy lifting
Stopping smoking

6. Complications of Inguinal hernia

Most cases of Inguinal hernia are not life threatening. But sometimes an inguinal hernia may become strangulated or trapped. In these cases, a part of intestine becomes trapped within the hernia and the bulge does retract into the abdomen. The blood supply to the trapped part of intestine is also reduced, resulting in ischemia and gangrene of the part of intestine. It is a surgical emergency and surgery is needed to relieve the trapped part of intestine. The common symptoms of an strangulated or incarcerated inguinal hernia are:

Extreme pain, tenderness and redness in the area of the bulge
Nausea and vomiting
Constipation
Fever
Rapid heart rate

7. Diagnosis of Inguinal hernia

Your doctor will make a diagnosis of inguinal hernia by taking a detailed history and physical examination. Your doctor will ask you to stand and cough to feel the hernia as it moves into the groin or scrotum. Your doctor may also check to see if the hernia can be gently massaged back into its proper position in the abdomen. Inguinal hernia is a clinical diagnosis and usually no other tests are required.

8. Treatment of Inguinal hernia

If your inguinal hernia is not causing any symptoms and is not uncomfortable, your doctor may advise for a “wait and watch” approach. If you are having constipation or cough, they will be adequately managed to prevent an increase in the inguinal hernia.

Surgical Management of Inguinal hernia

Surgery is the only treatment to totally remove a trapped inguinal hernia and prevent constriction.\ Hernia surgery is also called herniorrhaphy. There are two main types of surgery to repair hernias. Those are open hernia repair and laparoscopic hernia repair.

Open hernia repair:

In open hernia repair, your doctor will give an incision in the groin area and will move the hernia back into the abdomen, and will then close the abdominal wall with stitches to fill the gap and prevent hernia to occur again. Your doctor may also place a synthetic mesh to provide additional support.

Laparoscopic hernia repair:

In laparoscopic hernia repair, your doctor will not give a big incision but rather will make several small, half-inch incisions in the lower abdomen. Your doctor will then insert a laparoscope, which is a thin tube with a tiny video camera attached. Your doctor will then push back hernia into the abdomen and will repair the defect using synthetic mesh.

9. Diet and Exercise

To prevent constipation, increase your water intake, use stool softeners, and increase dietary fiber intake. If you have any type of hernia it is advisable to limit strenuous physical activity until the hernia is repaired. After a hernia is repaired, make sure to consult your physician about when it would be safe to resume physical exercise.

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