Inguinal Hernia: Symptoms, Surgical Repair & Causes

Medical review: Dr. Clarisse Bezerra
Family Doctor
December 2021

An inguinal hernia is a bulge that emerges in the groin area. It happens more frequently in men, and is characterized by a part of the intestine that protrudes through a weak point in the abdominal muscles.

There are 2 main types of inguinal hernias:

  • Direct inguinal hernia: This type is more common in adults and the elderly and occurs as a result of straining increases pressure in the abdomen (e.g. after lifting heavy objects)
  • Indirect inguinal hernia: This type is more common in babies and children and occurs due to a congenital problem that allows a piece of the intestine to enter the groin and, in some cases, the scrotum.

In both cases, surgery is necessary to repair the hernia and replace the intestine in the correct spot. Any weakened muscles are reinforced to prevent reoccurrence.

Inguinal hernia symptoms

The most common symptoms of an inguinal hernia are:

  • A lump or swelling in the groin area;
  • Groin pain or discomfort when standing up, bending over, or lifting weights;
  • Feeling of heaviness in the groin;
  • Pain that radiates to the testicles in the case of men.

In babies, a hernia can be more difficult to identify because a bulge in the groin may not be very obvious, even when changing a diaper. However, one way to assess the presence of the hernia is to look at the groin when the baby is crying or when the baby is having a bowel movement or coughing, as pressure caused by strain will make the hernia more visible.

With almost all inguinal hernias, doctors can push the hernia back into the abdomen, and alleviate any symptoms temporarily. However, surgery is always necessary to correct the problem permanently. When the hernia does not return to the inside of the abdomen, there is a high risk of strangulation, in which the intestine becomes trapped and necrosis can occur.

How to know if the hernia is strangulated

To find out if the hernia is being strangulated (ie. if the intestine is stuck) it is important to be aware of some symptoms, such as:

  • Very intense pain in the hernia area;
  • Vomiting;
  • Abdominal distension;
  • Constipation or unable to pass a bowel movement;
  • Groin swelling.

Strangulation is more frequent in babies, as the hernia is often difficult to identify and, therefore, as treatment is not started in time, allowing the hernia to worsen. Therefore, it is advised that visit a pediatrician as soon as possible if you suspect your baby has a hernia. 

Repairing through surgery

Inguinal hernia repair surgery, also known as inguinal hernioplasty, is the best form of treatment, and it is especially indicated for patients who have symptoms. The surgery is performed under spinal anesthesia and lasts about 2 hours.

This type of surgery can be done in the traditional way, in which a cut is made in the region of the hernia to place the intestine in the correct location, or laparoscopically, in which only 3 small cuts are made, and a synthetic mesh may be placed to reinforce weakaned abdominal muscles to prevent the formation of a new hernia. However, the type of surgery performed will depend on the type of hernia and the health status of the patient.

Recovery

Recovery is relatively quick, but as hernioplasty is almost always done traditionally, you will likely need to stay in the hospital for 1 to 2 days for vital sign monitoring and observation.

After, when returning home, it is important to take specific precautions, especially during the first 2 weeks. These precautions can include: 

  • Avoid bending at the abdome until the wound is completely healed;
  • Do not hold on more than 2 kg (or about 4.5lb) in weight;
  • Do not sleep on your stomach;
  • Increase intake of fiber-rich foods to avoid constipation and straining to pass stool.

In addition, it is also advised to avoid any heavy physical activity and sitting for a long time during the first month, which is why driving is not recommended.

How diagnosis is confirmed

Inguinal hernia diagnosis is usually made by the doctor after visually assessing it. While evaluating the hernia, the doctor may ask you to cough or strain the abdominal muscles, to see if the hernia bulges, which will also help with its identification. However, in some cases, it may be necessary to perform other diagnostic tests to confirm a hernia, such as an ultrasound.

What Causes an Inguinal Hernia

An inguinal hernia occurs when the abdominal wall is weakened, allowing the intestine to put pressure on the muscle and eventually protrude under the skin. For this reason, a hernia can only happen when there is a weakening of the muscles in the abdomen, which is more common in people with:

  • Increased abdominal pressure, due to a chronic cough or constipation;
  • Congenital defects in the abdominal region, in the case of children;
  • People who are obese or who have hypertension
  • People who smoke.

In addition, hernias are also much more common in children or the elderly, due to the fragility of the abdominal wall.

Possible complications

The main complication of a hernia is when the intestine becomes strangulated in the abdominal wall, eventually losing its blood supply. When this happens, the intestinal tissue can die, causing severe pain, vomiting, nausea, and difficulty moving.

These cases usually only happen when the hernia is not treated. If this happens, you should go to the emergency room as soon as possible to prevent complete tissue death. Surgery may be necessary to remove a part of the intestine if it does die and is not recoverable.

In addition, as a consequence of inguinal hernia, a scrotal hernia may develop, in which the hernia reaches the scrotum. Therefore, in addition to intestinal strangulation, there may also be changes in sperm production and storage, leading to infertility. 

How to prevent a hernia

It is not always possible to prevent a hernia from appearing, however, there are some measures that can reduce the risk, such as:

  • Exercise regularly, at least 3 times a week, to keep your muscles strong;
  • Eat a diet rich in vegetables and other fiber, to decrease any constipation that could increase abdominal pressure;
  • Avoid picking up very heavy objects, especially without help.

In addition, quitting smoking and maintaining an ideal body weight also help to reduce pressure in the abdominal region, decreasing the chances of a hernia. 

Was this information helpful?

Atualizado por Tua Saude editing team, em December de 2021. Medical review por Dr. Clarisse Bezerra - Family Doctor, em November de 2021.

References

  • NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DESEASES. Hernia Inguinal . Available on: <https://www.niddk.nih.gov/health-information/informacion-de-la-salud/enfermedades-digestivas/hernia-inguinal>. Access in 28 Dec 2021
  • VACCA, Vincent M. . Hernia inguinal. La lucha contra la profusión. Elsevier. Vol.35. 2.ed; 26-33, 2018
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  • OLIVEIRA, FÁBERSON JOÃO M.; RIBAS, CIRO N.; DORNELLES, VANESSA; TONETO, THEOBALD MARCELO G. Abaulamento em região inguinal. Available on: <https://docs.bvsalud.org/biblioref/2018/02/859322/abaulamento-em-regiao-inguinal.pdf>. Access in 22 Oct 2021
  • CLAUS, Christiano Mario P.; OLIVEIRA, Flávio M. M.; FURTADO, Marcelo L. et al. Orientações da Sociedade Brasileira de Hérnia (SBH) para o manejo das hérnias inguinocrurais em adultos. Rev Col Bras Cir. Vol 46. 4 ed; 2019
Medical review:
Dr. Clarisse Bezerra
Family Doctor
Dr. Bezerra possesses a medical degree and specializes in family medicine. She is licensed to practice under CRM-CE licence #16976.