Inguinal Hernia: Symptoms, Causes, Treatment

The term hernia refers to the cases when internal parts of the body push through a muscle weakness or a tissue wall that surrounds it. 

This leads to the formation of a bulge. Sometimes hernias are painful and have a major impact on quality of life. 

There are many types of hernia, but inguinal hernia is the most common. 

Learn more about it below.

What is an inguinal hernia?

Inguinal hernia is the most common type of hernia, and it occurs in the abdomen, i.e., near the groin. It is the bulging of the abdomen content through a weak spot in the lower portion of the abdominal wall. 

This type of hernia usually contains a fat part of the small intestine, but in women, it may contain an ovary. 

Yes, women can develop inguinal hernia too. Men are most commonly affected, though. About 27% of men and 3% of women will develop an inguinal hernia at one point or another in their lives (1).

An inguinal hernia can develop at either of the inguinal canals, i.e., the passages that go through the abdominal wall on each side of the groin area. 

There are two types of inguinal hernia:

  • Direct hernia – penetrates directly through the inguinal canal’s wall, and affects adults.
  • Indirect hernia – reaches the inguinal canal via the top, usually occurs as a birth defect.

Signs and symptoms

Sometimes inguinal hernias are asymptomatic, i.e., without specific signs and symptoms. In some cases, the symptoms may come and go. 

The most common symptoms of an inguinal hernia include:

  • A bulge in the groin region on either side of a pubic bone (more prominent when a person is upright, especially when they strain or cough)
  • Aching or burning sensation at the bulge (may radiate through the pelvis or down the leg)
  • Dragging or heavy sensation in the groin area
  • Pain or discomfort in the groin area, particularly when lifting, coughing, or bending over
  • Pressure, heaviness, or weakness in the groin
  • Pain and swelling around testicles (occasionally, when the protruding intestine descends into the scrotum)

A hernia can be incarcerated or trapped in the abdominal wall if an affected person cannot push it back in. This leads to strangulation of the hernia, which cuts off blood supply to the incarcerated tissue. Without treatment, a strangulated hernia can be life-threatening. 

Symptoms of strangulated hernia are listed below:

  • Fever
  • Severe and sudden pain that intensifies quickly
  • Nausea and/or vomiting
  • Reddish, purple, or dark bulge
  • Bulge larger than before
  • Inability to pass gas or move bowels

Persons who experience the abovementioned symptoms should seek emergency care.

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When to see a doctor

As soon as you notice the bulge in the groin area, schedule an appointment to see a doctor. The healthcare provider will recommend the best solution and may even delay the surgery if it doesn’t bother you. 

Make sure to seek immediate care if the hernia bulge changes color and becomes red, dark, or purple, especially if you also experience other symptoms of strangulated hernia.

doctor

What does a hernia look like on a man?

On a man, an inguinal hernia looks like a bump or bulge in the groin area or scrotum. The bulge is more noticeable when a man is standing or when it’s bearing down with force. In the beginning, a hernia isn’t that noticeable. 

As it grows bigger, it can be visible. This is especially the case when a man is laughing or coughing. 

The more it grows, the easier it is to see it in the groin area. At that point, an affected man may find certain types of underwear or clothes uncomfortable and may start looking for looser items.

What can be mistaken for a hernia?

The appearance of a bulge in a groin area immediately makes us think of an inguinal hernia. While hernia is the most likely cause of a bulge in this area, it’s not the only one. 

In fact, a hernia can be mistaken for several problems, including:

Groin strain 

This is an injury that occurs due to a tear or overstretch of a groin muscle. This injury can cause a lump in the groin area. 

Groin strain usually happens during exercise, skating, running, or playing soccer and basketball. A lump caused by groin strain may be mistaken for a hernia. Plus, both conditions cause weakness.

Ovarian cyst 

This is a fluid-filled sac in or on an ovary. Hernias in women can be small, subtle, and internal, unlike hernias in males. 

Therefore, ovarian cysts can be mistaken for hernias because they’re also small and internal. 

So, if a woman experiences persistent pain, especially in the groin area, an inguinal hernia could be the cause.

Groin hematoma 

This is a collection of blood that forms outside the blood vessels in the groin area. This condition usually results from damage to the blood vessel’s wall. The damage causes leakage of blood into the surrounding tissues. 

Like hernias, groin hematomas appear as bulges. The size of groin hematoma varies from small to large.

Groin lipoma 

This is a round or oval-shaped lump of tissue growing beneath the skin. This fatty tumor usually forms on the chest, shoulders, back, arms, thighs, or bottom. But they can also develop in the groin area. Groin lipomas are rare but can be mistaken for inguinal hernia (2).

Undescended testicles (in newborns) 

This is a testicle that hasn’t moved into its position in the scrotum before birth. Undescended testicles are almost always linked to inguinal hernias because the path that the testicle takes to the scrotal area is also the site where inguinal hernias form.

Other causes

Other possible causes of groin pain and lumps include femoral artery aneurysm (bulging in the wall of the femoral artery in the thigh), athletic pubalgia (injury to tendon/muscle in the lower abdomen), hydrocele (scrotal swelling), spermatocele (cyst in the epididymis), epididymitis, swollen lymph node, swollen masses, and tumors.

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Causes

An inguinal hernia develops due to a weakness or opening in the lower abdominal wall. This opening allows the tissue from the abdomen to go through and cause a bulge. Weakness in the abdominal wall usually occurs before birth, but it can appear later in life too.

In many cases, the cause of inguinal hernia is unknown. A single cause of this condition doesn’t exist. Instead, several causes could be involved.

Some of the biggest causes of an inguinal hernia include:

  • The preexisting weak spot in the abdominal wall
  • Increased pressure in the abdomen
  • Pregnancy
  • Chronic sneezing or coughing
  • Strenuous activities
  • Straining during urination and bowel movements
  • Normal age-related tissue degeneration

Risk factors

Everyone can develop an inguinal hernia, but some people are at a higher risk than others. 

Common risk factors for an inguinal hernia include:

  • Being a male
  • Being white
  • Overweight or obesity
  • Older age
  • Family history
  • Chronic cough
  • Low birth weight or premature birth
  • Previous inguinal hernia
  • Chronic constipation
  • Smoking cigarettes

Diagnosis

Diagnosis of inguinal hernia requires a physical examination. A doctor checks for a bulge in the groin area during a physical exam. 

The patient usually needs to stand during the exam. First, a healthcare provider performs a visual inspection to rule out obvious asymmetry in the scrotum or groin. 

Then, the doctor palpates the scrotum and groin in order to detect the presence of a bulge from a hernia. 

The last part of the physical exam is reserved for palpitation of the inguinal canal, which is accessed through the scrotum.

Since coughing makes a hernia more prominent, the doctor may ask a patient to cough (3).

A doctor can usually diagnose an inguinal hernia based on a physical exam only. But sometimes, it may not be clear whether a patient has a hernia or something else. 

When that happens, a healthcare provider orders imaging tests such as MRI, CT scan, or abdominal ultrasound. 

imaging scans

Do testicular hernias go away?

Testicular hernias do not go away on their own. Surgery is the only way to repair and get rid of a hernia. 

While many people can delay the surgical procedure for months or years, some patients need it in the early stages because they develop symptoms that affect their quality of life.

Inguinal hernias affect people differently, so the experience varies from one person to another. 

Doctors may advise patients with small, unproblematic hernias to watch out for the symptoms, which would signify that surgery is necessary. They may recommend delaying surgery in cases of health problems that could make surgery dangerous, skin infections, or when patients are taking blood thinners. 

In these cases, it is necessary to resolve the infection or other health problems and adjust medications before a patient undergoes surgery.

Hernias tend to grow with time. The more the abdominal muscle wall weakens, the more tissue bulges through. 

Increased size of the inguinal hernia raises the risk of complications. In order to reduce the risk of problems such as strangulation, doctors recommend surgery. 

How serious is an inguinal hernia?

Inguinal hernia is more serious than people believe. While hernia itself is not necessarily dangerous, it can lead to severe and life-threatening complications without treatment. 

The bulge itself is not an emergency, but a hernia is a progressing condition that can lead to problems that require urgent medical attention. Learn more about complications of inguinal hernia in the section below. 

Since inguinal hernias can cause serious problems, the last thing you should do is ignore the bulge. 

Hernias are considered an avoidable cause of death. It’s not that common for people to die from an inguinal hernia, however, especially after surgery (4).

infection after prostate surgery

Complications of inguinal hernia

Complications of inguinal hernia occur when the condition is left untreated. The primary complications are incarceration and strangulation of the bulge. The latter can be life-threatening (5). 

Sometimes hernia contains part of the small intestine, and it can get strangulated or incarcerated. This leads to intestinal obstruction and even death of the affected part of the intestine.

Inguinal hernia can also form significant pressure on surrounding tissues. For example, large hernias in men can extend into the scrotum and cause swelling and pain.

Treatment

The main treatment for inguinal hernia is surgery. The surgical procedure has a high success rate, and it is frequently performed. 

There are two approaches for inguinal hernia repair, and the surgeon performs the one that is most suitable for a patient’s condition. 

These include:

Open inguinal herniorrhaphy 

A surgeon makes one larger incision over the abdomen near the groin area. Then, they push the bulge back into the abdomen. This procedure requires general or local anesthesia. 

Once the bulge is pushed back, the surgeon sews the weakened area and often uses synthetic mesh to reinforce it. This is called hernioplasty.

Laparoscopic inguinal herniorrhaphy 

This is a more minimally invasive hernia repair. It is performed under general anesthesia. The surgeon makes several small incisions in the abdomen and employs laparoscopic instruments to repair a hernia. 

Compared to open surgery, this procedure involves minimal scarring and faster recovery. Since the minimally invasive hernia surgery enables a surgeon to avoid scar tissue from previous procedures, it is most suitable for patients with recurring hernias.

Some patients may have health problems that make it difficult to perform surgery. In these cases, a doctor may massage the hernia back into its place. 

A patient may need to wear a truss or belt to hold the hernia in while they’re doing some activities that would otherwise cause a bulge.

What will happen if the inguinal hernia is left untreated?

Untreated hernias worsen and further affect a person’s quality of life. Hernias do not go away without surgery. When left untreated, the inguinal hernia increases the risk of complications. 

The risk is the highest for children mainly because their bodies are still developing and growing, meaning hernias would also enlarge faster. People who don’t treat their hernias often develop various problems that impact their daily life and activities.

What foods should I avoid with an inguinal hernia?

People with an inguinal hernia should avoid foods that cause gas and bloating. These foods usually include mushrooms, onions and garlic, cabbage vegetables such as broccoli and cauliflower, and some fruits such as pears, apples, cherries, and dried fruit. 

You may also want to avoid or reduce your intake of hard candy, dairy products, carbonated drinks and beer, and chewing gums. Focus on eating fiber-rich foods that don’t leave you bloated.

Conclusion

Inguinal hernia is the most common type of hernia. It worsens and becomes bigger with time. The only treatment is surgery, but not all patients need it immediately. When left untreated, the condition can cause serious complications.

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Sources

  1. Öberg S, Andresen K, Rosenberg J. Etiology of Inguinal Hernias: A Comprehensive Review. Front Surg. 2017. https://pubmed.ncbi.nlm.nih.gov/29018803/ 
  2. Gerych I, Ivankiv T, Ogurtsov O, Kalynovych N. Giant right groin lipoma mimicking inguinal hernia. Int J Surg Case Rep. 2015. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4485679/ 
  3. Hammoud M, Gerken J. Inguinal Hernia. [Updated 2022 Jun 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. https://www.ncbi.nlm.nih.gov/books/NBK513332/ 
  4. Primatesta P, Goldacre MJ. Inguinal hernia repair: incidence of elective and emergency surgery, readmission and mortality. Int J Epidemiol. https://pubmed.ncbi.nlm.nih.gov/8921464/
  5. Morrison Z, Kashyap S, Nirujogi VL. Adult Inguinal Hernia. [Updated 2022 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. https://www.ncbi.nlm.nih.gov/books/NBK537241/

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