An inguinal hernia is one of the most common types of hernia, especially in men. It is commonly called a rupture and is very often caused by lifting a heavy object or excessive straining when going to the toilet. The first symptom may be a burning sensation in one or both sides of the groin, perhaps without any swelling initially. But in time, a swelling usually appears in the groin area, and this can often be pushed back in when lying down. The swelling will probably re-emerge when walking around, lifting objects, sneezing or coughing. The swelling may be accompanied by a burning sensation and discomfort, especially when pressure is applied to the area. Over time, the swelling may get more painful and harder to push back in, and it may reach the point where it cannot be pushed back at all.
What is the swelling in the groin?
The swelling that is symptomatic of any hernia or rupture is a pouch that pushes through a weak point in a muscle sheet, such as the abdominal wall. In the case of an inguinal hernia, the pouch is a sac containing bowel or fatty tissue which pushes through an existing gap – the inguinal canal. In men, the inguinal canal lets the baby’s developing testicle and blood vessels drop into the scrotum. This leaves a potential weakness which probably explains the high incidence (27%) of men suffering an inguinal hernia at some point in their lives. In women there are similar inguinal canals, but they are less prone to hernias (only 3%).
When the swelling can be pushed back, it is called a “reducible” hernia, and when it cannot be pushed back it is called an “irreducible” or “incarcerated” hernia. Inguinal hernias do not get better by themselves – ultimately an operation is required to repair the hernia, preferably before complications arise. The bowel may get stuck in the sac and the blood supply may get cut off, resulting in damage or death of a portion of the bowel. This is called a “strangulated hernia”. The strangulated bowel may cause a blockage in the bowel, resulting in vomiting and pain. Immediate surgery is required if a hernia becomes strangulated.
How are inguinal hernias treated?
Not all groin pains and swellings are inguinal hernias. It is possible that the pain is caused by groin strain, and the swelling might just be muscular. In such cases the conditions might clear up, so a wait-and-see approach might be appropriate. Not all inguinal hernias cause groin pains and so some people don’t seek treatment anyway. But once it is clear that you do have an inguinal hernia, it is better to treat it sooner rather than later. Medical imaging can be used to confirm the diagnosis of a hernia.
Some people opt to wear an inguinal hernia belt to hold the hernia in place. These are useful to provide comfort whilst waiting for the operation, but they should only be regarded as an alternative to surgery in those cases where an operation is not possible.
Inguinal hernias are easily treated, preferably early on to prevent strangulation. Surgery is required to push the sac with the bowel or fatty tissue back inside the abdomen. If the bowel or fatty tissue is strangulated and damaged, portions may need to be removed. A sheet of mesh is usually used to strengthen the site of the hernia so as to prevent reoccurrence.
The surgery is fairly straightforward and can usually be conducted as an out-patient. Traditionally an open operation was required, but increasingly laparoscopic surgery is now used instead. The advantages of laparoscopic hernia repair are: quicker recovery; less pain, lower risk of infection, smaller wounds, lower risk of adhesions. The disadvantages are that it is a longer operation and requires general anesthesia, so older patients and those with certain medical conditions may be advised to have open surgery instead since it can be done under local anesthesia.
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