INGUINAL HERNIA

An inguinal hernia is the protrusion of abdominal contents, usually the intestines, into the inguinal region through a weakness or defect in the abdominal wall.  In men, the testes usually descend through this canal shortly before birth. In women, the canal is the location for the uterine ligament.  The resulting bulge can be painful, especially when you cough, bend over or lift a heavy object.

Some have no apparent cause, but others can be due to the following:

  • Increased pressure within the abdomen
  • A pre-existing weak spot in the abdominal wall
  • A combination of increased pressure within the abdomen and a pre-existing weak spot in the abdominal wall
  • Straining during bowel movements or urination
  • Strenuous activity
  • Pregnancy
  • Chronic coughing or sneezing

Factors that contribute to developing an inguinal hernia include:

  • Being male. Men are eight times more likely to develop inguinal hernia
  • Older age.  Muscles weaken as you age.
  • Family history
  • Chronic cough
  • Chronic constipation
  • Pregnancy.  Being pregnant can weaken the abdominal muscle and cause increased pressure inside your abdomen.
  • Premature birth or low birth weight.
  • Previous inguinal hernia or hernia repair.

Complications of an inguinal hernia include:

  • Pressure on surrounding tissue.  In men, large hernias can extend into the scrotum, causing pain and swelling.
  • Incarcerated hernia.  If the contents of the hernia become trapped in the weak point in the abdominal wall, it can obstruct the bowel, leading to severe pain, nausea, vomiting, and the inability to have a bowel movement or pass gas.
  • Strangulation.  An incarcerated hernia can cut off blood flow to part of your intestine.  Strangulation can lead to the death of the affected bowel tissue.

Inguinal hernias can be either indirect or direct.

An indirect inguinal hernia is the most common type. It often occurs in premature births, before the inguinal canal can fully develop. However, this type of hernia can occur at any time during your life. This condition is most common in males.

A direct inguinal hernia most often occurs in adults. The popular belief is that weakening muscles during adulthood lead to a direct inguinal hernia.

Inguinal hernia signs and symptoms include:

  • A bulge in the area on either side of the pubic bone, which becomes more obvious when upright, especially if you cough or strain.
  • A burning or aching sensation at the bulge.
  • Pain or discomfort in your groin, especially when bending over, coughing or lifting.
  • A heavy or dragging sensation in your groin.
  • Weakness or pressure in your groin.
  • Pain and swelling around the testicles when the protruding intestine descends into the scrotum.

DIAGNOSIS

Your doctor can make this determination during a physical exam. During the exam, your doctor will ask you to cough while standing so they can check the hernia when it’s at its largest.

If the diagnosis is not readily apparent, your doctor might order an imaging test, such as an abdominal ultrasound, CT scan, or MRI.

 

TREATMENT

Surgery is the primary treatment for inguinal hernias. It’s a very common operation and a highly successful procedure when done by a well-trained surgeon. Your doctor will recommend either herniorrhaphy (“open” repair) or laparoscopic surgery (done through a small scope).

Open repair involves making an incision into the groin and returning the abdominal tissues to the abdomen and repairing the abdominal wall defect. Laparoscopy uses several short incisions rather than a single, longer incision. This surgery may be preferable if you want a shorter recovery time.

Laparoscopy is a minimally invasive procedure, in which the surgeon operates through several small incisions in your abdomen. A small tube equipped with a tiny camera (laparoscope) is inserted into one incision. Guided by the camera, the surgeon inserts tiny instruments through other incisions to repair the hernia using synthetic mesh

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