Inguinal Hernia

What is an inguinal hernia?

An inguinal hernia is when part of your intestine pushes through a weak spot in your lower belly (abdominal) wall. This area is called the groin. The hernia creates a lump in your groin. Over time, the hernia may get bigger.

Most inguinal hernias, even large ones, can be made smaller and pushed back into your belly using gentle massage and pressure.

What causes an inguinal hernia?

There are two types of inguinal hernias: indirect and direct.

Indirect inguinal hernia. This is the most common type. It happens when an opening in your belly (abdominal) wall does not close normally before birth. That leaves a weak spot in the belly wall.
Direct inguinal hernia. This type occurs mainly in adult males. It is caused by a weakening of abdominal muscle tissue over time. This happens because of aging and long-term stress on the weakened belly muscles.

Who is at risk for an inguinal hernia?

An inguinal hernia can happen at any age.

You are at greater risk for an inguinal hernia if you:

Are male
Are obese
Are a pregnant woman
Have a family history of inguinal hernias
Smoke

Some activities may also raise your risk for an inguinal hernia. These include:

Doing a lot of heavy lifting
Long-term (chronic) coughing
Straining to have a bowel movement

What are the symptoms of an inguinal hernia?

Some inguinal hernias are painful while others don’t cause any pain.

Each person’s symptoms may vary. Symptoms may include:

A lump in the groin or in the sac that holds the testicles (the scrotum)
Pain or pressure in the groin that gets worse when you cough, strain, lift, or exercise
A burning feeling in the lump
Steady, growing pain if the blood supply to the bulging part of the intestine is cut off (called a strangulated hernia)

In severe cases, the intestine is partly or fully blocked. Symptoms in severe cases may also include:

Infection
Nausea
Vomiting
Lack of hunger

The symptoms of an inguinal hernia may look like other health problems. Always see your healthcare provider to be sure.

How is an inguinal hernia diagnosed?

Your healthcare provider will likely be able to tell that you have an inguinal hernia by looking at your past health and giving you a physical exam.

During the physical exam, they will try to push the hernia back into your belly.

You may also have imaging tests, including:

Ultrasound (sonography). This creates images of blood vessels, tissues, and organs on a computer screen using high-frequency sound waves. It is used to see the intestine and abdominal wall and check blood flow through different vessels.
X-ray. This test makes pictures of internal tissues, bones, and organs on large sheets of film. It uses invisible electromagnetic energy beams.
CT scan. This test shows detailed images of any part of the body, such as the bones, muscles, fat, and organs. A CT scan is more detailed than a regular X-ray. It uses a combination of X-rays and computer technology to make images of the body.
MRI. This test uses a magnetic field, radio waves, and a computer to view parts of the body.

How is an inguinal hernia treated?

An inguinal hernia will not heal on its own. If you have symptoms or the hernia is growing, you may need surgery.

There are two types of surgery for an inguinal hernia: traditional open hernia repair (herniorrhaphy) or laparoscopic hernia repair.

Open hernia repair. Your surgeon will cut the skin at the groin. They will push the bulging intestine back into your belly. Then, a stitch will close the opening in the muscle wall. Sometimes your surgeon may fix the weak area and make it stronger with mesh or wire (hernioplasty).
Laparoscopic hernia repair. Your surgeon will make a few small cuts (incisions) in your lower belly. They will insert a thin, flexible tube (laparoscope) into one of the cuts. The tube has a tiny video camera in it that is attached to a screen. This lets your healthcare provider see inside your belly. They will use long, thin tools in the other cuts to repair the hernia with mesh.

Inguinal hernias that are not causing any symptoms can be closely watched. If symptoms occur, your surgeon can repair the hernia through open surgery or laparoscopic surgery. Some surgeons recommend repair of all groin hernias in women. This is because it can be difficult to tell an inguinal hernia from a more complicated type of hernia (femoral hernia) in women.

You will need surgery right away if your small intestine gets stuck in the groin (incarcerated hernia) or if blood supply to your small intestine is blocked (strangulated hernia).

In some cases, a hernia may come back after surgery. This is less likely to happen when mesh is used to support the weak belly muscles.

What are possible complications of an inguinal hernia?

An inguinal hernia can lead to other problems such as:

Incarcerated hernia. This is when part of the small intestine gets stuck in the groin and can’t be pushed back into your belly. Get emergency medical care right away.
Strangulated hernia. If the incarcerated hernia is not treated, blood supply to the small intestine is blocked. This is a life-threatening condition. Get emergency medical care right away.
Hole (perforation). A hole (perforation) in the intestine may happen if the hernia is strangulated and part of the intestine dies from lack of blood. This is when the pinched-off part of the intestine, or bowel, is removed. In this case, you may need a bowel resection.
Peritonitis. If the hernia is sore and the skin over it is red and warm, you may have an infection of the lining of your belly (peritonitis).

Key points about inguinal hernia

An inguinal hernia happens when part of the intestine pushes through a weak spot in the belly (abdominal) wall.
The hernia creates a soft lump under the skin.
Most inguinal hernias can be pushed back into the belly with gentle massage and pressure.
An inguinal hernia will not heal on its own. If you have symptoms, or the hernia is growing, you may need surgery. Some surgeons recommend the repair of all groin hernias in women. Hernias that do not cause symptoms can be monitored, especially in men.
You will need surgery right away if your small intestine gets stuck in the groin (incarcerated hernia) or if blood supply to your small intestine is blocked (strangulated hernia).

Next steps

Tips to help you get the most from a visit to your healthcare provider:

Know the reason for your visit and what you want to happen.
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your healthcare provider tells you.
At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your healthcare provider gives you.
Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are and when you should report them.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your healthcare provider if you have questions.