Inguinal Hernia

Definition

An inguinal hernia, or a groin hernia, is a protrusion (lump) of the small intestine or fatty tissue into the groin through a weakness or tear in the abdominal wall.

Description

In a man, an inguinal hernia develops in the region where the spermatic cord and blood vessels to the testicles pass out of the abdominal cavity and into the scrotum. The area where these pass through is called the inguinal canal.

In a woman, an inguinal hernia develops where the connective tissue binding the uterus exits from the abdomen to join with the tissue surrounding the vaginal opening.

There are two (2) TYPES of inguinal hernias - indirect and direct.

An indirect hernia affects men only. A loop of intestine passes down the inguinal canal from where a testis descends into the scrotum.

A direct hernia affects both sexes. The intestinal loop forms a swelling in the inner part of the fold of the groin.

Additionally, there are three (3) CLASSIFICATIONS of hernia - reductible, incarcenated and strangulated.

In a reductible hernia the protrusion can be put back into place.

In an incarcenated hernia the protrusion can't be put back into place without surgery because some surrounding tissues or parts have grown together.

In a strangulated hernia the protrusion becomes twisted or swollen and interferes with the normal blood flow and muscle action. Immediate surgery is needed in this type of hernia.

Causes and Risk Factors

Inguinal hernias are usually caused by a congenital defect which occurs as a weakness in the inguinal canal manifesting after injury, pregnancy or aging. Inguinal hernias may appear following surgery or after heavy lifting, birthing a child, exercising, persistent coughing, straining while urinating or defecating or by gaining a lot of weight.

Symptoms

Frequently hernias produce no symptoms. However, some people may experience the following symptoms:

• A lump or swelling in the groin

• A sudden pain into the scrotum

• Abdominal discomfort

• A heavy feeling in the groin

• Pain in the groin while standing or moving

Diagnosis

If the lump is large, the doctor can see an obvious swelling or lump in the groin. If the hernia is small the doctor will examine the groin area for a bulge in the affected area.

Treatment

If the hernia is causing only slight discomfort and can be pushed back (reductible hernia), the doctor will recommend that the patient wear a supportive garment called a truss. A truss is a device that puts pressure on the hernia and holds it in.

Hernias that are painful and can't be pushed back (incarcenated or strangulated hernia) are treated surgically. There are two surgically procedures available for the treatment of inguinal hernias - open surgery or laparoscopy.

Open surgery is the most common type of treatment, accounting for 95 percent of inguinal repairs. This procedure is done under local anesthesia and requires a 4- to 6-inch incision in the groin. The doctor then pushes the herniated tissue back into place and sutures the opening shut. Sometimes a small piece of synthetic material is placed over the gap to serve as a scaffolding on which scar tissue will grow. Full recovery time takes 4 to 6 weeks.

Laparoscopy is done under general anesthesia and involves three small incisions (1/2 inch or less) in the abdomen which in then inflated with carbon dioxide. A laparoscope (a fiber-optic narrow tube with a light on the end) and other instruments are inserted through the incisions. Using a monitor the surgeon pushes the herniated tissue back into place and staples a patch over the opening. Full recovery takes a week or less.

Prevention

Although there is not much a person can do to totally prevent a hernia many experts suggest:

• Keeping weight down

• Keeping the abdominal muscles in shape

• Avoid lifting heavy objects

• Avoid straining to urinate or defecate

Questions to Ask Your Doctor

Is it an inguinal hernia?

What type is it?

Where is it located?

Do you recommend surgery?

How will this be performed?

What are the risks?

Will there be a complete recovery?