Inguinal Hernia

Inguinal hernias occur when tissues like the intestines bulge through a defect or weakness in the abdominal wall. They occur near the inguinal canal, which is a specific structure in the groin area. Inguinal hernias are the most common type of hernia, affecting between 15% and 20% of the population. In fact, groin hernias are the most frequently encountered surgical condition by primary care doctors.

The inguinal type is specific to the groin area, unlike umbilical hernias which develop around the navel or hiatal hernias which form at the top of the stomach.

Groin hernias are more common in men than in women. Roughly 90% of inguinal hernias happen in men, with only 10% in women. They are also age-dependent, with the majority forming after age 40.

Types

There are two main types of inguinal hernias: direct and indirect. Indirect inguinal hernias are the most common type in both men and women. They can be further classified into congenital—the defect is present at birth—or acquired, which develops later in life. 

Inguinal hernias result from a weakness or defect in the abdominal wall. This can result from defective tissue abnormalities but also from repeated stretching of the wall from straining or heavy lifting. Continued straining can aggravate symptoms and lead to further complications.

Most indirect inguinal hernias result from a birth defect in which an anatomical structure called the internal inguinal ring fails to close. This creates a defect through which abdominal tissues can pass. Although the defect is present at birth, it may take years before any symptoms manifest. Women and children with groin hernias are more likely to have this type.

Both inguinal hernia types can become incarcerated or strangulated. Incarceration means that the tissues in the hernia sac becomes trapped outside of the abdominal wall and cannot be pushed back inside. This can develop further into strangulation, where the blood supply to the affected tissues is cut off, potentially leading to tissue death.

Strangulated inguinal hernias are medical emergencies and require immediate medical attention.

Many patients do not experience any hernia symptoms. However, symptoms can develop as inguinal hernias worsen. The first sign many people notice is a small bulge at the site that may become larger when straining. Sometimes symptoms may improve when resting or lying down.

Johns Hopkins University notes that men and women may notice different symptoms as their hernia grows. Men may notice swelling around their testicles or a tugging sensation around the scrotum, whereas women might not have a bulge at all.

Patients may experience other symptoms of inguinal hernias that can signify a medical emergency.

These are often symptoms of bowel obstruction and require immediate medical attention.

The cause of inguinal hernia is a weak spot on the abdominal wall in the inguinal canal. This can result from a birth defect or from weaknesses that develop over time. A failure of the abdominal wall to fully close during fetal development is the main contributing factor to indirect inguinal hernias.

Certain behaviors and lifestyle choices can contribute to the development of hernias. For example, individuals who frequently lift heavy objects are at a higher risk of developing a direct inguinal hernia due to the repeated stretching of tissues in the groin. Additionally, each type of hernia has different risk factors.

White males over 40 are the most likely subset of the population to develop inguinal hernias. Men have an estimated lifetime risk of inguinal hernia of 27% compared to 3% in women.

Doctors usually diagnose hernias with a physical examination. They will feel for a bulge, sometimes asking a patient to cough or bear down to enlarge the hernia. A physical exam can also help a doctor determine if surgery is necessary.

Some patients, especially women who did not develop a bulge, may need imaging tests such as MRI or ultrasound for a proper diagnosis.

Early diagnosis is important for establishing a treatment plan, ruling out other potential causes for a groin bulge and preventing complications.

Doctors use several treatment approaches for inguinal hernias. The presence and severity of symptoms significantly influence the choice of treatment.

Many patients first try a conservative treatment approach for hernias. This can include lifestyle changes, such as avoiding heavy lifting or straining and watchful waiting to see if the condition stabilizes. A doctor may also try to massage the hernia back through the abdominal wall.

However, doctors rarely recommend watchful waiting for non-pregnant women, even if they’re asymptomatic. This is because this demographic is at a higher risk of developing femoral hernias, which are more likely to block blood supply.

Hernia repair surgery provides a long-term solution by closing the tear. During a repair, doctors insert a mesh or use the surrounding tissue to reinforce the abdominal wall. This is a common procedure, with medical providers performing over 800,000 hernia repairs annually. Recurrence rates are between 0.5% and 15%.

Doctors can perform hernia repairs through open or laparoscopic techniques. The latter is less invasive and offers a shorter recovery time.

Using Hernia Mesh for Inguinal Hernia Repair

The use of hernia mesh in hernia repair surgery reduces recurrence rates. It also allows for shorter recovery times since doctors disturb less surrounding tissue. However, it still has risks. Hernia mesh failure is a serious potential complication.

If this happens, a doctor must perform revision surgery to remove and replace the failed mesh. Other potential complications from a failed hernia mesh repair include bowel blockages, pain, infection, mesh migration and nerve entrapment.

Several hernia mesh manufacturers recalled some of their products. Many patients who experienced complications after hernia mesh failure filed hernia mesh lawsuits seeking compensation.

Many patients go home on the same day as their hernia mesh surgery. Surgery recovery usually takes an average of three to six weeks. During the first two weeks, patients are limited in strenuous physical activities such as lifting. After four to six weeks, most patients can resume normal activities and return to work.

General guidelines include gentle exercise such as walking, rest and drinking plenty of fluids. Doctors may prescribe or recommend medication for pain management, and patients should avoid activities that cause pain to worsen. Additionally, patients should report any symptoms that could indicate complications, such as worsening pain, fever or changes in bowel movements, to their doctor.

Every patient and procedure is unique. It’s important to follow the advice of your repair surgeon to develop an appropriate recovery plan.