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Inguinal Hernia

Introduction

An inguinal hernia is a protruding mass of intestinal tissue that presents as a bulge in the weakened part of the inguinal canal located in the abdominal area.

While an inguinal hernia may not necessarily cause harm, it may lead to pain and discomfort when straining, bending over or coughing.

Types of inguinal hernia

Indirect inguinal hernia

The most common type of inguinal hernia is an indirect inguinal hernia. Largely prevalent in males, the indirect inguinal hernia extends into the scrotum.

Direct inguinal hernia

A direct inguinal hernia doesn't follow the inguinal ring into the scrotum.

Incarcerated hernia

Most inguinal hernias can be pushed back into the intestine. If the tissue becomes stuck, this is known as an incarcerated hernia. An incarcerated hernia can lead to a life-threatening strangulated hernia so urgent medical attention must be sought if it can't be pushed back in.

Strangulated hernia

A strangulated hernia is an incarcerated hernia which has severed the blood flow to the tissue. Symptoms include severe pain, nausea, vomiting, fever, change in colour in the hernia bulge and changes in gas function.

A strangulated hernia can be life-threatening, and you must seek urgent medical attention.

Causes

If weakness is present in the abdominal or groin muscles, persistent pressure from the intestinal tissue may lead to an inguinal hernia. More common in males, risk factors that can cause pressure include:

  • A previous hernia.
  • Premature birth.
  • Obesity.
  • Pregnancy.
  • Persistent heavy cough.
  • Straining caused by constipation.
  • Heavy lifting.

Symptoms

An inguinal hernia presents in one or more of the following symptoms:

  • A protruding bulge in the groin or abdomen area becoming more prominent when coughing.
  • Pain in the groin area intensifying when bending or lifting.
  • Pressure in the groin.
  • Pain or swelling of the testicles or scrotum.
  • In children, loss of appetite or irritability.

While an older child or adult will be able to push an inguinal hernia back into place to diagnose it, hernias in babies may be identified by a bulge in the abdomen or groin area which is more noticeable when they're crying or coughing.

Diagnosis

An inguinal hernia is generally diagnosed visually from a physical examination. An ultrasound of the abdomen and groin may be recommended to identify the condition to diagnose the severity of the hernia.

Treatment

While an inguinal hernia won't resolve itself, it can be pushed back in and the patient may not need any treatment.

In cases where a hernia causes severe and ongoing pain or complications, it can be resolved with a straightforward surgical procedure.

Laparoscopic inguinal herniorrhaphy

Small incisions are made in the abdomen, and the surgeon treats the hernia with keyhole surgery.

Open inguinal herniorrhaphy

In open surgery, a larger incision is made in the affected abdominal area; this is carried out under general anaesthetic.

In both surgical procedures, the hernia is put back into place, and the abdominal wall is repaired with mesh.

Laparoscopic herniorrhaphy is the preferred treatment for an inguinal hernia as it is a more precise method of surgery and recovery is faster.