By Alex Bigale, PTA
What is An Inguinal Hernia?
An Inguinal Hernia occurs when part of the intestines or fat protrude through a hole, tear, or weakened portion of the lower abdominal wall; more specifically near the groin or inguinal region. This disorder commonly occurs in men more than women. There are two types of inguinal hernias that occur: indirect and direct.
Indirect Inguinal Hernia
Occurs when there is a deficiency in the abdominal wall (usually congenital or present at birth) that allows for the protrusion of inguinal contents through the abdominal wall.
Direct Inguinal Hernia
Occurs when a defect in the abdominal wall builds over time due to muscle weakness. Any activity that causes increased intra-abdominal pressure can lead to the formation of the hernia.
*Indirect hernias are the cause of the majority of hernias diagnosed in smaller children, but adult males typically fall into the category of direct inguinal hernias.*
Signs and Symptoms of An Inguinal Hernia
- Bulging on the side of the pubic bone which becomes more prominent with prolonged standing.
- Pain or burning in the region which can intensify with bending, lifting, or straining.
- For men, possible pain/swelling of the testes if the hernia protruded through the scrotum.
- A heavy or weak feeling in the inguinal (lower abdominal region)
- Protrusion of the hernia with crying, couching, or straining when having a bowel movement.
- Prolonged standing can cause protrusion in older children.
When Can An Inguinal Hernia Become Dangerous?
An inguinal hernia itself is not a life threatening condition, but can become dangerous if the contents of the hernia are not returned back into the abdomen. If part of the intestine becomes trapped in the abdominal wall or scrotum, incarceration of the intestine/fat occurs. If the hernia is incarcerated for a prolonged period of time, the blood flow to that portion of the small intestine can become blocked and will cause that section of the intestine to die. This strangulation of the hernia/intestine is life threatening and requires immediate medical care.
Treatment of An Inguinal Hernia
Once an inguinal hernia is diagnosed via physical exam, x-ray, or MRI, the only treatment to fix the hernia is surgical repair. There are two main types of surgical repair: open hernia repair and laparoscopic repair.
Open Hernia Repair:
During this surgical procedure, an incision is made in the groin and the surgeon pushes the hernia back into place. The surgeon will then repair the abdominal wall and place a synthetic mesh over area for reinforcement. The incision is then closed with stitches, staples, or surgical glue.
For this procedure, the surgeon with use several small incision to complete the surgery. Sometimes the surgeon will choose to pump a gas into the abdominal cavity to make the hernia easier to work on. Using a small camera, the surgeon will put the hernia back in place and use a synthetic mesh to reinforce the abdominal wall. These approximately ½ inch incisions can be closed with stitches, staples, or surgical glue.
After either type of surgical repair, the patient will experience discomfort in the abdomen and may be prescribed pain medication. Typically the patient will be restricted from heavy lifting and intense activities for several weeks to allow everything to heal properly. Patients who elect the laparoscopic repair usually heal faster and have less discomfort, but are at a greater risk for the hernia to return than those who elect the open repair.