Inguinal Hernia

Have you ever felt a nagging discomfort in your groin area? It might be an inguinal hernia, a common condition affecting millions worldwide. An inguinal hernia disease develops when abdominal tissue, such as part of the intestine, pushes through a weak spot in the abdominal muscles. This condition can occur in anyone, but it's more common in men and can cause pain and other complications if left untreated. Let's explore the different inguinal hernia types, their symptoms, and why they develop. 

What is an Inguinal Hernia? 

An inguinal hernia disease is a common condition that arises when abdominal tissue, such as fat or the intestine's section, pushes through a weak spot in the lower abdominal wall. This bulging typically happens in the groin area, specifically in the inguinal canal 
passageway. 

Types of Inguinal Hernias 

The following are two main inguinal hernia types: 

• Indirect Inguinal Hernias: They are the most prevalent, accounting for about 80% of all inguinal hernias. They happen when abdominal contents enter the inguinal canal through the deep inguinal ring. This type is often congenital, resulting from incomplete closure of the processus vaginalis during foetal development. Indirect hernias are more prevalent in younger patients and tend to occur more frequently as a right inguinal hernia. 
• Direct Inguinal Hernias: These hernias develop when abdominal contents protrude directly through a weakness in the posterior wall of the inguinal canal, specifically in an area known as Hesselbach's triangle. Direct hernias are more common in older individuals and are often associated with abdominal wall laxity or increased intra- abdominal pressure. 

Inguinal Hernia Symptoms 

The most common symptom of an inguinal hernia disease is an apparent bulge in the groin area. This swelling may become more apparent when standing upright or during activities that increase pressure in the abdominal cavity, such as straining, coughing, or lifting heavy objects. The bulge often disappears when lying down. Other symptoms may include: 

• Continuous aching or burning sensation at the site of the hernia, which may intensify when bending over or during physical exertion 
• A feeling of weakness, pressure, or a dragging sensation in the groin 
• Extension into the scrotum, causing it to enlarge and leading to pain and swelling around the testicles 

Causes and Risk Factors of Inguinal Hernia 

The exact reason for inguinal hernias is unclear, but several factors contribute to their development. These may include: 

• Age: As people age, the muscles surrounding the abdomen may weaken, increasing the risk of hernia formation. 
• Gender: Men are more susceptible to inguinal hernias, being eight times more likely to develop them than women. 
• Increased Abdominal Pressure: This pressure can result from various activities, such as straining during bowel movements or urination, heavy lifting, or persistent coughing or sneezing. 
• Pregnancy: It can also increase abdominal pressure and weaken abdominal muscles, leading to hernias in women. 
• Past History: Individuals who have had a previous inguinal hernia or hernia repair 
• Other Risk Factors: These include a family history of hernia, being white, having a low body mass index (BMI), and a history of premature birth or low birth weight. 

Complications of Inguinal Hernia 

Inguinal hernias can cause several serious complications if left unattended. These may include: 

• Strangulation: This complication occurs when the blood supply to the herniated tissue is cut off. Strangulation of hernia is life-threatening and requires immediate medical attention. Strangulation happens in about 2-3 out of every 100 cases within the first year, with the risk decreasing after that time. 
• Incarceration: Incarceration occurs when the herniated tissue gets entrapped in the abdominal wall and cannot be pushed back. This condition can cause bowel obstruction, leading to severe pain, nausea, vomiting, and constipation. If left untreated for more than six hours, an incarcerated hernia can progress to strangulation. 
• Chronic Pain: This pain can persist for months or even years after surgery and may impact daily activities. 
• Other Potential Complications: These include seroma (fluid accumulation), hematoma (blood collection), and surgical site infections. 

Diagnosis 

• Medical History and Physical Evaluation: Doctors may ask about the symptoms, history of past hernia, and other associated conditions. During the physical assessment, the doctor examines the abdomen, paying close attention to the groin area. The doctors usually ask the patient to stand and cough or strain, which can make the hernia more visible or palpable. 
  • The doctor may attempt to gently massage the contents of the hernia back into the abdomen. This process helps determine if the hernia is reducible or incarcerated. The physical examination is often sufficient to diagnose an inguinal hernia, with a sensitivity of 75% and specificity of 96%. 
• Imaging Tests: In cases where the diagnosis is unclear or complications are suspected, doctors may perform imaging tests, such as abdominal ultrasounds, MRIs, and CT scans, to get detailed pictures of the inguinal hernia and surrounding organs. 

Treatment for Inguinal Hernia 

The primary inguinal hernia treatment is surgery, which aims to push the bulge back into place and strengthen the abdominal wall. Doctors recommend inguinal hernia surgery if the hernia causes pain, severe symptoms, or complications. There are two main surgical approaches: 

• Open surgery involves making a single incision to push the hernia back into the abdomen. 
• Laparoscopic surgery, a less invasive technique, uses several smaller incisions and special instruments to repair the hernia. 

When to See a Doctor 

Some of the instances that may warrant immediate medical attention are: 

• If you notice a bulge in your groin area, especially one that becomes painful or cannot be pushed back 
• If you experience persistent pain, discomfort 
• If the size of your hernia starts to cause problems. 
• If you develop sudden, severe pain, nausea, vomiting, or difficulty passing stool or wind (these symptoms could indicate a strangulated hernia or bowel obstruction) 
• A hernia bulge that turns red, purple, or dark or becomes firm and tender (these symptoms may suggest that the blood supply to the trapped tissue has been cut off) 

Prevention 

While it's not always possible to prevent an inguinal hernia, especially indirect hernias that are present at birth, there are several preventive steps you can take to diminish your risk of developing a direct hernia. These are: 

• Use Proper Lifting Methods: When handling heavy objects, bend from your knees, not your waist, and lift using the muscles in your legs. 
• Maintaining a Healthy Body Weight: More than normal body weight puts additional pressure on your abdominal wall, potentially weakening it over time. 
• Regular Cardiovascular Exercise: Walking or cycling can help you manage weight and improve overall fitness. 
• Strengthening Your Core Muscles: Exercises like planks and sit-ups can better support your abdominal area. 

Conclusion 

Inguinal hernias are a common yet often misunderstood medical condition. While inguinal hernia surgery remains the primary treatment for inguinal hernias, prevention is always better than cure. You can lower your likelihood of developing an inguinal hernia by maintaining a healthy weight, using proper lifting techniques, and strengthening core muscles. If you suspect you have an inguinal hernia, don't hesitate to consult a doctor. With the right approach, most people can recover completely and return to their normal activities without long-term issues. 

FAQS 

1. Who does inguinal hernia affect? 

Inguinal hernias can affect anyone, but they are far more common in men. The lifetime risk for men is 27-42%, compared to only 3.5-8% for women. This difference is due to anatomical factors. Inguinal hernias are more prevalent in older individuals, particularly those over 65. Risk factors include being overweight, male, older, and having a family history of inguinal hernias. 

2. How common are inguinal hernias? 

Inguinal hernias are extremely common, accounting for about 75% of all abdominal wall hernias. Every year, approximately 20 million people worldwide undergo surgery to repair an inguinal hernia. The prevalence is about 4% in those over 45 years old. 

3. How to cure inguinal hernia without surgery? 

While surgery is the definitive treatment for inguinal hernias, some non-surgical approaches can help manage symptoms. These include avoiding heavy lifting, maintaining a healthy weight, eating a fibre-rich diet to prevent constipation, and using ice packs for pain relief. However, these methods do not cure the hernia and should not be considered long-term solutions. 

4. What is the leading cause of inguinal hernia? 

The leading cause of inguinal hernia is a weakness or formation of an opening in the lower abdominal wall. This can occur at birth or develop over time due to contributing factors such as chronic coughing, strain during bowel movements, heavy lifting, or pregnancy. In some cases, the cause may not be apparent. 

Dr. Prashant Bhowate

CARE Medical Team