Inguinal hernia

What is inguinal hernia?

An inguinal hernia is a bulge of abdominal contents, usually fat or part of the small intestine, through a weak area in the lower abdominal wall in the groin. It often slides in and out, getting bigger on standing or straining and smaller when lying down. It is much more common in men than in women.

Inguinal hernias form through one of the two passages in the lower abdominal wall, one on each side of the groin, called the inguinal canals. The lining of the abdomen bulges through and forms a sac, which usually contains fat or part of the small intestine. Many slide in and out. Inguinal hernias are much more common in men, and a person with a hernia on one side may develop one on the other side as well.

What causes an inguinal hernia?

An inguinal hernia forms at a natural weak point in the groin, sometimes present since birth. Pressure inside the abdomen from heavy lifting, long-term straining when passing stool or urine, and a persistent cough can push tissue through. Risk rises with age and is higher in men and in those with a family history.

• A weak area in the abdominal wall present since birth
• Lifting heavy objects
• Long-term straining when passing stool or urine
• A persistent cough
• Increasing age, with risk highest in older adults
• Being male, a family history of inguinal hernia, previous prostate surgery or a connective tissue disorder

What are the symptoms?

The main sign of an inguinal hernia is a bulge in the groin that may disappear when lying down. It can cause discomfort or pain, especially when bending, coughing or lifting, and a heavy, dragging feeling. In men the swelling can extend towards the scrotum. Some hernias cause no symptoms at all.

• A bulge or lump in the groin that may go away when lying down
• Discomfort or pain in the groin, especially when bending, coughing or lifting
• A heavy, dragging feeling in the groin
• Swelling that can extend towards the scrotum in men
• No symptoms at all in some people

When is an inguinal hernia an emergency?

See a doctor about any new groin lump. Seek emergency care if a hernia becomes painful and cannot be pushed back, the lump turns firm or changes colour, or you have increasing abdominal pain, nausea, vomiting or cannot pass wind. These can mean a trapped hernia whose blood supply is at risk.

The warning signs below need prompt attention.

• A painful bulge that cannot be pushed back
• Increasing abdominal pain
• Nausea or vomiting
• The lump becoming firm, tender, or the skin over it changing colour
• Being unable to pass stool or wind

How is it diagnosed?

An inguinal hernia is usually diagnosed by examining the groin while you stand and lie down, and while you cough. The doctor checks whether the lump can be pushed back. Ultrasound or other imaging is used only if the diagnosis is unclear, and your general health is assessed before surgery is planned.

• Examination of the groin while you stand and lie down, often while you cough
• Checking whether the lump can be pushed back in
• Ultrasound or other imaging if the diagnosis is not clear
• Assessment of your general health before planning surgery

How is an inguinal hernia repaired?

Some men with an inguinal hernia causing little or no discomfort can choose monitoring after assessment; women generally need timely surgical assessment. Repair is by keyhole surgery through a few small cuts or open surgery through one cut in the groin. The hernia is pushed back and the weak area is reinforced, usually with a mesh. Surgery is often done as a day case.

• Careful monitoring for a hernia that is not causing symptoms, with a plan if it changes
• Laparoscopic (keyhole) repair through a few small cuts
• Open repair through a single cut in the groin
• A mesh placed over the weak area in most repairs, or stitches alone in some cases
• General, regional or local anaesthetic depending on the method and your health
• Emergency surgery if the hernia is trapped or its blood supply is cut off

What are the risks and complications?

Complications of inguinal hernia repair include wound infection, bruising, pain or numbness in the groin lasting more than three months, the hernia returning, damage to nearby structures such as the bowel or bladder, and blood clots.

• Wound infection
• Bruising or swelling in the groin or genitals that can last weeks to months
• Pain or numbness in the groin lasting longer than three months
• The hernia coming back
• Damage to nearby structures such as the bowel, blood vessels or bladder
• Blood clots, including deep vein thrombosis