What Is an Inguinal Hernia?
An inguinal hernia is when tissue from inside your abdomen (your belly) pokes through a weak spot in your muscles. Your abdominal muscles protect organs such as your intestine, pancreas, and liver. They reach all the way down to your groin, which is where an inguinal hernia can form.
It’s named for the inguinal canal, which is a passage in your lower abdominal wall that has blood vessels and nerves. In men, the spermatic cord (a group of nerves, vessels, and ducts that connects the testes to the abdomen) passes through the inguinal canal; in women, it holds ligaments that support the uterus.
An inguinal hernia could be a serious health problem, so don't ignore symptoms such as pain in your groin when you cough or lift something heavy. A physical exam is usually all it takes to diagnose the problem. If the hernia is large, you may need surgery to fix it.
Inguinal Hernia Symptoms
You could have an inguinal hernia if you:
Feel pain when you cough, bend, or lift something heavy
See a bulge on one side of your groin that becomes more noticeable when you're standing
Feel pressure, weakness, or heaviness in your groin
Have pain or swelling around your testicles
Feel a burning or aching sensation at the site of the hernia’s bulge
Inguinal Hernia Types
There are two types of inguinal hernias:
Indirect hernias happen while a baby is still in the womb. The inguinal canal has two openings on either end that normally close before the baby is born. But sometimes one or both of them don't close and tissue in the abdomen may poke through the hole. This hernia may be there at birth, or it might not happen for several years.
Direct hernias happen later in life when abdominal tissues poke out through a weak spot in the abdominal wall.
Inguinal Hernia Causes
A baby can get an indirect inguinal hernia if their inguinal canal doesn't fully close while they're developing. This can leave a hole where abdominal tissue can poke through.
Causes of direct inguinal hernias in adults include:
A weak spot in your abdominal wall
Pressure inside your abdomen
Straining when going to the bathroom
Doing strenuous activities and lifting heavy things
Coughing and sneezing a lot
Inguinal Hernia Risk Factors
You are more likely to get an inguinal hernia if you are:
- Assigned male at birth: Inguinal hernias are eight times more common in men than in women.
- Older: Your abdominal wall naturally weakens with age.
- White: Inguinal hernias are most common in non-Hispanic white men.
- Pregnant: Your abdominal muscles get weaker and there is more pressure in the abdomen during pregnancy.
Other things that increase your risk of an inguinal hernia:
- Family history: If someone in your close family has had a hernia, you are more likely to have one too.
- Chronic cough: This creates pressure in the abdomen.
- Chronic constipation: Straining while going to the bathroom increases pressure in the abdomen.
- Frequent strenuous activities: A lot of walking, standing, lifting heavy objects, or intense exercise creates pressure in the abdomen.
- Low birth weight and premature birth:Babies born early or with a low birth weight are more likely to have inguinal hernias.
- Past inguinal hernia: If you've already had an inguinal hernia, your risk of having another one is higher.
Inguinal hernias in newborns
Indirect hernias develop in babies before they're born. They're much more common in boys than in girls. Up to 5% of baby boys are born with inguinal hernia. It's much more common in babies born prematurely. They have up to a 30% chance of being born with an inguinal hernia. A baby can have a hernia on one side or both sides of their groin.
You can't always see an inguinal hernia in a baby. You may only notice it when a baby cries or strains. Babies with an inguinal hernia may be more fussy or cranky while you are feeding them.
If you do notice a bulge, talk to your doctor. Your baby may need to have a simple surgery to remove the hernia. In the meantime, it's not an emergency unless you notice any of these symptoms:
- A lot of pain and tenderness
- Bruising or redness near the bulge
- Not wanting to eat
- Nausea and vomiting
- Blood in their stool (their poop)
If your baby shows any of these symptoms, it's important to get them treated right away.
Inguinal Hernia Diagnosis
See your doctor if you have symptoms of an inguinal hernia. They’ll check your groin area for swelling or a bulge. They’ll probably ask you to stand and cough. This can make a hernia more obvious.
If your doctor doesn’t see any swelling in the area, they may order imaging tests, such as an abdominal ultrasound, CT scan, or MRI.
Inguinal hernia ultrasound
Your doctor can use ultrasound to easily diagnosis your hernia. This technology uses sound waves to create pictures of your internal organs and any other tissues. It's a painless procedure that can often be done in a doctor's office.
Inguinal Hernia Treatment
Hernias don't go away on their own, and they usually get larger over time. If your hernia is small and doesn't bother you, you might not need immediate treatment. But if it's large and causing discomfort, you will need surgery.
Inguinal hernia surgery
There are two types of surgery for inguinal hernias:
Open hernia repair: After you're given a drug that makes you sleep, your doctor makes a small cut in your groin and moves the tissue that's poking out back behind the abdominal wall. Then they sew the abdominal tissue closed and may use a mesh material to strengthen the area. The doctor then closes the incision with staples, stitches, or surgical glue.
Minimally invasive hernia repair: While you are under general anesthesia, your doctor makes a few tiny cuts in your abdominal tissue. Air is used to inflate your abdomen so the doctor can see the hernia better. Then the doctor puts a laparoscope -- a narrow tube with a small camera attached to it -- through one of the incisions. Using the camera as a guide, the doctor uses small tools inserted through the other incisions to fix the hernia with mesh.
This minimally invasive procedure might sound more complicated than the open hernia repair, but the incisions are very small, which means your recovery from inguinal hernia surgery might be faster. You might have less pain and scarring and be able to get back to your daily life sooner.
Inguinal hernia treatment without surgery
If your hernia is small and you don't need to have surgery yet, there are some things you can do to improve any symptoms you may have and prevent your hernia from getting worse:
Avoid constipation: Drink plenty of fluids, avoid stress, and eat more fiber from fruits, vegetables, whole grains, nuts, and seeds.
Maintain a healthy weight: This lowers your risk of developing a hernia and prevents any possible complications.
Take it easy: If you can, avoid intense activities that put pressure on your abdomen. Things such as lifting heavy weights could make your hernia worse.
Temporary hernia treatment
If your hernia is large or causing discomfort, see your doctor. They may schedule surgery and suggest what you can do in the meantime to ease any pain, such as:
Use a hernia belt to provide support.
Hold your hernia when you cough, sneeze, or put pressure on your abdomen in any other way.
Use over-the-counter pain medication.
Don't lift anything heavy.
Inguinal Hernia Prevention
You can't prevent indirect hernias that happen before birth. You can't always prevent direct hernias either, but you can take steps to reduce your risk. Things you can do to prevent hernias are the same as nonsurgical treatments for inguinal hernias:
- Avoid constipation by drinking fluids, managing stress, and eating fiber-rich foods.
- Avoid straining when going to the bathroom.
- Maintain your weight or lose weight if your doctor advises you to.
- Lift heavy things carefully, ensuring correct form by bending at the knees, not the waist.
- Stop smoking, which can cause a chronic cough that puts pressure on your belly.
Inguinal Hernia Complications
If you don’t treat an inguinal hernia, it could lead to problems such as:
Pressure and pain that spreads: Most inguinal hernias get larger over time if you don’t fix them with surgery. In men, large hernias can bulge down into the scrotum, causing swelling and pain.
Incarcerated hernia: This happens when the hernia gets trapped in your abdominal wall. You won't be able to push it back in.
Strangulated hernia: An incarcerated hernia stuck outside the abdominal wall can get squeezed. When this happens, the blood flow to the hernia is cut off, which can cause the hernia tissues to die. If part of your intestine is strangulated, you can have intestinal obstruction. That means food and liquids can't pass through your intestines.
Intestinal obstruction can cause:
Severe pain in your belly
Other signs you may have an incarcerated or strangulated hernia:
Your bulge is bigger than it was.
You can't push the bulge back in.
You see redness around the bulge.
You have a fever.
You have severe or sudden pain around the hernia.
Incarcerated and strangulated hernias are life-threatening. Get to an emergency room right away if you have any of these symptoms.