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Inguinal hernia

Published by Bupa's health information team, March 2009.

This factsheet is for people who have an inguinal hernia, or who would like information about it.

An inguinal hernia is a bulge or swelling that develops when tissue (often consisting of fatty tissue or part of the bowel) protrudes out of its normal place, usually through a gap in the muscles.

Inguinal hernias can be uncomfortable but are rarely dangerous. Each year in the UK, about 70,000 people have surgery to repair an inguinal hernia.

• About inguinal hernia
• Symptoms of inguinal hernia
• Complications of inguinal hernia
• Causes of inguinal hernia
• Diagnosis of inguinal hernia
• Treatment of inguinal hernia
• Prevention of inguinal hernia
• Further information
• Questions and answers
• Related topics
• Sources

About inguinal hernia

The abdominal wall is a sheet of tough muscle and tendon that runs between your ribs and your groin (upper part of your leg). Your abdominal wall acts like a natural corset holding all the abdominal contents of your body in place. There are, however, natural weaknesses in the abdominal wall, such as where the blood vessels and nerves pass through.

An inguinal hernia develops when a sac containing a piece of the bowel, or one of the layers of tissue that coat the organs inside the abdomen, bulges out through the muscles of the abdominal wall to create a lump in the groin or scrotum. The hernia occurs where there is a weakness in the "inguinal triangle". This is an area in the groin where there is an opening between the layers of muscle that form the abdominal wall.

The position of an inguinal hernia

Both men and women can get inguinal hernias, on one or sometimes both sides of the groin. However, they are much more common in men. Men have around a one in four chance of getting an inguinal hernia at some point in their lives, Only about three in 100 women are likely to be affected.

Anything that increases pressure in the abdomen, such as heavy lifting, sneezing or straining to go to the toilet, can increase the chance of a hernia. Being overweight also makes hernias more likely, particularly in men.

Symptoms of inguinal hernia

The first thing you will probably notice is discomfort in the groin area and/or a lump. Often the lump can be gently pushed back, or it will disappear when you lie down. This is a reducible hernia. A hernia will protrude again when you stand or cough or sneeze.

About one in three people who have surgery don't experience any pain, so you may not have pain. Some people do feel heaviness, aching or pain in the area. The pain is not usually severe but can get worse if you are active. Having a hernia and doing heavy work such as lifting may feel uncomfortable.

Unless you have complications, the lump won't be red, hot or tender to touch. A hernia that is strangulated (see Complications) may be very painful.

Another form of hernia at the top of the inside of the thigh is called a femoral hernia. These are less common than inguinal hernias but are more likely to become complicated (see Related topics).

Complications of inguinal hernia

An inguinal hernia is not usually a medical emergency. However, a hernia can get bigger and become impossible to push back. This is called an incarcerated hernia. There is a risk that the blood supply to the loop of bowel may be cut off if it's contained inside the hernia. This is called a strangulated hernia. Without blood supply, the loop of bowel begins to die and the bowel itself may become blocked. This is a serious complication that requires urgent surgery.

Causes of inguinal hernia

Many people are born with a natural weakness in the muscles of the groin. In boys and men, this is caused by the route the testicles take during development in the womb. Early in pregnancy, the testicles form next to the kidneys in the abdomen and, before birth, move down into the scrotum. This leaves a channel that may not close as firmly as it should and can act as a route for a hernia.

Diagnosis of inguinal hernia

Your GP will examine your groin. This may be while you are standing up, lying down or coughing. He or she will try to see if the lump in your groin can be pushed back in. This is called reducing the hernia. Some small hernias may be diagnosed using an ultrasound machine. Your GP may then refer you to a general surgeon if he or she thinks you may need to have an operation.

Treatment of inguinal hernia

Self-help

A form of support belt called a truss may provide temporary support over the area of weakness but trusses shouldn't be used long-term and some people find them hard to manage.

If you smoke and are going to have an operation, you should try to stop smoking.

Medicines

There are no medicines or proven alternative remedies for treating an inguinal hernia.

Surgery

This is the main treatment for an inguinal hernia. The operation to repair the defect in the abdominal wall is sometimes called a herniorrhaphy. The aim of a hernia repair operation is to push the hernia sac back into place and strengthen the abdominal wall.

There are two main types of inguinal hernia repair - open and keyhole (laparoscopic). In most cases, the operation is an open repair, which involves a small cut in the groin. To strengthen the area of weakness, the surgeon will often stitch in place a piece of artificial mesh, made from polypropylene. Whichever surgical technique is used, research has shown that for most people the operation is best done as a day case, without needing an overnight stay in hospital. You may be offered a regional anaesthetic - to numb the groin area - or general anaesthetic so you will be asleep during the operation and feel no pain.

Afterwards there may be bruising and numbness. There is a risk of getting a wound infection. In the longer term, there is a risk of having long-term pain in the area of the operation. This may affect up to one in ten people. After the operation, surgeons generally recommend returning to your normal level of activity quite quickly. Five to eight days off work is usually enough, unless you do strenuous work in which case 14 days may be required.

Prevention of inguinal hernia

Obesity, coughing and straining to go to the toilet can increase the pressure in the abdomen and make a hernia more likely. Getting help with these problems by losing weight, treating your cough and eating more fibre may reduce the chance of you getting an inguinal hernia. If your cough is caused by smoking, you should stop smoking. See Related topics for information.

Further information

• Core Charity
  www.corecharity.org.uk

Related topics

• Femoral hernia
• Fibre
• General anaesthesia
• Giving up smoking
• Healthy weight for adults
• Hiatus hernia
• Inguinal hernia repair
• Local anaesthesia and sedation

Sources

• Jenkins J T, O'Dwyer P J. BMJ. 2008. Inguinal hernias. 336:269-272
• Kingsnorth A, LeBlanc K. Hernias: inguinal and incisional. The Lancet, 2003 11/8;362(9395):1561-1571
• Nienhuijs S, Staal E, Strobbe L, Rosman C, Groenewoud H, Bleichrodt R. Chronic pain after mesh repair of inguinal hernia: a systematic review. The American Journal of Surgery, 2007 9;194(3):394-400
• Robinson PHE, Lansdown MJ, Inguinofemoral hernia: accuracy of sonography in patients with indeterminate clinical features, Am J Roentgenol 2006 187(5)(Nov):168-178

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: March 2009