Information on Inguinal Hernias

So, what is an inguinal hernia?

A hernia is a lump that occurs when part of the intestine, fat, or other abdominal tissue protrudes through an area of weakness in the abdominal wall. When this occurs in the groin, it is described as an inguinal hernia.

Nearly 80% of all hernias occur in the groin or inguinal region. They are much more common in boys and men (98%). Most hernias occur because of a combination of an opening or weakness in the muscle and tissues of the abdominal wall, combined with an increase in the internal pressure in the abdomen. An increase in abdominal pressure can occur if you are carrying extra weight, lifting a lot of of heavy objects and if you have a persistent sneeze or coughing.

Having a hernia can be uncomfortable or can be accompanied by intense pain which gets worse during a bowel movement, passing urine, heavy lifting or straining. They may be present at birth or develop later in life. Around 25 out of every 100 men will develop an inguinal hernia at some point in their life. This compares with only 2 in 100 hernias in women. When an abnormal opening or defect occurs on both sides of the groin, it is called a bilateral inguinal hernia.

The risk of getting a hernia increases with age. Surgery  to fix a hernia is one of the most common types of surgery performed both in Scotland and worldwide. Around 20 million hernia operations are performed globally each year.

Inguinal/groin hernias

The most common hernia.

1 in 4 men will develop this type of hernia at some point in their life

Generally, abdominal hernias need to be seen and felt to be diagnosed.

What are the symptoms of an inguinal hernia?

An inguinal hernia may produce a variety of different symptoms.

  • Some people may notice a protrusion or bulge in the groin, scrotum or abdominal area that often increases in size when coughing or straining
  • Others may feel pain when passing urine or when passing a bowel movement.
  • Numbness or irritation due to pressure on the nerves around earlier.
  • Mild pain or pressure at the hernia site
  • Hernias may be noticed when lifting heavy objects. The pain can be sharp and immediate.
  • On occasion, an inguinal hernia may just give rise to a dull aching sensation, a vague feeling of fullness, nausea or constipation.
  • Sharp abdominal pain and vomiting can mean that the intestinal has slipped through the hernia sac and is strangulated. This is a surgical emergency and immediate treatment may be required.

These symptoms typically get worse toward the end of the day or after standing for long periods of time and may disappear on lying down. These symptoms may limit activity and ability to work. Although persons can live for years with a hernia, it will not go away without treatment. Over time, most inguinal hernias have a tendency to increase in size. They can occasionally become life-threatening if bowel within the hernia becomes obstructed (known as a strangulated hernia). 

Why do inguinal hernias develop?

There is no obvious cause for most individuals who develop a hernia. However there are some low risk factors including the following:

  • Older age. Muscles become weaker as one gets older
  • Obesity. Increased weight puts extra pressure on abdominal wall muscles
  • Chronic straining or sudden twists, pulls are strains may be associated with the development of a hernia (e.g. violent coughing or heavy lifting)
  • Family history
  • Connective tissue disorders
  • Congenital weakness or hernia at birth. In males, improper closure of the abdominal cavity during the body’s development in the womb may lead to a hernia at birth or predispose to developing a hernia later in life. 
  • Pregnancy. One in 2000 women develop area during pregnancy

Do all hernias need to be repaired?

Not all hernias need to be repaired. Small hernias that are not causing any symptoms such as pain can be managed using a non operative (Watchful waiting) approach. If your hernia does need repair, surgery is the only way to do it. Your surgeon may recommend surgical repair:

  • If the hernia is painful.
  • If the hernia is strangulated. This means the tissue has become trapped or twisted and may not be getting enough blood. A strangulated hernia is dangerous.
  • To prevent the hernia from becoming painful or strangulated.
  • Diagram of abdomen with inguinal and femoral hernias

Are there different types of inguinal hernia?

Inguinal hernias are divided into 2 different types, direct and indirect.

Both occur in the area of where the skin crease at the top of the thigh joins the torso (the inguinal crease). Both of these types of hernias can appear as a bulge in the inguinal crease. Distinguishing between the direct and indirect hernia, however, is not that important because both are treated the same. Hernias occur at this site as there is an inherent weakness here due to a natural opening to allow blood vessels to travel to the scrotum and the vas deferens (a narrow tube) to carry sperm back from the testicle.

Indirect inguinal hernia:

An indirect hernia follows the pathway that the testicles made during prebirth development. It descends from the abdomen into the scrotum. This pathway normally closes before birth but remains a possible place for a hernia. Sometimes the hernia sac may protrude into the scrotum. This type of hernia may occur at any age.

Direct inguinal hernia:

The direct inguinal hernia occurs slightly to the inside of the site of the indirect hernia, in a place where the abdominal wall is naturally slightly thinner. It rarely will protrude into the scrotum. Unlike the indirect hernia, which can occur at any age, the direct hernia almost always occurs in the middle-aged and elderly because their abdominal walls weaken as they age.

Emergency hernia surgery

Can an inguinal hernia cause a serious problem?

Most abdominal hernias appear suddenly when the abdominal muscles are strained. You may feel tenderness, a slight burning sensation, or a feeling of heaviness in the bulge. It may be possible to push the hernia back into place with gentle pressure, or the hernia may disappear by itself when you lie down. Being able to push the hernia back is called reducing it. On the other hand, some hernias cannot be pushed back into place, and are termed incarcerated or irreducible.

Most hernias do not cause too much pain and many cause no pain at all. Persistent, severe or increasing discomfort is a worrying feature and might indicate that the hernia has become “stuck” or incarcerated. This situation can progress to the development of tissue damage or even gangrene within the hernia which becomes a surgical emergency. If a hernia becomes increasingly painful which is not relieved by lying down, you should seek immediate medical advice as this might be an indicator that it has become incarcerated.  

Watchful waiting

Nonsurgical treatment of inguinal hernias

Watchful waiting (non operative approach) is an option for patients with an inguinal hernia that is not causing symptoms.  The risk of hernia incarceration highest in the first year after diagnosis and may be as high as 1-2%. Thereafter, the yearly risk of incarceration is less. It is therefore reasonable to consider a watch and wait approach if an individual is having no symptoms and is not concerned about the risk of incarceration.

The risk of incarceration is much higher in femoral hernias and almost half of these will develop an acute problem within two years of diagnosis. They should therefore almost always be treated with surgery.

Trusses and supports have fallen out of favour. It is not uncommon for a patient to come in for review with the trusts in place and the hernia is actually out on the trusses putting pressure on the groin which actually prevents the hernia from going back in. Long-term use of trusses may also lead to thinning and weakness of the muscles of the groin.

How are inguinal hernias repaired?

If surgery is recommended, the operation is most commonly performed either as an open surgery or a “keyhole” or laparoscopic repair. Surgery can be performed either using a surgical mesh to reinforce the body tissues or using sutures to draw connective tissues together. The vast majority of inguinal hernia repairs in adults in Scotland and worldwide are now performed using surgical mesh. This is usually a “tension-free” technique that uses a mesh of inert, sterile material (usually includes polypropylene plastic) to cover the affected area.

Alternatively, the operation may be performed as “keyhole” surgery (laparoscopic), through small incisions in the skin using special instruments. A more detailed explanation of what is involved with inguinal hernia repair is available on our dedicated Inguinal Hernia Surgery page.

However, there is some ongoing controversy surrounding the safety of using surgical mesh for hernia repair following media coverage of the use of surgical mesh in gynaecological procedures. There is now a lot of evidence to show that patients who undergo a mesh repair are less likely to have a recurrence or experience other complications such as chronic pain.

Want to see a specialist about your hernia?

Contact the Scottish Hernia Centre

Can I undergo inguinal hernia surgery at the Scottish Hernia Centre?

Richard Molloy an experienced hernia surgeon performs open tension-free repair and laparoscopic inguinal hernia surgery at the Scottish Hernia Centre, based at Ross Hall hospital Glasgow. At your initial consultation, he will assess your hernia and any other medical problems before discussing the surgical options for repair.

The Scottish Hernia Centre is based at Ross Hall hospital Glasgow. BMI Ross Hall Glasgow is Scotland’s premier private hospital, where a highly trained team of nurses, doctors, physiotherapists and support staff work together in a state of the art hospital enabling us to treat even the most complex hernia in a safe and comfortable environment.
