An inguinal hernia (inguinal hernia) is a condition in which the intra-abdominal adipose tissue or part of the small intestine protrudes through a weak spot of the lower abdominal muscles.
This type of hernia is called inguinal because part of the small intestine or abdominal fat slips through a muscle-weak area in the inguinal ring (inguinal canal).
A hernia can occur at any time from childhood to adulthood and is much more common in men than in women.
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Anatomy
The abdomen is covered with a layer of muscles and strong tendons (abdominal wall) extending from the ribs to the groin and legs.
The abdominal wall has the task of enclosing and restraining the internal organs, including the intestine.
There are certain areas where this structure is weaker and where the weight of the organs favors the exit of a section of the intestine to the outside.
The inguinal hernia is formed in the inguinal canal, which is located above the inguinal ligament.
Through this virtual tunnel run the man’s spermatic cord and the woman’s round uterine ligament.
Classification of inguinal hernias
There are two types of hernia:
- Indirect (lateral) hernia is the most common type of hernia, it can occur in newborns and often causes pain in the scrotum.
In the last months of pregnancy, the testicles of the child migrate from the groin through the inguinal canal into the scrotum; at birth, the inguinal canal closes.
The scrotum must be outside the abdomen, as the temperature must be 35-36° and not 37° as in the rest of the body.
In girls, the inguinal canal closes earlier, because no sexual organ has to sink below the groin.
Since the closure of the canal occurs at the end of pregnancy, there is a significantly increased risk of a hernia in premature births.
Indirect hernia occurs in newborns because part of the intestine sinks indirectly through the inguinal canal. - Direct (medial) hernia is rare in children and newborns, but common in older men.
This type of hernia occurs due to weakness of the abdominal wall in the groin.
Long-lasting and frequent stresses (including chronic cough) are among the most common causes of direct hernia. - The internal oblique hernia is the least common.
The clinical results help to understand whether the hernia occurred directly or indirectly. Usually, in adults, this type is confirmed during surgery.
This distinction has little clinical significance, especially for adults.
Inguinal hernias tend to grow larger over time.
Causes of a hernia
Repeated exertion during bowel movements as well as urination can cause a fracture, often associated with prostate problems.
Chronic cough in lung diseases or after a history of smoking can contribute to the development of a hernia.
The causes of a hernia also include hard training sessions for competition preparation or bodybuilding exercises.
Being overweight is also a risk factor.
In some patients, weight loss can prevent the formation of an inguinal hernia or its growth.
Pregnant women need to check with the surgeon whether a normal birth is possible or a caesarean section would be better.
Risk factors for inguinal hernia
In infants: male, premature birth.
In adults: male sex, excess weight, constipation, chronic cough, lifting heavy loads.
Symptoms of hernia
Some inguinal hernias do not cause symptoms. Sometimes you don’t notice it until the doctor discovers them during a routine medical examination.
Often, however, you can see and feel swelling caused by a hernia.
The swelling is more visible when standing, especially when coughing.
Signs and symptoms of inguinal hernia:
- A swelling on both sides of the pubic bone if it occurs bilaterally, or only on one side if it occurs unilaterally.
- Burning, bubbling or pain at the level of the hernia.
- Pain or discomfort in the groin, especially when bending, coughing or getting up from sitting.
- A feeling of heaviness or a pull in the groin.
- Weakness in the groin.
- In rare cases, pain and swelling in the area of the testicles, when the passing intestine descends laterally of the testicle into the scrotum.
One should be able to push the hernia back into the abdomen while lying down with feeling and easily, possibly one hears cooing intestinal noises (borborygmus).
If this is not possible, you can put on an ice pack. This can reduce the swelling and cause the hernia to recede. It can be helpful to position the pelvis above the head height.
Complications of a hernia
Complications of inguinal hernia include:
- Pressure on the surrounding tissue. Most inguinal hernias increase in size over time if surgical treatment is not given. Large hernias can exert a lot of pressure on the surrounding tissue. In men, a fracture can spread to the scrotum and cause groin pain and swelling.
- Incarcerated hernia. In some cases, the weakened area where the hernia has formed swells, and the “hole” in the inguinal ligament narrows. If the mesh or an intestinal loop gets stuck in the groin and cannot be pushed back into the abdomen, intestinal obstruction (occlusion) can occur, causing extremely severe pain, nausea, vomiting and the inability to defecate or intestinal gas leakage.
- Strangulation. An incarcerated hernia can interrupt blood flow to the intestine. This disorder is called strangulation and can lead to the death of the affected intestinal tissue. A strangulated hernia hurts extremely, is dangerous and requires immediate surgery.
Diagnosis of inguinal hernia
Examine the patient both standing and lying down and ask him to cough.
Insert a finger above the scrotal sac into the outer inguinal ring and palpate for a lump when coughing – cough impulse.
Hernias probably slip back when they are in the scrotum.
How is an inguinal hernia treated?
Surgery is the most effective treatment for an inguinal hernia; Medication does not help because it is a mechanical disorder.
When does surgery have to be performed?
Reposition of an inguinal hernia is carried out by surgery, in which the bulge is shifted back inwards and the abdominal wall is strengthened. Surgery may be advisable if symptoms are severe, long-standing, or complications occur.
The hernated part of the intestine can:
- block in the inguinal canal, causing occlusion – this leads to nausea, vomiting and abdominal pain, and also to a painful protrusion in the groin;
- being disconnected from the blood supply (known as hernia entrapment), emergency surgery is essential within a few hours to free the disconnected tissues and restore the blood supply. The operation is aimed at freeing the hernia and preventing serious complications.
What is the therapy for a hernia?
In adults, inguinal hernias that enlarge and cause symptoms or become pinched must be treated surgically.
In infants and children, inguinal hernias are always operated on to avoid pinching.
The operation is usually performed on an outpatient basis (without an inpatient overnight stay).
The recovery time varies depending on the size of the hernia, technique used, age and state of health of the patient. The two main surgical procedures for a hernia are:
- Open surgery. This option is chosen when the hernia is operated on for the first time, not during relapses. The operation lasts 30-40 minutes and is performed on an outpatient basis, i.e. the patient is discharged on the same day. In open hernia surgery, also called herniorrhaphy, local anesthesia is performed in the abdomen or locoregional anesthesia in the spine to anesthetize the operating area.
After that, the surgeon makes an incision in the groin, returns the hernia to the abdomen and strengthens the muscle wall with suture stitches. The muscle-weak area is usually reinforced with a synthetic mesh to give more support. This operation is called hernioplasty. - Laparoscopy. This surgical method is chosen if the fracture occurs again (recurrence). Laparoscopic surgery is performed under general anesthesia. The surgeon makes various small incisions on the lower abdomen and inserts a laparoscope, a thin tube with a small video camera at the tip.
The video camera sends an enlarged image from inside the body to a monitor, giving the surgeon a detailed view of the hernia and surrounding tissue.
Looking at the monitor, the surgeon uses special instruments to correct the fracture and insert a synthetic mesh.
People undergoing laparoscopic surgery usually require a shorter recovery time. However, the doctor may advise against laparoscopic surgery if it is not the best method, the hernia is very large, or if the patient has already had pelvic surgery.
Most adults have discomfort after surgery and need painkillers. Strong efforts such as heavy lifting should be avoided for several weeks. The doctor tells the patient when he can easily return to work.
Infants and children have some complaints, but they usually return to their normal activities after a few days.
What are the complications of inguinal hernia surgery?
Surgical intervention to correct an inguinal hernia is quite safe, and complications are rare. Knowing the risk factors allows the patient to report any postoperative symptoms to the doctor as soon as they occur.
- Risk of general anesthesia
- Recurrence of the hernia
- Bleeding
- Wound infection
- Painful scar
- Lesions on internal organs
Recovery after surgery of an inguinal hernia
Most patients with a hernia are able to return to their normal activity within three to four weeks, including sexual intercourse.
The surgical area is painful, especially in the first week.
During this period, during activities that increase pressure in the abdomen, the wound area should be protected by applying light pressure to the incision.
Risky activities for the scar include:
- shifting from a lying to a sitting position,
- getting up from sitting,
- Sneeze
- Cough
- Cry
- pressing during bowel movements,
- Vomit.
Natural remedies for inguinal hernia
Therapy with a wrapping system
There is a wrapping technique that takes place around the pelvis and supports the inguinal fractions.
If it is applied during the day for a few months, it can be achieved that the hernia returns to the groin.
You can also wear support underwear, through which the exiting intestine is pushed back to its anatomical seat.
