Inguinal hernia symptoms occurs in the groin (the area between the abdomen and thigh). It is called "inguinal" because the intestines push through a weak spot in the inguinal canal, which is a triangle-shaped opening between layers of abdominal muscle near the groin. Obesity, pregnancy, heavy lifting, and straining to pass stool can cause the intestine to push against the inguinal canal. The danger from herniation arises when the organ protruding through the opening is constricted to the extent that circulation is stopped or when the protruding organ impairs the function of other structures. Indirect hernias, one of the most common abdominal hernias, are five times more common than direct hernias, and are seven times more frequent in males, due to persistence of the process vaginalis during testicular descent. They are very common (it is estimated that 7% of the population will develop an abdominal wall hernia) and their repair is one of the most frequently performed surgical operations.
Direct inguinal hernias occur when abdominal contents herniate through a weak point in the fascia of the abdominal wall and into the inguinal canal. Indirect inguinal hernias occur when abdominal contents protrude through the deep inguinal ring; this is ultimately caused by failure of embryonic closure of the processus vaginalis.
In men, indirect hernias follow the same route as the descending testes, which migrates from the abdomen into the scrotum during the development of the urinary and reproductive organs. The larger size of their inguinal canal, which transmitted the testicle and accommodates the structures of the spermatic cord, might be one reason why men are 25 times more likely to have an inguinal hernia than women. The internal inguinal ring, which is the beginning of the inguinal canal, remains as an opening in the internal oblique muscle, which forms the muscular outer wall for the spermatic cord. When the opening is larger than necessary for passage of the spermatic cord, the stage is set for an indirect inguinal hernia. The protrusion of peritoneum through the internal inguinal ring can be considered an incomplete obliteration of the processus. Although several mechanisms such as strength of the posterior wall of the inguinal canal and shutter mechanisms compensating for raised intra-abdominal pressure prevent hernia formation in normal individuals, the exact importance of each factor is still under debate.
In the female, groin hernias are only 4% as common as in males. Indirect inguinal hernia is still the most common groin hernia for females. If a woman has an indirect inguinal hernia, her internal inguinal ring is patent, which is abnormal for females. The protrusion of peritoneum is not called "processus vaginalis" in women, as this structure is related to the migration of the testicle to the scrotum. It is simply a hernia sac. The eventual destination of the hernia contents for a woman is the labium majoris on the same side, and hernias can enlarge one labium dramatically if they are allowed to progress.
Sympoms of Inguinal Hernia
Symptoms of inguinal hernia may include a lump in the groin near the thigh; pain in the groin; and, in severe cases, partial or complete blockage of the intestine. The doctor diagnoses hernia by doing a physical exam and by taking x rays and blood tests to check for blockage in the intestine. Hernias present as bulges in the groin area that can become more prominent when coughing, straining, or standing up. They are often painful, and the bulge commonly disappears on lying down. The inability to "reduce", or place the bulge back into the abdomen usually means the hernia is "incarcerated," often necessitating emergency surgery.
As the hernia progresses, contents of the abdominal cavity, such as the intestines, can descend into the hernia and run the risk of being pinched within the hernia, causing an intestinal obstruction. If the blood supply of the portion of the intestine caught in the hernia is compromised, the hernia is deemed "strangulated," and gut ischemia and gangrene can result, with potentially fatal consequences. The timing of complications is not predictable; some hernias remain static for years, others progress rapidly from the time of onset. Provided there are no serious co-existing medical problems, patients are advised to get the hernia repaired surgically at the earliest convenience after a diagnosis is made. Emergency surgery for complications such as incarceration and strangulation carry much higher risk than planned, "elective" procedures.
The diagnosis of inguinal hernia rests on the history given by the patient and the physician's examination of the groin. Further tests are rarely needed to confirm the diagnosis. However, in unclear cases an ultrasound scan or a CT scan might be of help, especially to rule out a hydrocele. Usually, there is no obvious cause of a hernia, although they are sometimes associated with heavy lifting.
Inguinal Hernias can be seen in infants and children. This can happen when the lining around the abdominal organs does not close properly before birth. About 5 out of 100 children have inguinal hernias (more boys than girls). Some may not have symptoms until adulthood. In children, the vast majority of inguinal hernias are indirect.Incarceration represents the most common complication associated with inguinal hernias, the incidence could be as high as 30% for infants younger than 2 months. There are usually no symptoms that a child has an inguinal hernia until abdominal organs are forced into the sac. Swelling can sometimes be seen in the groin area when a baby is crying or straining or when an older child coughs, strains or stands for a long time. If the bulging can be gently pressed back into the abdomen, the hernia is known as reducible. If a loop of the intestine is forced into the sac, the hernia is then known as incarcerated (irreducible). An infant or a child will show signs of irritability, loss of appetite, tenderness and swelling of the abdomen or have trouble having a bowel movement. With incarceration, the intestines have entered the sac and are being strangled. This portion of the intestines could die.
If you have any of the following, you are more likely to develop a hernia:
* Family history of hernias
* Cystic fibrosis
* Undescended testicles
* Extra weight
* Chronic cough
* Chronic constipation, straining to have bowel movements
* Enlarged prostate, straining to urinate
The main treatment for inguinal hernia is surgery to repair the opening in the muscle wall. This surgery is called herniorrhaphy. Sometimes the weak area is reinforced with steel mesh or wire. This operation is called hernioplasty. If the protruding intestine becomes twisted or traps stool, part of the intestine might need to be removed. This surgery is called bowel resection. There are various surgical strategies which may be considered in the planning of inguinal hernia repair. These include the consideration of mesh use, type of open repair, use of laparoscopy, type of anesthesia, appropriateness of bilateral repair, etc. During surgery conducted under local anaesthesia, the patient will be asked to cough and strain during the procedure to help in demonstrating that the repair is "tension free" and sound.
Before surgery, you will be given a sedative to make you drowsy. A local or spinal numbing medicine (anesthesia) will be used so you do not feel pain during the procedure. In some cases, the procedure is done while you are under general anesthesia (unconscious and pain-free). The surgeon makes a cut over the area of the hernia. The bulging tissue or organ is placed back inside the muscle wall, the muscle tissue is repaired, and the skin is closed. In many inguinal hernia repairs, a small piece of plastic mesh is used to repair the defect in the muscle tissue.
Laparoscopic hernia repair is becoming more popular. This approach uses a minimally invasive technique.
Risks for any anesthesia include:
* Reactions to medications
* Problems breathing
Risks for any surgery include:
Additional risks of hernia repair include:
* Injury to nearby structures
* Hernia returns