An inguinal hernia or groin hernia occurs when tissue, such as part of the intestine, protrudes through a weak spot in the abdominal muscles. This results in a bulge that can be painful, especially when you cough, bend over or lift a heavy object.
This type of hernia will not improve on its own. The pain may improve but the bulge will persist. Your doctor is likely to recommend surgery to fix a hernia, especially one that continues to be painful or enlarges. “Once torn, it stays open, and that is the reason why an inguinal hernia can’t fix itself,” explained Dr. Sam Phinney, a surgeon at CU Medicine General Surgery in Highlands Ranch.
Inguinal hernias are very common, though men are eight times more likely to develop one than women. “Because of the testicles, there’s about a 25% lifetime risk for men having this type of problem,” added Phinney. “Inguinal hernias are completely possible and frequently seen in females, still the most common hernia seen, though far less frequently than in males.”
In men, the weak spot usually occurs in the inguinal canal, where the spermatic cord enters the scrotum. In women, the inguinal canal carries a ligament that helps hold the uterus in place, and hernias sometimes occur where connective tissue from the uterus attaches to tissue surrounding the pubic bone.
What causes an inguinal or groin hernia?
Some inguinal hernias have no apparent cause. Others might occur as a result of:
- Increased pressure within the abdomen
- A preexisting weak spot in the abdominal wall
- Straining during bowel movements or urination
- Strenuous activity
- Chronic coughing or sneezing
In many people, the abdominal wall weakness that leads to an inguinal hernia occurs prior to birth when a weakness in the abdominal wall muscle doesn't close properly. Other inguinal hernias develop later in life when muscles weaken or deteriorate due to aging, strenuous physical activity or coughing that accompanies smoking. “Sometimes it’s just bad luck, sometimes it’s a contrast in changes in activity,” said Phinney.
Inguinal hernia signs and symptoms
“Sometimes patients feel like it’s like lightning. Sometimes it’s the sensation of tearing or burning,” Phinney said when describing how a groin hernia feels. He also mentioned that sometimes patients with hernias can’t feel it and that simply means it’s not big enough to be felt.
Signs and symptoms include:
- A bulge in the area on either side of your pubic bone which becomes more obvious when you're upright, especially if you cough or strain
- A burning or aching sensation at the bulge
- Pain or discomfort in your groin, especially when bending over, coughing or lifting
- A heavy or dragging sensation in your groin
- Weakness or pressure in your groin
- Pain and swelling around the testicles when the protruding intestine descends into the scrotum
See your doctor if you have a painful or noticeable bulge in your groin on either side of your pubic bone. The bulge is likely to be more noticeable when you're standing, and you usually can feel it if you put your hand directly over the affected area.
Treatment of an inguinal or groin hernia
A physical exam is typically all that's needed to diagnose an inguinal hernia. Your doctor will check for a bulge in the groin area. Because standing and coughing can make a hernia more prominent, you'll likely be asked to stand and cough or strain.
Your doctor might also order an imaging test, such as an abdominal ultrasound, CT scan or MRI. If you have an inguinal or groin hernia, you will likely need surgery to fix it.
There are two general types of hernia operations — open hernia repair and laparoscopic hernia repair. Robotic assisted laparoscopic surgery is preferred for most hernia repairs, especially when mesh is to be placed.
Open surgery is still pretty minimally invasive with only a three to five centimeter incision in the groin crease, but there is slightly more risk to open surgery. “It’s also adjacent to some sensory nerves so there’s a higher rate of chronic pain,” said Phinney. “Our preference here at Highlands Ranch is to offer a general anesthetic and a robotic-assisted laparoscopic repair.”
With laparoscopic surgery, three to four very small incisions are made in your abdomen. Gas is used to inflate your abdomen to make the internal organs easier to see.
A small tube equipped with a tiny camera, the laparoscope, is inserted into an incision. Guided by the camera, the surgeon inserts tiny instruments through other small incisions to repair the hernia using synthetic mesh. “The role of mesh is to help us do a good tension-free repair with a lower risk of recurrence,” Phinney added.
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