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If you do not have an inguinal hernia, see information on common types of hernias. These include incisional, epigastric, and umbilical hernias in children and adults.
An inguinal hernia (say "IN-gwuh-nul HER-nee-uh") occurs when tissue pushes through a weak spot in your groin muscle. This causes a bulge in the groin or scrotum. The bulge may hurt or burn.
Most inguinal hernias happen because an opening in the muscle wall does not close as it should before birth. That leaves a weak area in the belly muscle. Pressure on that area can cause tissue to push through and bulge out. A hernia can occur soon after birth or much later in life.
You are more likely to get a hernia if you are overweight or you do a lot of lifting, coughing, or straining. Hernias are more common in men. A woman may get a hernia while she is pregnant because of the pressure on her belly wall.
The main symptom of an inguinal hernia is a bulge in the groin or scrotum. It often feels like a round lump. The bulge may form over a period of weeks or months. Or it may appear all of a sudden after you have been lifting heavy weights, coughing, bending, straining, or laughing. The hernia may be painful, but some hernias cause a bulge without pain.
A hernia also may cause swelling and a feeling of heaviness, tugging, or burning in the area of the hernia. These symptoms may get better when you lie down.
Sudden pain, nausea, and vomiting are signs that a part of your intestine may have become trapped in the hernia. Call your doctor if you have a hernia and have these symptoms.
A doctor can usually know if you have a hernia based on your symptoms and a physical exam. The bulge is usually easy to feel.
If you have a hernia, it will not heal on its own. Surgery is the only way to treat a hernia.
If your hernia does not bother you, you most likely can wait to have surgery. Your hernia may get worse, but it may not. In some cases, hernias that are small and painless may never need to be repaired.
Most people with hernias have surgery to repair them, even if they do not have symptoms. This is because many doctors believe surgery is less dangerous than strangulation, a serious problem that occurs when part of your intestine gets trapped inside the hernia.
But you may not need surgery right away. If the hernia is small and painless and you can push it back into your belly, you may be able to wait.
Babies and young children are more likely to have tissue get trapped in a hernia. If your child has a hernia, he or she will need surgery to repair it.
A hernia may come back after surgery. To reduce the chance that this will happen, stay at a healthy weight. Do not smoke, avoid heavy lifting, and try not to push hard when you have a bowel movement or pass urine.
Learning about inguinal hernia:
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Inguinal hernias, which occur when tissue bulges through the abdominal (belly) muscles and into the groin, are caused by:
Conditions that increase pressure within the abdominal cavity, such as frequent coughing or being overweight, may contribute to the development of hernias.
A femoral hernia, sometimes mistaken for an inguinal hernia, occurs when tissue bulges from the lower abdomen into the upper thigh, just below the groin crease. The cause of a femoral hernia is often difficult to determine.
If you do not have an inguinal hernia, you may have one of the other common types of hernia. These include incisional, epigastric, and umbilical hernias in children and adults.
Symptoms of an inguinal hernia may include:
You may have sudden pain, nausea, and vomiting if part of the intestine becomes trapped (strangulated) in the hernia.
Other symptoms of a hernia include:
In infants, a hernia may bulge when the child cries or moves around.
Strangulated hernias, in which part of the intestine becomes trapped in the hernia, are more common in infants and children than in adults. They can cause nausea and vomiting. An infant with a strangulated hernia may cry and refuse to eat. A strangulated hernia is a medical emergency that requires immediate surgery.
Inguinal hernias typically flatten or disappear when they are pushed gently back into place or when you lie down. Over time, hernias tend to increase in size as the abdominal muscle wall becomes weaker and more tissue bulges through.
If you can't push your hernia back into your belly, it is incarcerated. A hernia gets incarcerated when tissue moves into the sac of the hernia and fills it up. This is not necessarily an emergency.
But if a loop of the intestine is trapped very tightly in the hernia, the blood supply to that part of the intestine can be cut off (strangulated), causing tissue to die. In a man, if tissue is trapped, the testicle and its blood vessels can also be damaged. A strangulated hernia is a medical emergency that requires immediate surgery.
In adults, a hernia that can be pushed back into the abdomen can be surgically repaired at a convenient time. This is because strangulation is rare in adults. A hernia that cannot be pushed back can be repaired when surgery is convenient unless you have increased pain, redness of the overlying skin, fever, nausea and vomiting, or abdominal bloating. If any of these symptoms occur, the hernia may need to be fixed sooner.
Inguinal hernias can come back after surgical repair. But in women it is rare for inguinal hernias to recur.
Infants or children with an inguinal hernia need to have surgery as soon as possible because of the increased risk that a part of the intestine will become trapped and blood supply will be cut off, leading to tissue death.
Incarceration, when intestinal or abdominal tissue fills up the sac of a hernia, occurs in about 2 or 3 out of 10 infants younger than 6 months who have hernias. Most incarcerated hernias occur before the infant is 1 year old.1 Female infants face a higher risk of incarceration.
Many things can increase your risk for having an inguinal hernia.
In children, risk factors for inguinal hernia include:
Call a doctor immediately if:
Call a doctor if:
Talk with your doctor before wearing a corset or truss for a hernia. These devices are not recommended for treating hernias and sometimes can do more harm than good.
Watchful waiting is a period of time during which you and your doctor observe your symptoms or condition but you do not receive medical treatment. If you are not sure whether you have groin muscle strain or a hernia, watchful waiting with home treatment for 1 to 2 weeks is appropriate. If you have pain that is increasing or severe, an obvious lump, or evidence of bowel blockage or urinary symptoms, call your doctor for an evaluation.
Watchful waiting is not appropriate for infants and children who have inguinal hernias.
You and your doctor can decide whether you should have surgery to fix your hernia or if you can wait. If your hernia does not bother you, you can probably wait to have surgery.
The following health professionals can diagnose an inguinal hernia:
A general surgeon or pediatric surgeon with experience in inguinal hernia repair will be needed to perform hernia repair surgery.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
The diagnosis of inguinal hernia is usually based on your medical history and a physical exam. Tests such as ultrasound and CT scans are not usually needed to diagnose an inguinal hernia. In most cases, a doctor can identify an inguinal hernia during a physical exam.
A urine test (urinalysis) may be done to rule out a urinary tract infection. A urinary tract infection or kidney stone may cause pain in the groin that can be mistaken for hernia pain. Further tests may be done to rule out other conditions that could be contributing to the hernia, such as colon or prostate cancer or lung diseases that cause chronic coughing.
If surgery is planned, other tests may be needed to evaluate the status of any current health problems, such as lung, heart, or bleeding problems.
Surgery is the only treatment and cure for inguinal hernia. Hernia repair is one of the most common surgeries done in the United States. About 750,000 people have hernia repairs each year.2
Many doctors recommend surgery to repair a hernia because it prevents strangulation, which occurs when a loop of intestine is trapped tightly in a hernia and the blood supply is cut off, which kills the tissue. Strangulation requires immediate surgery, although the condition is rare in adults. Infants and children always need surgery to repair a hernia because of the increased risk of incarceration and strangulation.
If your hernia does not bother you, you may not need to have surgery. Waiting to have surgery does not increase the chance that part of your intestine or abdominal tissue will get stuck in your hernia. Waiting will also not increase your risk for problems, if you decide to have surgery later. In some cases, hernias that are small and painless may never need to be repaired.
Talk with your doctor before wearing a corset or truss for a hernia. These devices are not recommended for treating hernias and sometimes can do more harm than good.
In a child, a hernia that is incarcerated may be pushed back into the abdomen by a doctor. But surgery is still needed because of the increased risk of strangulation.
A surgeon's experience plays an important role in the risk of a hernia recurring. If you are thinking about having hernia surgery, ask the surgeon how many of these surgeries he or she has done and about his or her recurrence rates. Recurrence rates for adults tend to be higher for surgeries that do not use mesh (a synthetic patch).
Some people with other medical conditions may choose not to have surgery or may not be able to have hernia surgery.
Most inguinal hernias cannot be prevented, especially in infants and children. Adults may be able to prevent a few hernias or prevent a hernia from recurring by following some of these suggestions:
Surgery has generally been recommended for all inguinal hernias to avoid complications such as strangulation, in which a loop of intestine becomes tightly trapped in a hernia, cutting off the blood supply to that part of the intestine.
If a hernia in an adult can be pushed back (reduced), surgery can be done at the person's convenience. If it cannot be pushed back, surgery must be done sooner. But surgery may not be needed if the hernia is small and you do not have symptoms. Consult with your doctor to decide if you need hernia repair surgery.
In most cases, a child with an inguinal hernia will need surgery to correct it.
Infants 6 months of age and younger who have inguinal hernias have a much higher risk of strangulation than older children and adults. So surgery for inguinal hernias in infants is not delayed like it can be for adults.
One of the major decisions concerning infants and children is whether to explore the opposite groin area for a hernia during a hernia repair. A hernia develops in the other side of the groin in about 30 out of 100 children who have had hernia surgery.
Things to think about in deciding whether the other side should be explored include the overall health of the child, the risk of incarceration of a hernia, and the experience level of the surgeon (how many of these surgeries the doctor has done and his or her recurrence rates).
Two types of surgery are done to repair inguinal hernias:
Laparoscopic surgery may not be possible for a person who has tissues that have grown together (adhesions) from previous abdominal operations.
Most hernias that will recur do so within 5 years after surgery.
The risk of a hernia coming back after surgery varies depending on a surgeon's experience, the type of hernia, if mesh is used, and the person's age and overall health.
There are some considerations before having inguinal hernia repair surgery, such as what kind of hernia repair is done most at the hospital or clinic. Talk with your doctor so that you make the best decision for your condition.
Recurrent inguinal hernias are harder to repair and pose more risks than initial hernia repairs. The risks linked with recurrent hernia surgery are more scar tissue, numbness and pain after surgery, and a greater chance of injury to a testicle or the spermatic cord.
Conditions that might increase the risk of recurrence include abdominal muscles that are not strong or healthy enough to "hold" the stitching (suture) material and bleeding or infection that weaken the repair.
Fertility is usually not affected by an inguinal hernia or hernia surgery. But in males there is a chance that surgery or an incarcerated hernia can cause injury to the vas deferens, the tube that carries sperm from the testicles to the urethra. It is not yet known how often or to what degree this affects a man's ability to father a child. In rare cases, surgery or an incarcerated hernia may injure the blood vessels that supply one or both testicles with blood, which may cause the affected testicle to shrink.
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- Aiken JJ, Oldham KT (2011). Inguinal hernias. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 19th ed., pp. 1362–1368. Philadelphia: Saunders Elsevier.
- Jeyarajah DR, Harford WV (2010). Abdominal hernias and gastric volvulus. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 9th ed., vol. 1, pp. 379–395. Philadelphia: Saunders.
- Sherman V, et al. (2010). Inguinal hernias. In FC Brunicardi et al., eds., Schwartz's Principles of Surgery, 9th ed., pp. 1305–1342. New York: McGraw-Hill.
- Harmon JW, Wolfgang CL (2007). Hernias of the groin and abdominal wall. In NH Fiebach et al., eds., Principles of Ambulatory Medicine, 7th ed., pp. 1673–1681. Philadelphia: Lippincott Williams and Wilkins.
- Deveney KE (2010). Hernias and other lesions of the abdominal wall. In GM Doherty, ed., Current Diagnosis and Treatment: Surgery, 13th ed., pp. 724–736. New York: McGraw-Hill.
Other Works Consulted
- Chow A, et al. (2008). Inguinal hernia, search date September 2007. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
- Feldman LS, et al. (2007). Laparoscopic hernia repair. In WW Souba et al., eds., ACS Surgery: Principles and Practice, 6th ed., pp. 850–869. New York: WebMD.
- Fitzgibbons RJ Jr, et al. (2006). Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: A randomized clinical trial. JAMA, 295(3): 285–292.
- McCormack K, et al. (2003). Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database of Systematic Reviews (1).
- Society for Surgery of the Alimentary Tract (2006). SSAT patient care guidelines: Surgical repair of groin hernias. Available online: http://www.ssat.com/cgi-bin/hernia6.cgi.
|Primary Medical Reviewer||E. Gregory Thompson, MD - Internal Medicine|
|Specialist Medical Reviewer||Kenneth Bark, MD - Surgery, Colon and Rectal|
|Last Revised||November 15, 2012|
Last Revised: November 15, 2012
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