Inguinal hernia

What is a hernia?

An inguinal hernia is a hernia in the area of the inguinal canal. This is located on both sides of the body approximately between the lower abdomen and thigh. In medical terminology, an inguinal hernia is also called a “hernia inguinalis”.

In a true inguinal hernia, the front abdominal wall “breaks” at a weak point in the groin area. This creates a gap in the abdominal wall (hernial orifice) through which part of the viscera (hernial contents) protrude. The exuded parts of the abdominal organs – for example the intestines – are still covered by the peritoneum. A protrusion of the peritoneum forms, which looks like a small sac. This is why it is also referred to as a hernia sac.

An inguinal hernia is one of the most common hernias: Three quarters of all hernias occur in the groin area. In addition, a hernia can also occur in the area of surgical scars (incisional hernia), the navel (umbilical hernia), below the inguinal ligament on the thigh (femoral hernia), the abdominal wall (epigastric hernia) or next to an artificial anus (parastomal hernia).

At what age does a hernia occur?

Inguinal hernia is a common condition. It can occur at any age and is sometimes congenital. The frequency of new cases per year in adults is estimated at up to 3 percent. Between 3 and 5 percent of all newborns are born with an inguinal hernia. At around 90 percent, men make up the majority of those affected. The reason for this is that the inguinal canal is narrower in women than in men. In 60 percent of cases, the hernia occurs on the right side. A further 25 percent of inguinal hernias occur on the left side. The remaining 15 percent relate to both sides.

Inguinal hernia: these are the causes and risk factors

The inguinal hernia occurs at a weak point in the wall of the inguinal canal. This runs diagonally through the layers of the abdominal wall. It contains important nerve tracts, blood vessels, lymphatic vessels and, in men, the vas deferens. The inguinal canal is protected by muscles, ligaments and connective tissue. However, the inguinal canal has natural weak points. As a result, a gap can form in this area under heavy pressure, for example due to lifting and carrying or as a result of pregnancy.

There are two types of hernia:

• Indirect inguinal hernia: Most people affected have an indirect inguinal hernia. In this case, the hernia sac protrudes through the inner opening into the inguinal canal. As the opening is located to the side of the center of the body, doctors also refer to it as a lateral inguinal hernia. From here, the hernia sac can penetrate through the inguinal canal towards the center of the body to the scrotum or labia. Indirect inguinal hernia is usually congenital. In this case, the inguinal canal has not closed completely during development.
• Direct inguinal hernia: In a direct inguinal hernia, the contents of the hernia penetrate vertically through the abdominal wall. It therefore bypasses the inguinal canal and penetrates directly to the outside. As the hernia site is close to the center of the body, this form is also known as a medial inguinal hernia. In most cases, the wall weakness is acquired, which is why it is mainly adults who develop a direct hernia. These are mostly men.

There are numerous factors that weaken the abdominal wall and increase the pressure in the abdominal cavity. These include:

• Abdominal surgery: Scarring can cause the abdominal wall muscles to become less flexible and less able to absorb pressure in the abdominal cavity.
• Increased pressure in the abdomen: In addition to coughing, vomiting, lifting and carrying heavy loads, constipation, obesity or pregnancy can also increase the pressure in the abdomen or groin area.

Last but not least, weak connective tissue and anatomical weakness make it harder for the groin to withstand increased pressure.

How does a hernia manifest itself?

An inguinal hernia can be recognized by the following symptoms, among others:

• A visible and palpable swelling in the groin area
• Pain when lifting heavy loads and during bowel movements
• Sometimes also pulling pain on the affected side, which radiates into the scrotum or labia

The symptoms typically worsen when there is increased pressure in the abdomen, for example due to coughing, sneezing or straining. However, it is also possible that an inguinal hernia does not cause any symptoms at all.

Severe pain usually only occurs when the spilled intestines – such as parts of the bowel – become trapped. Nausea and vomiting may then also occur. Caution: This is a medical emergency and should be treated immediately. Otherwise there is a risk of serious complications – for example, inflammation of the abdominal organs.

Inguinal hernia: Diagnosis with us

An inguinal hernia is usually easy for the doctor to recognize through a physical examination. For example, swelling in the groin area usually occurs when the affected person is standing or lying down. Even when coughing or pressing, the fracture site is usually easy to see and feel. If the diagnosis is unclear, the doctor will also arrange for a further examination. This is useful if the hernia is small, the patient has a tight abdominal wall or is very overweight and the hernia is not easily recognizable at first glance.

Inguinal hernia: prevention, early detection, prognosis

There are actually several ways in which you can prevent a hernia – at least to a certain extent:

• It is important that you avoid being overweight in order to relieve the abdominal wall.
• Well-trained abdominal muscles also offer a certain degree of protection.
• Take care not to lift heavy loads if possible – especially if you have weak connective tissue. Even after groin surgery, you should not lift or carry anything heavy as prescribed by your doctor.
• Drinking plenty of fluids and eating a high-fiber diet prevents constipation and prevents you from having to push during bowel movements.

Course and prognosis of an inguinal hernia

Parts of the abdominal organs can become trapped in an untreated hernia. This can lead to complications later on. If a section of bowel remains trapped, it may die under certain circumstances. This complication must be surgically removed, although there is an increased surgical risk here.

A surgically treated hernia, on the other hand, almost always heals without complications. Nevertheless, there is a small risk of five to ten percent that it will break again afterwards. To prevent a recurrence of the inguinal hernia after the operation, you should not lift any heavy loads after the procedure as recommended by your surgeon and ensure that your bowel movements are as soft as possible.

In rare cases, further complications may occur. These include an accumulation of fluid, a severing of one of the two spermatic cords, an injury to the testicular vessels, the intestines or the bladder, and chronic pain due to nerve irritation. Sometimes a blood clot (thrombosis) can also form in the large leg vein. If it comes loose, it can enter the lungs with the blood and lead to a dangerous vascular occlusion (embolism).

Treatment of the hernia depending on the severity

The treatment of an inguinal hernia depends on its severity. The crucial question is whether the contents of the hernia can be pushed back into the abdominal cavity. If this is the case, it is a reducible inguinal hernia. This most common form of inguinal hernia can be treated surgically.

If the doctor is unable to return the hernia contents to their normal position by hand, this is an irreducible inguinal hernia . This form requires immediate surgery. If this is not done, adhesions may occur. There is also a risk of parts of the abdominal organs becoming trapped. This is a medical emergency that must be treated within a few hours. Otherwise serious complications can occur.

In case of a surgical intervention, the Institute of Anesthesiology will select the anesthesia procedure that is individually adapted to you.