An inguinal hernia is when a loop of intestine enters the inguinal canal, a tubular passage through the lower layers of the abdominal wall.
Causes, incidence, and risk factors
Usually, there is no apparent cause of a hernia , although they are sometimes associated with heavy lifting. A hernia occurs when part of an organ (usually the intestine) protrudes through a weak point or tear in the thin muscular wall that holds the abdominal organs in place. In men, a hernia can develop in the groin near the scrotum . A direct inguinal hernia creates a bulge in the groin area, and an indirect hernia descends into the scrotum. Inguinal hernias occur less often in women than men. Inguinal hernias are also seen in infants and children. Hernias can occur when a portion of the peritoneum (the lining around all the organs in the abdomen) does not close properly before birth. This causes a small portion of the intestine to push out into the opening (a bulge might be seen in the groin or scrotum). According to the American Academy of Pediatrics, 5 out of 100 children have inguinal hernias (more boys than girls). Some may not have symptoms until adulthood. A family history of hernias increases the risk. Those with cystic fibrosis and undescended testicles are also more susceptible to inguinal hernias.
Signs and tests
A physical examination confirms the presence of the hernia . The mass may increase in size when coughing, bending, lifting, or straining. The hernia (bulge) may not be obvious in infants and children, except when the child is crying or coughing.
Treatment
An inguinal hernia can often be pushed back into the abdominal cavity. However, if it cannot be pushed back through the abdominal wall (reduced), the herniated bowel may become trapped in the inguinal ring (incarcerated), and its blood supply may be compromised (strangulated). Without treatment, the strangulated loop of intestine dies, because of loss of blood flow. Surgery to reposition the loop of intestine and secure the weakened muscles in the abdomen is usually indicated. MEDICATIONS: There are no medications to treat inguinal hernias, however, medications may be prescribed to manage the pain associated with surgical repair. SURGERY: Hernia repair is performed as an outpatient procedure using local or general anesthesia. An incision is made over the inguinal area, and the segment of bowel is placed back into the abdominal cavity. The muscle and fascia are stitched closed to repair the hernia . A piece of plastic mesh is often used to reinforce the defect in the abdominal wall. You will return from surgery with a large dressing over the surgical site. This dressing will remain in place for a day or two. Occasionally a corset or support may be used after surgery to support weak muscles during recovery. Potential complications of this procedure include infection and abscess formation.
Expectations (prognosis)
The outcome is expected to be good with treatment. Recurrence is rare (1-3%).
Complications
An incarcerated hernia can lead to strangulated intestine, which can result in gangrene, a life-threatening condition requiring emergency surgery.
Calling your health care provider
Go to the emergency room or call the local emergency number (such as 911) if a hernia cannot be reduced or pushed back into the abdomen by gentle pressure, or if nausea and vomiting other new symptoms develop in a person with a hernia.
Prevention
Hernias may occur more often in patients who are overweight, have a chronic cough, chronic constipation, or prostatic hypertrophy which leads to straining with urination. Treatment of these conditions may reduce the risk of developing a hernia. There may be a genetic predisposition to the development of hernias.