Inguinal Hernia, Adult

ExitCare ImageMuscles help keep everything in the body in its proper place. But if a weak spot in the muscles develops, something can poke through. That is called a hernia. When this happens in the lower part of the belly (abdomen), it is called an inguinal hernia. (It takes its name from a part of the body in this region called the inguinal canal.) A weak spot in the wall of muscles lets some fat or part of the small intestine bulge through. An inguinal hernia can develop at any age. Men get them more often than women.

CAUSES

In adults, an inguinal hernia develops over time.

  • It can be triggered by:

  • Suddenly straining the muscles of the lower abdomen.

  • Lifting heavy objects.

  • Straining to have a bowel movement. Difficult bowel movements (constipation) can lead to this.

  • Constant coughing. This may be caused by smoking or lung disease.

  • Being overweight.

  • Being pregnant.

  • Working at a job that requires long periods of standing or heavy lifting.

  • Having had an inguinal hernia before.

One type can be an emergency situation. It is called a strangulated inguinal hernia. It develops if part of the small intestine slips through the weak spot and cannot get back into the abdomen. The blood supply can be cut off. If that happens, part of the intestine may die. This situation requires emergency surgery.

SYMPTOMS

Often, a small inguinal hernia has no symptoms. It is found when a healthcare provider does a physical exam. Larger hernias usually have symptoms.

  • In adults, symptoms may include:

  • A lump in the groin. This is easier to see when the person is standing. It might disappear when lying down.

  • In men, a lump in the scrotum.

  • Pain or burning in the groin. This occurs especially when lifting, straining or coughing.

  • A dull ache or feeling of pressure in the groin.

  • Signs of a strangulated hernia can include:

  • A bulge in the groin that becomes very painful and tender to the touch.

  • A bulge that turns red or purple.

  • Fever, nausea and vomiting.

  • Inability to have a bowel movement or to pass gas.

DIAGNOSIS

To decide if you have an inguinal hernia, a healthcare provider will probably do a physical examination.

  • This will include asking questions about any symptoms you have noticed.

  • The healthcare provider might feel the groin area and ask you to cough. If an inguinal hernia is felt, the healthcare provider may try to slide it back into the abdomen.

  • Usually no other tests are needed.

TREATMENT

Treatments can vary. The size of the hernia makes a difference. Options include:

  • Watchful waiting. This is often suggested if the hernia is small and you have had no symptoms.

  • No medical procedure will be done unless symptoms develop.

  • You will need to watch closely for symptoms. If any occur, contact your healthcare provider right away.

  • Surgery. This is used if the hernia is larger or you have symptoms.

  • Open surgery. This is usually an outpatient procedure (you will not stay overnight in a hospital). An cut (incision) is made through the skin in the groin. The hernia is put back inside the abdomen. The weak area in the muscles is then repaired by herniorrhaphy or hernioplasty. Herniorrhaphy: in this type of surgery, the weak muscles are sewn back together. Hernioplasty: a patch or mesh is used to close the weak area in the abdominal wall.

  • Laparoscopy. In this procedure, a surgeon makes small incisions. A thin tube with a tiny video camera (called a laparoscope) is put into the abdomen. The surgeon repairs the hernia with mesh by looking with the video camera and using two long instruments.

HOME CARE INSTRUCTIONS

  • After surgery to repair an inguinal hernia:

  • You will need to take pain medicine prescribed by your healthcare provider. Follow all directions carefully.

  • You will need to take care of the wound from the incision.

  • Your activity will be restricted for awhile. This will probably include no heavy lifting for several weeks. You also should not do anything too active for a few weeks. When you can return to work will depend on the type of job that you have.

  • During "watchful waiting" periods, you should:

  • Maintain a healthy weight.

  • Eat a diet high in fiber (fruits, vegetables and whole grains).

  • Drink plenty of fluids to avoid constipation. This means drinking enough water and other liquids to keep your urine clear or pale yellow.

  • Do not lift heavy objects.

  • Do not stand for long periods of time.

  • Quit smoking. This should keep you from developing a frequent cough.

SEEK MEDICAL CARE IF:

  • A bulge develops in your groin area.

  • You feel pain, a burning sensation or pressure in the groin. This might be worse if you are lifting or straining.

  • You develop a fever of more than 100.5° F (38.1° C).

SEEK IMMEDIATE MEDICAL CARE IF:

  • Pain in the groin increases suddenly.

  • A bulge in the groin gets bigger suddenly and does not go down.

  • For men, there is sudden pain in the scrotum. Or, the size of the scrotum increases.

  • A bulge in the groin area becomes red or purple and is painful to touch.

  • You have nausea or vomiting that does not go away.

  • You feel your heart beating much faster than normal.

  • You cannot have a bowel movement or pass gas.

  • You develop a fever of more than 102.0° F (38.9° C).