Inguinal hernia

An inguinal hernia is the protrusion of the contents of the abdomen through the inguinal region of the abdominal wall. This inguinal region is the weak part of the abdominal wall. This region consists of a deep inguinal ring, inguinal canal and superficial inguinal ring.

An inguinal hernia is the most common type of all the hernias with 73% prevalence.

Types:
INDIRECT INGUINAL HERNIA DIRECT INGUINAL HERNIA
Abdominal content enters deep inguinal ring travel whole length of the inguinal canal and protrudes from superficial inguinal ring Abdominal content protrude directly through a weak opening called Hessel bachs triangle.
Appearance of a hernia is downward, oblique. Appearance of a hernia is like a bulge, spherical.
It has to be reduced by doctor or patient himself, doesn’t reduce itself (nonreducible). It reduces when patient lie down(reducible).
It occurs mostly in young age. It is seen mostly in elderly people.


Symptoms

Symptoms of inguinal hernia include:

Dragging or aching type of pain is present. It is the earliest and common symptom which appears much before the lump of a hernia appears. Pain may be localised to one region or can be present in all over the abdomen due to dragging of the contents. You may also observe lump or bulge in the groin region.

In advanced cases symptoms like vomiting abdominal distension, intestinal obstruction may occur due to complications.

Diagnosis

Diagnostic tests are performed to confirm the diagnosis and to rule out other abdominal conditions such as hydrocele, femoral hernia, epididymitis, and varicocele.

Your doctor performs a physical examination and examines the groin area for a bulge and makes the provisional diagnosis. To confirm the diagnosis, your doctor may recommend imaging tests such as ultrasonography, magnetic resonance imagining (MRI), or computed tomography (CT) scans.

Causes

An inguinal hernia can be congenital (by birth) or acquired (excessive fat, weakness of muscle after multiple pregnancies, after surgical procedures).

Complications

If the contents of the hernia become trapped in the weak point of the abdominal wall, it can obstruct the bowel causing intestinal obstruction. Strangulation may cause gangrene. In few cases, there may be chances recurrence of hernia even after surgical procedure.

Risk factors

About 25% of males and 5% of females develop an inguinal hernia. Male to female ratio of occurrence is 9:1. Prevalence of a hernia increases with age. The risk factors for inguinal hernia include chronic cough, obesity, pregnancy, and powerful muscular effort like straining or heavy lifting. All these factors are responsible for increasing intra-abdominal pressure hence pushing the abdominal content through the inguinal canal.

Past medical history of appendectomy, chronic cough, multiple pregnancies, constipation, family history, and recurrent pregnancies are more likely to be associated with higher number of inguinal hernia cases.

Conservative treatment: Inguinal truss is used in cases of reducible hernia where patient refuses for operative procedures. A truss acts by pressing the interior wall against the posterior wall and prevents hernia to come out.

Operative treatment: Herniorrhaphy, an open repair or laparoscopy procedures are performed to treat inguinal hernias surgically.

The lifetime risk of inguinal herniation is approximately 27% for men and 3% for women. So, following few measures may help preventing a hernia or keep an existing hernia from getting worse. This include:

  • Quit smoking.
  • Maintain a healthy body weight.
  • Avoid straining during bowel movements or urination.
  • Lift objects by bending your knees and not your back.
  • Avoid lifting weights that are too heavy for you.