Inguinal hernia: symptoms and complaints

The most significant symptom of inguinal hernia is bulging in the groin and the scrotum. At first, the patient experiences a swelling in the femoral area which disappears again when the patients stops pushing or lies down. In a later stage, the patient is usually able to push back the swelling by hand. An inguinal hernia can be painful but isn’t necessarily so.

Other symptoms of an inguinal hernia are:

• Heaviness, swelling and a burning sensation in the hernial region, the scrotum or the thigh. Men may experience a swollen scrotum, women a swelling in the femoral area around the vagina (labia).
• Discomfort and pain in the groin. Bending over or lifting can worsen the symptoms.
• Discomfort and pain that only eases when the patient lies down. This type of discomfort only occurs when the hernia grows.
• Sudden pain, nausea or vomiting when the intestines get blocked in the hernia.

Inguinal hernias become flatter or disappear when pushed back gently or when the patient lies down. After a while, hernias tend to grow in size when the abdominal muscle wall weakens and more tissue herniates.

When the hernia is impossible to push back, it is constricted. A hernia becomes constricted when tissue fills up the hernia sack. This in itself is not an emergency, unless an intestinal loop gets constricted in the hernia, causing the blood supply to the loop to be strangulated which can ultimately cause the tissue to die. A constricted hernia is a medical emergency demanding immediate action.

Inguinal hernias can be repaired surgically. This procedure may prove vital in case of pain, fever, nausea and vomiting or when a hernia becomes constricted. Recurrence is not uncommon after inguinal hernia surgery, especially among male patients.

Risk factors

The following factors may increase the risk of inguinal hernia:

Changeable factors

• Obesity or recent weight loss
• Weak abdominal muscles due to unhealthy diet and/or lack of physical exercise
• Chronic coughing

Unchangeable factors

• Gender (men)
• Weak muscles since birth
• Weak muscles due to aging
• Already having suffered one or more inguinal hernias (relapse)

Factors for children

• Low birth weight (less than 1500 grams)
• Undescended testicles
• Family history
• Various birth factors

Inguinal hernia diagnosis

An inguinal hernia can be diagnosed fairly easily. A urine test may confirm a urinary tract infection (UTI). Other tests may help rule out other conditions possibly contributing to the hernia, such as colon cancer or lung cancer causing excessive coughing.

Inguinal hernia treatment

Surgical operation is required for all inguinal hernias. An operation is necessary to prevent complications such as strangulation. For children, surgery is almost always the preferred option. If the hernia can be pushed back, the surgery is non-urgent and will be executed at the patient’s earliest convenience. If the hernia can’t be pushed back, surgery cannot be postponed.

There are two types of operations:

Open inguinal hernia repair

In case of open inguinal hernia repair (also called the Lichtenstein procedure) a long incision is made in the groin. If the hernia bulges out of the abdomen, it is pushed back into place. If the hernia is located in the inguinal canal, it has to be pushed back or removed surgically.

The weak spot in the muscular wall where the hernia bulges, is usually repaired by placing a small piece of synthetic tissue over the weakened area in the abdominal wall after the hernia is pushed back. Some patients get to return home the same day of the surgery. Recovery time is about three weeks.

Laparoscopic inguinal hernia repair

A laparoscopic inguinal hernia repair (TEP) resembles other exploratory surgeries. A small incision is made above the navel, under general anesthesia. A small camera is inserted though the incision, other instruments through two incisions in the lower abdomen. Most patients get to return home the same day of the surgery. Recovery time is one to two weeks.

Advantages

A TEP offers the following advantages compared to open inguinal hernia repair:

• Smaller incisions
• Less painful
• Shorter recovery time
• More suitable for repairing recurring hernias
• The possibility of spotting and repairing a second hernia on the other side

Risks

A laparoscopic inguinal hernia repair (TEP) contains the following risks:

• Risks of general anesthesia
• Pain in the testes or spermatic chord
• Damage to the spermatic chord, possibly leading to infertility
• Fluid or blood in the scrotal, groin or abdominal muscles
• Bladder trauma and/or not being able to urinate
• Infection caused by the synthetic tissue or staples
• Formation of scar tissue (adhesion)
• Trauma to the abdominal organs, blood vessels and nerves
• Numbness or pain to the thigh
• Trauma to the testes causing testicular atrophy (rare)
• Relapse (1 to 10% chance)

Therefore, laparoscopic inguinal hernia repair isn’t recommended in case of:

• A constricted hernia
• A general medical condition that is too severe for general anesthesia
• Hemophilia or other blood disorders
• Regular intake of blood coagulation medication
• Multiple abdominal surgeries in the past
• Severe lung diseases
• Pregnancy
• Obesity

Some patients require special preparation to lower their chance of complications if one or more of the following factors apply to them:

• A history of blood clots in major blood vessels
• Smoking
• Intake of large doses of aspirin
• Intake of blood thinners
• Severe urinary problems