Inguinal Hernia: Types, Causes, Symptoms, Treatment, Prevention, Investigations
Hernia is a condition which occurs due to bulging of a part of the inner tissue such as muscle, intestines, fat, etc caused by weak abdominal wall resulting in discomfort, pain and many other complications.
An inguinal hernia is a condition which occurs due to protrusion of soft tissue, specifically intestinal part, from a weaker point that tears off in the lower abdominal wall. This often results in painful bulge, particularly while coughing, bending and lifting heavy weights.
Approximately 80 percent of hernia cases are recorded as inguinal hernia. Males are 25 times more prone to inguinal hernia when compared to females. The estimated rate of population of patients suffering with inguinal hernia is found to be five percent.
Inguinal hernias are of two types. It can either be direct or indirect. Direct inguinal hernias occur due to herniation of the abdominal part from a weak point present in the inguinal canal and the abdominal wall. Indirect hernias often result due to bulging of the part of the abdomen because of the deep inguinal ring. Indirect hernias are quite uncommon and usually are a result of some birth defect.
In case of men, the weak spot usually develops along the inguinal canal. Inguinal canal is the region where the spermatic cord holds the vas deferens i.e. the tube that carries sperm and enters into the scrotum. In case of women, the inguinal canal carries a ligament that keeps the uterus in its place. In some cases the hernia may affect the place where connective tissue from uterus connects to tissue that surrounds the pubic bone.
An inguinal hernia is a disorder which does not have the quality of getting healed on its own. Inguinal hernia if left untreated can force the contents present in the abdomen such as intestines to protrude into the hernia resulting in rapid progression. The herniating tissues often include complications like strangulation i.e. pinching that is usually responsible for intestinal blockages and may also stop the blood supply causing ischemia which can also end up in life-threatening complications. Therefore surgical intervention is often required for repairing inguinal hernia that becomes large and painful.
Types of Inguinal Hernia
Inguinal hernia is broadly classified into two types:
- Direct inguinal hernia.
- Indirect inguinal hernia.
Direct Inguinal Hernia: Direct inguinal hernia is a condition which often occurs due to protrusion of intestinal part from weaker abdominal muscles or weak point within the wall of the inguinal canal. Direct inguinal hernia is very frequent in adults when compared to children and is very rare in children.
Indirect Inguinal Hernia: Indirect inguinal hernia is a condition which occurs due to inguinal canal being left in an open state that otherwise gets closed around the time of birth. As a result, an area of intestine slips down from inguinal canal. Although indirect inguinal hernia is often diagnosed within the beginning year of life but in some cases it does not show up until the time of adulthood. Indirect inguinal hernia is usually seen in about 1 to 5 percent of normal newborns and about 10 percent in premature infants.
In adults, the projection and experience of direct and indirect inguinal hernias are usually similar to each other. Direct and indirect inguinal hernias may affect either or both the sides of the groin. However, treatment procedure for both direct and indirect inguinal hernias is also similar.
Causes and Risk Factors of Inguinal Hernia
Although the clear cause of inguinal hernia may not be known in some cases, the common causes may include:
- Increased stress in the abdomen.
- An old weak spot present in the abdominal wall.
- A combination of increased stress in the abdomen along with a pre-existing weak spot present in the abdominal wall.
- Straining at the time of urination and bowel movements.
- Heavy lifting.
- Fluid in the abdomen or ascites.
- Chronic sneezing and coughing.
- Family history.
- Individuals performing job that involve standing for prolong periods.
- Performing heavy or strenuous physical activities.
- Premature birth.
- History of hernias meaning if a person develops inguinal hernia on one side, that person is likely to develop another on the opposite side at a later date.
Signs and Symptoms of Inguinal Hernia
The symptoms of inguinal hernia may include.
- Pain in the groin while performing exercise.
- Pain with increased abdominal pressure such as with coughing or sneezing.
- A bulge in the groin region that disappears on lying down.
- A bulge noticeable in the region present at the either side of pubic bone.
- A gurgling, aching and burning sensation could also be experienced in the bulge.
- Discomfort and pain could also be experienced in groin, particularly while coughing, lifting and bending over.
- Dragging and heavy sensation may be experienced in groin.
- Pressure and weakness in groin.
- Pain and swelling in the scrotum or around the testicles.
Treatment for Inguinal Hernia
There may be some cases where inguinal hernia may not require any treatment. Otherwise, most of the hernias need to be treated surgically. A truss, which is a device worn around the groin to put pressure on the hernia helping to keep it under control, is used temporarily until the surgery can be performed. People with advanced age or poor health who do not qualify for surgery may need to use this device permanently.
Hernia repair can be performed either by laparoscopic surgery or through open surgery. Both the procedures need about an hour to be performed and can be done in an outpatient setting.
Open Surgery: Many cases of inguinal hernias are often repaired by open surgery which is performed under local or general anesthesia. Open surgery is performed by making an incision in the groin in order to push the herniated tissue back in its original place and repairing the opening of hernia with stitches. In several cases, a small piece of synthetic mesh material is used for reinforcing the region for prevention of recurrent hernia.
Laparoscopic Surgery: Laparoscopic hernia repair is performed by making three small incisions in the wall of abdomen in order to inflate the abdomen with a gas. Then a laparoscope is inserted through the incisions in order to push the herniated intestine back into its original place and repairing the opening of the hernia with the help of surgical staples. Although this surgery has impressed many patients, it is less affective when compared to open surgery.
Prevention for Inguinal Hernia
- Maintaining a healthy body weight.
- Performing exercises that help in strengthening abdominal muscles.
- Straining while urinating or defecating must be avoided.
- Lifting heavy objects must be avoided.
Investigations for Inguinal Hernia
A thorough subjective and medical history is performed to diagnose inguinal hernia. A physical examination of groin area exhibits the activities of bulge and exacerbation of symptoms. Patient is also asked to stand in order to strain or cough which also helps in determining inguinal hernia.