What is an Inguinal Hernia
An inguinal hernia forms in the inguinal canal (left or right) at the base of the abdomen, close to the groin area. They are a result of either fatty or intestinal tissue pushing through a weak region in the abdominal wall.
Many do not seek medical help because it causes no symptoms and is small. However, evaluation by a doctor can help prevent complications in the future.
Types of Inguinal Hernia
Inguinal hernias can be of four types: Indirect or direct, incarcerated or strangulated.
Indirect inguinal hernia: Indirect inguinal hernia, a commonly observed hernia, often has been known to occur in premature births, before the closure of the inguinal canal.
This type of hernia may also occur at any other point in life. Its formation is mostly observed in males.
Direct inguinal hernia: A direct inguinal hernia is believed to be formed as a result of aging, which is responsible for the weakening of the muscles.
A direct inguinal hernia is much more predominant in males, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
Incarcerated inguinal hernia: A hernia where the bulging tissue cannot be pushed back into its original position is an incarcerated hernia. The tissue gets stuck in the groin area.
Strangulated inguinal hernia: The intestine is an incarcerated hernia and with no blood flow to it, is a strangulated inguinal hernia. It is a serious and life-threatening medical condition. It needs to be treated as a medical emergency.
Causes of Inguinal Hernia
There is no specific cause for most inguinal hernia. Others could be formed because of the following causes:
- A weak spot in the abdominal wall.
- Pressure impinging from inside the abdomen.
- Strenuous urination or bowel movements (e.g. constipation).
- Strained coughing or frequent sneezing.
- Frequent vigorous activity.
- Pregnancy
- At birth, due to improper closure of the peritoneum (abdominal lining).
- With ageing, as the muscles weaken.
- Coughing, due to smoking activity.
- Obesity
- Family history with a close relative developing the condition.
- Low birth weight or premature birth.
- Inguinal hernia in childhood predisposes for its development in later years.
- Cystic fibrosis.
Diagnosis for Inguinal Hernia
A physical evaluation, while the patient is standing, is usually good enough for a doctor to access an inguinal hernia.
The patient may be asked to cough while standing, as the bulge of the hernia in the groin region becomes prominent on coughing.
An abdominal ultrasound, CT, or MRI scans are recommended should the evaluation by the doctor be inconclusive.
Treatment options for Inguinal Hernia
If the hernia formed is small and not causing a lot of discomforts the doctor may recommend observation and ask to wear a truss to support the bulge (to relieve symptoms).
For children, the doctor may attempt manual pressure to push back the hernia in its original position. However, if the hernia continues to enlarge and is painful, surgery is the only course of action.
There are two types of surgical interventions:
Open Hernia Repair
Open hernia repair is done under local anesthesia and sedation or even general anesthesia. An incision is made in the groin area and the bulging tissue is pushed back into the abdomen.
The weakened area is then stitched. It may also be reinforced with a synthetic mesh (hernioplasty). The incision is then closed with surgical glue, staples, or stitches.
Laparoscopic surgery
This is a minimally invasive surgery. Small incisions are made in the abdomen. Gas is used to inflate the abdomen to have a better view of the internal organs.
A small tube connected to a small camera (laparoscope) is inserted along with tiny instruments through the other incisions and repair the hernia. Recovery post-surgery is easier and it is an effective alternative for recurrent hernias or bilateral hernias.
Recovery is rapid with laparoscopic surgery compared to open repair.
