Inguinal Hernia: Causes

What causes inguinal hernia?

Hernia is when part of a tissue or an organ bulges through a weak point in the body

Sometimes, inguinal hernias may have no known cause. In other cases, it may occur due to

• Elevated pressure within the abdomen.
• Pre-existing weak spots in the abdominal wall, for example, from birth.
• Weakness of the abdominal wall due to aging or injury.
• Straining during bowel movements due to chronic constipation.
• Strenuous exercise, especially heavy weight lifting.
• Pregnancy.
• Chronic coughing or sneezing.

Risk factors for inguinal hernia:

• Male sex
• Being older
• Being white
• Family history
• Chronic cough
• Chronic smoking
• Chronic constipation
• Pregnancy
• Premature birth and low birth weight 
• Previous inguinal hernia or hernia repair surgery

What is inguinal hernia?

A hernia is when part of a tissue or an organ bulges through a weak point in the body. There are various types of hernias occurring in different parts of the body.

An inguinal hernia occurs when part of the intestine or surrounding fat and structures bulge through a weak point in the lower abdominal wall. Sometimes, lower abdominal organs such as parts of the female reproductive organs can also bulge through the weak point. They’re more common in men than in women. In men, an inguinal hernia can cause a bulge in the groin and scrotum. Sometimes, it may be difficult to distinguish between inguinal hernia and femoral hernia. Femoral hernia presents as a small- to medium-sized lump in the groin. 

Inguinal hernia may be asymptomatic initially, but it can worsen and lead to life-threatening complications. An inguinal hernia doesn't disappear on its own, and surgery is usually required to fix an inguinal hernia.

What are the signs and symptoms of inguinal hernia?

Inguinal hernia signs and symptoms include:

• A bulge on either side of the pubic bone, more commonly on the right side
• Bulge becomes more prominent, especially while coughing or straining
• Pain or discomfort at the site of the bulge
• The feeling of heaviness or a dragging sensation in the groin
• Weakness or increased pressure in the groin
• Pain and swelling around the testicles if the protruding intestine descends into the scrotum

Signs and symptoms in children:

Inguinal hernias in newborns and children occur due to weakness in the abdominal wall that's present at birth. A hernia may be visible only while crying, coughing, or straining during bowel movements. Infants may be irritable and may not eat properly.

What is a hernia?
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What happens if inguinal hernia is not treated?

If untreated, the following complications can occur:

• Pressure on surrounding tissues: Inguinal hernias tend to worsen and apply pressure over the surrounding structures, reducing blood flow.
• Incarceration: If the contents of the hernia are not able to be pushed back, it means they are incarcerated (trapped) in the weak point in the abdominal wall. It can lead to strangulation.
• Strangulation: Incarcerated hernia can cut off blood flow to part of the intestine that is trapped by causing strangulation. This leads to the death of the affected tissues. A strangulated hernia is a medical emergency and requires immediate medical attention.

Signs and symptoms of a strangulated hernia include:

• Fever
• Sudden and severe pain at the hernia site
• Warmth and tenderness at the hernia site 
• Change of color of the bulge to red, purple or blue, or black
• Nausea
• Vomiting
• Difficulty passing gas and stools

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Can inguinal hernias be prevented?

The following tips may help prevent inguinal hernias:

• Maintaining healthy body weight and decreasing abdominal wall pressure
• Avoiding smoking and excessive alcohol
• Avoiding heavy lifting and straining while exercising
• Correcting chronic constipation to prevent straining during bowel movements. Eating a high-fiber diet and drinking plenty of fluids can help improve constipation, if not, seeking medical attention is required.
• Seeking medical attention to treat chronic cough

How is inguinal hernia treated?

In the early stages of inguinal hernia and when it is asymptomatic, the doctor might advise observation and follow-up. A supportive truss may be worn to help relieve symptoms, with the guidance of a doctor.

Surgery is recommended to fix hernia because they do not improve or disappear on their own. Surgery is performed under anesthesia. There are two general types of hernia surgeries—open hernia repair and laparoscopic repair.

• Open hernia repair: An incision is made in the groin, and the contents of the hernia are pushed back into the abdomen. The weakened area in the abdominal wall is usually reinforced with a synthetic mesh. This is called hernioplasty. It may take several weeks to fully recover and resume normal activities.
• Laparoscopic hernia repair: This is a minimally invasive procedure. Several small incisions are made over the abdomen through which a laparoscope (a small tube with a light source and camera) and surgical instruments are inserted. The abdominal wall is usually reinforced with a synthetic mesh. Recovery is faster than open surgery.