Inguinal Hernia

Topic Overview

What is an inguinal hernia?

An inguinal hernia (say "IN-gwuh-nul HER-nee-uh") occurs when tissue pushes through a weak spot in your groin muscle. This causes a bulge in the groin or scrotum. The bulge may hurt or burn.

See a picture of an inguinal hernia .

What causes an inguinal hernia?

Most inguinal hernias happen because an opening in the muscle wall does not close as it should before birth. That leaves a weak area in the belly muscle. Pressure on that area can cause tissue to push through and bulge out. A hernia can occur soon after birth or much later in life.

You are more likely to get a hernia if you are overweight or you do a lot of lifting, coughing, or straining. Hernias are more common in men. A woman may get a hernia while she is pregnant because of the pressure on her belly wall.

What are the symptoms?

The main symptom of an inguinal hernia is a bulge in the groin or scrotum. It often feels like a round lump. The bulge may form over a period of weeks or months. Or it may appear all of a sudden after you have been lifting heavy weights, coughing, bending, straining, or laughing. The hernia may be painful, but some hernias cause a bulge without pain.

A hernia also may cause swelling and a feeling of heaviness, tugging, or burning in the area of the hernia. These symptoms may get better when you lie down.

Sudden pain, nausea, and vomiting are signs that a part of your intestine may have become trapped in the hernia. Call your doctor if you have a hernia and have these symptoms.

How is an inguinal hernia diagnosed?

A doctor can usually know if you have a hernia based on your symptoms and a physical exam. The bulge is usually easy to feel.

How is it treated?

If you have a hernia, it will not heal on its own. Surgery is the only way to treat a hernia.

If your hernia does not bother you, you most likely can wait to have surgery. Your hernia may get worse, but it may not. In some cases, hernias that are small and painless may never need to be repaired.

Most people with hernias have surgery to repair them, even if they do not have symptoms. This is because many doctors believe surgery is less dangerous than strangulation, a serious problem that occurs when part of your intestine gets trapped inside the hernia.

But you may not need surgery right away. If the hernia is small and painless and you can push it back into your belly, you may be able to wait.

Babies and young children are more likely to have tissue get trapped in a hernia. If your child has a hernia, he or she will need surgery to repair it.

A hernia may come back after surgery. To reduce the chance that this will happen, stay at a healthy weight. Do not smoke, avoid heavy lifting, and try not to push hard when you have a bowel movement or pass urine.

Frequently Asked Questions

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	Should I have surgery for inguinal hernia now, or should I wait?

Cause

Inguinal hernias, which occur when tissue bulges through the abdominal muscles and into the groin, are caused by:

• An opening in the passage from the abdomen to the genitals (called the inguinal canal) that should close before birth but does not.
• Abdominal muscles that are weakened by aging and the daily wear and tear of life.

Conditions that increase pressure within the abdominal cavity, such as frequent coughing or being overweight, may contribute to the development of hernias.

A femoral hernia, sometimes mistaken for an inguinal hernia, occurs when tissue bulges from the lower abdomen into the upper thigh, just below the groin crease. The cause of a femoral hernia is often difficult to determine.

If you do not have an inguinal hernia, see our information on other types of abdominal wall hernias. Other types of hernias in the belly include spigelian, incisional, umbilical or periumbilical, and epigastric.

Symptoms

Symptoms of an inguinal hernia may include:

• A bulge in the groin or scrotum. The bulge may appear gradually over a period of several weeks or months, or it may form suddenly after you have been lifting heavy weights, coughing, bending, straining, or laughing. Many hernias flatten when you lie down.
• Groin discomfort or pain. The discomfort may be worse when you bend or lift. Although you may have pain or discomfort in the scrotum, many hernias do not cause any pain.

You may have sudden pain, nausea, and vomiting if part of the intestine becomes trapped (strangulated) in the hernia.

Other symptoms of a hernia include:

• Heaviness, swelling, and a tugging or burning sensation in the area of the hernia, scrotum, or inner thigh. Males may have a swollen scrotum, and females may have a bulge in the large fold of skin (labia) surrounding the vagina.
• Discomfort and aching that are relieved only when you lie down. This is often the case as the hernia grows larger.

See a picture of an inguinal hernia .

Hernia symptoms in children

In infants, a hernia may bulge when the child cries or moves around.

Strangulated hernias, in which part of the intestine becomes trapped in the hernia, are more common in infants and children than in adults. They can cause nausea and vomiting. An infant with a strangulated hernia may cry and refuse to eat. Strangulated hernias need treatment with surgery as soon as possible.

What Happens

Inguinal hernias typically flatten or disappear when they are pushed gently back into place or when you lie down. Over time, hernias tend to increase in size as the abdominal muscle wall becomes weaker and more tissue bulges through.

If you can't push your hernia back into your belly, it is incarcerated. A hernia gets incarcerated when tissue moves into the sac of the hernia and fills it up. This is not necessarily an emergency.

But if a loop of the intestine is trapped very tightly in the hernia, the blood supply to that part of the intestine can be cut off (strangulated), causing tissue to die. In a man, if tissue is trapped, the testicle and its blood vessels can also be damaged. A strangulated hernia is a medical emergency that requires immediate surgery.

In adults, a hernia that can be pushed back into the abdomen can be surgically repaired at a convenient time. This is because incarceration is rare in adults. A hernia that cannot be pushed back can be repaired when surgery is convenient unless you have increased pain, redness of the overlying skin, fever, nausea and vomiting, or abdominal bloating. If any of these occur, the hernia may need to be fixed sooner.

Inguinal hernias can come back after surgical repair. But in women it is rare for inguinal hernias to recur.

Fertility is usually not affected by an inguinal hernia or hernia surgery. But in males there is a chance that surgery or an incarcerated hernia can cause injury to the vas deferens, the tube that carries sperm from the testicles to the urethra.¹ It is not yet known how often or to what degree this affects a man's ability to father a child. In rare cases, surgery or an incarcerated hernia may injure the blood vessels that supply one or both testicles with blood, which may cause the affected testicle to shrink.

Hernias in children

Infants or children with an inguinal hernia need to have surgery as soon as possible because of the increased risk that a part of the intestine will become trapped and blood supply will be cut off, leading to tissue death.

Incarceration, when intestinal or abdominal tissue fills up the sac of a hernia, occurs in about 2 or 3 out of 10 infants younger than 6 months who have hernias. Most incarcerated hernias occur before the infant is 1 year old.¹ Female infants face a higher risk of incarceration.

What Increases Your Risk

Many factors can increase your risk for having an inguinal hernia.

Risk factors you cannot change

• Being male
• Having muscle weakness from birth, along with a hernia sac
• Having muscle weakness from aging
• Having one or more inguinal hernias

Risk factors for inguinal hernia in children

In children, risk factors for inguinal hernia include:

• Being born early and having low birth weight (less than 1500 g (3.3 lb)).
• Having one or both testicles that do not descend into the scrotum (undescended testicle).
• Having a family history of inguinal hernia.
• Having certain other birth defects or conditions, such as characteristics of each sex in a baby's genitals (ambiguous genitalia), abnormal position of the opening of the urethra on top of (epispadias) or underneath (hypospadias) the penis, or hydrocele, in which fluid builds up around one or both testicles.

Significant risk factors you can change

• Being overweight or having a recent, large weight loss (such as in crash dieting)
• Having weak abdominal muscles from poor diet, lack of exercise, or both
• Straining during urination or bowel movements
• Chronic coughing, such as from smoking

When To Call a Doctor

Call a health professional immediately if:

• Your child has an inguinal hernia that cannot be pushed back into the abdomen with gentle pressure.
• You or your child has an inguinal hernia and symptoms of strangulation, such as nausea, vomiting, fever, tenderness, and severe cramping pain in the groin area. These symptoms indicate that the intestine has lost blood supply.

Call a health professional if:

• Your infant has a definite lump in the groin area.
• You or your child has a tender bulge in the groin or scrotum, even if the bulge disappears when lying down.
• You or your child has increasing groin discomfort or pain. The discomfort may be increased by bending or lifting and may extend into the scrotum.

Talk with your health professional before wearing a corset or truss for a hernia. These devices are not recommended for treating hernias and sometimes can do more harm than good.

Watchful Waiting

Watchful waiting is a period of time during which you and your health professional observe your symptoms or condition but you do not receive medical treatment. If you are not sure whether you have groin muscle strain or a hernia, watchful waiting with home treatment for 1 to 2 weeks is appropriate. If you have pain that is increasing or severe, an obvious lump, or evidence of bowel blockage or urinary symptoms, call your doctor for an evaluation.

Watchful waiting is not appropriate for infants and children who have inguinal hernias.

If you or your child has not been diagnosed with an inguinal hernia but you have a bulge that can be pushed back into the abdomen with gentle pressure, call your doctor at your convenience to have the bulge evaluated.

You and your doctor can decide whether you should have surgery to fix your hernia or if you can wait. If your hernia does not bother you, you can probably wait to have surgery.

Who To See

The following health professionals can diagnose an inguinal hernia:

• Internist
• Family medicine doctor
• Pediatrician
• Emergency room doctor
• Surgeon
• Nurse practitioner
• Physician assistant

A general surgeon or pediatric surgeon with experience in inguinal hernia repair will be needed to perform hernia repair surgery.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

The diagnosis of inguinal hernia is usually based on your medical history and a physical exam. Tests such as ultrasound and CT scans are not usually needed to diagnose an inguinal hernia. In most cases, a doctor can identify an inguinal hernia during a physical exam.

An examination of urine (urinalysis) may be done to rule out a urinary tract infection. A urinary tract infection or kidney stone may cause pain in the groin that can be mistaken for hernia pain. Further tests may be done to rule out other conditions that could be contributing to the hernia, such as colon or prostate cancer or lung diseases that cause chronic coughing.

If surgery is planned, other tests may be needed to evaluate the status of any current health problems, such as lung, heart, or bleeding problems.

Treatment Overview

Surgery is the only treatment and cure for inguinal hernia. Hernia repair is one of the most common surgeries done in the United States. About 750,000 people have hernia repairs each year.² But if an inguinal hernia does not cause any symptoms, it may not need treatment.

Surgery

Many doctors recommend surgery to repair a hernia because it prevents strangulation, which occurs when a loop of intestine is trapped tightly in a hernia and the blood supply is cut off, killing the tissue. Strangulation requires immediate surgery, although the condition is rare in adults.

There are two types of hernia repair surgeries:

Open hernia repair surgery. During open surgery, the hernia is repaired through an incision in the groin. Open surgery has been done for many years.

Laparoscopic hernia repair. Laparoscopic hernia repair is a newer method for repairing an inguinal hernia in adults. A surgeon inserts a thin, lighted scope through a small incision in the abdomen. Instruments to repair the hernia are inserted through other abdominal incisions.

If your hernia does not bother you, you may not need to have surgery. Waiting to have surgery does not increase the chance that part of your intestine or abdominal tissue will get stuck in your hernia. Waiting will also not increase your risk for problems, if you decide to have surgery later. In some cases, hernias that are small and painless may never need to be repaired.

Often an inguinal hernia can be pushed back, or reduced, into the abdomen with gentle pressure. In an adult, a hernia that can be pushed back can be surgically repaired at a convenient time. Surgery can be delayed for months. But surgery cannot be delayed that long in infants and children because of the increased risk of incarceration and strangulation. See the Surgery section of this topic for more information.

Should I have surgery for inguinal hernia now, or should I wait?

Other treatments

Inguinal hernia cannot be treated with medicines. But pain medicine is given after hernia surgery.

Talk with your health professional before wearing a corset or truss for a hernia. These devices are not recommended for treating hernias and sometimes can do more harm than good.

Hernias in children

In a child, a hernia that is incarcerated may be pushed back into the abdomen by a doctor. But surgery is still needed because of the increased risk of strangulation.

• If the doctor cannot push the hernia back at the time of the exam, the child may be sedated and laid down with his or her head lower than the body, with an ice pack over the hernia.
• If the hernia does not reduce on its own, the doctor may try to push it back into the abdomen.
• If the hernia is reduced, surgery can be delayed for a short time.
• If the hernia cannot be reduced, immediate surgery is necessary.

What To Think About

In adults, if the hernia can be pushed back into the abdomen, surgery can be delayed. If strangulation is likely to occur, you may need surgery sooner.

Some doctors will watch and wait indefinitely with small hernias that bulge out directly through the abdominal wall and are not getting bigger. If these hernias do not cause symptoms, surgery may not be necessary.

A surgeon's experience plays an important role in the risk of a hernia recurring. If you are considering hernia surgery, ask the surgeon how many of these surgeries he or she has performed and about his or her recurrence rates. Recurrence rates tend to be higher for laparoscopic surgery and for other surgeries that do not use mesh (a synthetic patch).

Some people with other medical conditions may choose not to have surgery or may not be able to have hernia surgery.

• People with major health problems, such as uncontrolled diabetes, may need to bring these conditions under control before having hernia surgery.
• Conditions that cause coughing or straining to pass stools or urine (such as lung diseases or prostate problems) may need to be corrected before surgery so that the hernia is less likely to recur after repair.

Having laparoscopic surgery has some advantages over open surgery. The pain after surgery seems to be less with the laparoscopic surgery and people return to work earlier. But laparoscopic surgery is much more expensive and the hernia is more likely to come back. Laparoscopic surgery also has a higher risk of rare but serious complications.

Prevention

Most inguinal hernias cannot be prevented, especially in infants and children. Adults may be able to prevent a few hernias or prevent a hernia from recurring by following some of these suggestions:

• Avoid becoming overweight. Being overweight creates greater abdominal pressure and increases your risk for developing an inguinal hernia. Maintain a healthy weight through diet and exercise.
• Avoid rapid weight loss (such as in crash dieting). Rapid weight loss programs may be lacking in protein and vitamins that are needed for muscle strength, causing weakness in the muscles of the abdomen.
• Stop smoking. Chronic coughing from smoking increases the risk of developing a hernia.
• Avoid constipation and straining during bowel movements and urination. Straining causes increased pressure inside the abdomen.
• Use good body mechanics when lifting heavy objects. Lift with your legs, not with your back. For more information, see the topic Low Back Pain.

Home Treatment

Home treatment will not cure an inguinal hernia.

Certain changes in exercise, weight, and personal habits may help to prevent some hernias. Lifestyle changes also may prevent hernias from coming back after you have had surgery to repair a hernia.

Talk with your health professional before wearing a corset or truss for a hernia. These devices are not recommended for treating hernias and sometimes can do more harm than good. There may be certain situations when your doctor thinks a truss would work, but these are rare.

Medications

Inguinal hernias are not treated with medicine. But pain medicine is given after hernia repair surgery.

Surgery

Surgery has generally been recommended for all inguinal hernias to avoid complications such as strangulation, in which a loop of intestine becomes tightly trapped in a hernia, cutting off the blood supply to that part of the intestine. But surgery may not be needed if the hernia is small and you do not have symptoms. Consult with your doctor to decide if you need hernia repair surgery.

If a hernia in an adult can be pushed back (reduced), surgery can be done at the person's convenience. If it cannot be pushed back, surgery must be done sooner.

• During surgery, the hernia sac is removed and occasionally a couple of stitches are used to close the opening of the inguinal canal nearest the abdominal cavity (internal ring).
• Most hernia repairs are done as outpatient surgery. Anesthesia can be local, spinal, or general.
• The use of synthetic patches or mesh for hernia repair is becoming standard for adult surgery. The mesh or patch is used to strengthen the abdominal wall and prevent hernias from recurring. Previously, these were used mostly for hernias that were large or hard to repair.

Laparoscopic hernia surgery may have some advantages over open surgery in certain situations. Studies show that people have less pain after this type of surgery and return to work and other activities more quickly than after open repair. But laparoscopic surgery is more expensive than open repair. And laparoscopic surgery has a higher risk for serious complications.³ Recurrence rates are also higher with laparoscopic repair.⁴

The risk of a hernia coming back after surgery varies depending on a surgeon's experience, the type of hernia, the method of surgery, and the person's age and overall health.

• Recurrence rates after hernia repair are lower when experienced surgeons perform the procedure, especially for laparoscopic techniques.⁵
• The chance of a hernia coming back after open surgery ranges from 1 to 10 out of every 100 open surgeries done.⁶
• Up to 10% of hernias repaired with laparoscopic surgery may recur.⁴ Some studies have found recurrence rates as low as 0.25% to 2% for laparoscopic surgery.⁷
• Using mesh to repair the weak muscle in the stomach wall makes it up to half as likely that the hernia will come back.⁸

  Should I have surgery for inguinal hernia now, or should I wait?

Surgery in children

In most cases, a child with an inguinal hernia will need surgery to correct it.

Infants 6 months of age and younger who have inguinal hernias have a much higher risk of strangulation than older children and adults. Therefore, surgery for inguinal hernias in infants is not delayed like it can be for adults.

• Synthetic patches are not needed to repair an inguinal hernia in an infant.
• Some infants with an inguinal hernia may need to be hospitalized for surgery rather than have it in an outpatient setting. These include infants with lung problems, seizure disorders, or heart diseases from birth or those who were born prematurely.

Children are less likely than adults to have a hernia come back. Recurrence in children is less than 1%.¹

One of the major decisions concerning infants and children is whether to explore the opposite groin area for a hernia during a hernia repair. A hernia develops in the other side of the groin in about 30% of children who have had hernia surgery. The risk of developing a hernia on the other side is up to 50% in infants who had hernia surgery during the first year of life.¹

Issues to consider in deciding whether the other side should be explored include the overall health of the child, the risk of incarceration of a hernia, and the experience level of the surgeon (how many of these surgeries the doctor has performed and his or her recurrence rates).

Surgery Choices

Two types of surgery are done to repair inguinal hernias:

Open hernia repair (herniorrhaphy, hernioplasty)

Laparoscopic hernia repair

What To Think About

Studies show that the numbers of hernias that come back (recur) after laparoscopic surgery are higher than with open hernia repair using mesh.⁴ The laparoscopic procedure causes less pain and numbness after surgery and generally allows you to return to work and activities sooner. But serious complications such as bladder injury are more likely to occur with a laparoscopic procedure. Also, the success of a laparoscopic surgery depends more on the surgeon's experience, and laparoscopic surgery is more expensive than open surgery.³

Laparoscopic surgery may not be possible for a person who has tissues that have grown together (adhesions) from previous abdominal operations.

Most hernias that will recur do so within 5 years after surgery.

There are some considerations before having inguinal hernia repair surgery. Talk with your doctor so that you make the best decision for your condition.

Recurrent inguinal hernias are more difficult to repair and pose more risks than initial hernia repairs. The risks associated with recurrent hernia surgery are more scar tissue, numbness and pain after surgery, and a greater chance of injury to a testicle or the spermatic cord.

Conditions that might increase the risk of recurrence include abdominal muscles that are not strong or healthy enough to "hold" the stitching (suture) material and bleeding or infection that weaken the repair.

Fertility is usually not affected by an inguinal hernia or hernia surgery. But in males there is a chance that surgery or an incarcerated hernia can cause injury to the vas deferens, the tube that carries sperm from the testicles to the urethra.¹ It is not yet known how often or to what degree this affects a man's ability to father a child.

Other Treatment

Surgery is the only effective medical treatment and cure for inguinal hernia. Talk with your health professional before wearing a corset or truss for a hernia. These devices are not recommended for treating hernias and sometimes can do more harm than good.

Other Places To Get Help

Organization

Related Information

• Groin Problems and Injuries
• Umbilical Hernia in Children

References

Citations

1. Aiken JJ (2004). Inguinal hernias. In RE Behrman et al., eds., Nelson Textbook of Pediatrics, 17th ed., pp. 1293-1297. Philadelphia: Saunders.

2. Jeyarajah R, Harford WV (2006). Inguinal and femoral hernias (groin hernias) section of Abdominal hernias and gastric volvulus. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 8th ed., vol. 1, pp. 483-487. Philadelphia: Saunders/Elsevier.

3. McCormack K, et al. (2006). Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database of Systematic Reviews (1). Oxford: Update Software.

4. Neumayer L, et al. (2004). Open mesh versus laparoscopic mesh repair of inguinal hernia. New England Journal of Medicine, 350(18): 1819-1827.

5. Fitzgibbons RJ, et al. (2005). Inguinal hernias. In FC Brunicardi et al., eds., Schwartz's Principles of Surgery, 8th ed., pp. 1353-1394. New York: McGraw-Hill.

6. Harmon JW, Wolfgang CL (2007). Hernias of the groin and abdominal wall. In NH Fiebach et al., eds., Principles of Ambulatory Medicine, 7th ed., pp. 1673-1681. Philadelphia: Lippincott Williams and Wilkins.

7. Quilici P, et al. (2000). Laparoscopic inguinal hernia repair: Optimal technical variations and results in 1,700 cases. American Surgeon, 66(99): 848-852.

8. Deveney KE (2006). Hernias of the groin section of Hernias and other lesions of the abdominal wall. In GM Doherty, LW Way, eds., Current Surgical Diagnosis and Treatment, 12th ed., pp. 765-773. New York: Lange Medical Books/McGraw-Hill.

Other Works Consulted

• Neumayer L, et al. (2004). Open mesh versus laparoscopic mesh repair of inguinal hernia. New England Journal of Medicine, 350(18): 1819-1827.

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