Pathogenesis (development of disease)
Adult inguinal hernia is thought to be caused by disruption of the extracellular matrix: Matrix metalloproteases and their inhibitors show alterations; collagen metabolism is also impaired.
In inguinal hernia, abdominal viscera pass through the inguinal canal (canalis inguinalis). Direct (medial/acquired) can be distinguished from indirect (lateral) and femoral hernias:
- In direct inguinal hernia, there is a muscle weakness in the abdominal wall; in indirect hernia, the processus vaginalis peritonei (“vaginal skin process”; funnel-shaped protrusion of the peritoneum into the scrotum) has not closed during development.
- In femoral hernia (femoral hernia; femoral hernia; thigh hernia), the hernial orifice is between the ligamentum inguinale (lat. inguinal ligament) and the pelvic wall, i.e. in contrast to the inguinal hernia below the inguinal ligament.
Frequency: indirect inguinal hernia > direct inguinal hernia (about 2:1); timely > left-sided.
Etiology (causes)
Biographic causes
- Genetic burden – with a positive family history: 8-fold increase.
- Genetic diseases
- Marfan syndrome – genetic disorder that can be inherited in an autosomal-dominant manner or occur sporadically (as a new mutation); systemic connective tissue disorder that is most notable for tall stature, spider-limbedness, and hyperextensibility of the joints; 75% of these patients have an aneurysm (dangerous vascular bulge)
- Premature infants; urogenital malformations; gastroschisis (abdominal cleft; developmental disorder of the anterior abdominal wall); omphalocele (umbilical cord hernia).
- Gender – males to females 6-8: 1
- Age – increasing age
- Genetic diseases
Behavioral causes
- Consumption of stimulants
- Tobacco (smoking)
- Physical activity
- Heavy physical work
- Carrying heavy loads
- Underweight
- Overweight (BMI ≥ 25; obesity) – obesity
Disease-related causes
- Ascites (abdominal dropsy)
- Chronic constipation (constipation)
- Chronic obstructive pulmonary disease (COPD)
- Diverticular disease (protrusion of the intestinal wall).
- Collagenoses (collagen diseases)
- Prostate adenoma – benign tumor of the prostate gland.
- Trauma (injuries)
- Tumors in the abdomen
- Varices (varicose veins)
Other causes
- Weakness of connective tissue (disruption of the extracellular matrix).
- Pregnancy