Inguinal Hernia: Causes, Symptoms & Treatment

An inguinal hernia (groin hernia) is a physical condition of the inner abdominal wall. In this case, the custom wall in the groin area breaks, so that the abdominal organs are no longer held inside the abdomen. The most noticeable signs of a hernia are strong abdominal bulges and abdominal growths, as well as swelling in the groin area. In addition, those affected complain of pulling and stabbing pains in this area. An inguinal hernia should definitely be treated by a doctor as soon as possible, otherwise serious complications can set in.

What is a hernia?

Inguinal hernia (medically inguinal hernia) is a hernia of the soft tissues in the area of the inguinal canal. A distinction is made between direct inguinal hernias (usually located on the inside) and indirect inguinal hernias (usually breaking through on the outside and pulling inward). The difference is that the indirect hernias are mostly congenital and usually pull through the whole inguinal canal. Direct, on the other hand, break centrally through the weak point and are usually acquired hernias. However, this classification is more important for understanding, less for therapy. The inguinal hernia occurs in young and old. The male sex is significantly more often affected due to the anatomy.

Causes

Inguinal hernia usually develops on the basis of a pre-existing weakness of the connective tissue. A sudden increase in pressure in the abdomen (coughing, going to the toilet, heavy lifting, crying in infants) can cause a gap through which mostly parts of the intestine or just large mesh (this is fat between the intestinal loops) can pass. The indirect, congenital inguinal hernias are manifested by a painless swelling at the midline inguinal canal in the infant. When the pressure in the abdomen increases, loops of intestine are forced through a canal that has remained open (processus vaginalis testis). The intestines are usually easily pushed back in this type of inguinal hernia. Acquired inguinal hernias also rarely show pronounced symptoms. Here, too, only swelling and possibly a slight pain or feeling of pressure are indicative. Severe pain – especially if it occurs suddenly – is suspicious for an incarceration of the inguinal hernia. In this case, parts of the intestine pass through the hernia gap, swell due to the squeezed-off blood drainage and can thus no longer be pushed back into the abdominal cavity. An incarcerated inguinal hernia is an absolute surgical emergency situation, since the intestine is no longer supplied with blood and would die without therapy. The parts of the intestine that are not supplied with blood can also easily become infected, which can lead to life-threatening peritonitis.

Symptoms, complaints, and signs

Depending on whether the hernia is larger or smaller, more severe or attenuated symptoms occur. In a weakened form, there is a pulling sensation in the groin area during normal movements. As soon as the person rests, this pulling sensation disappears. If it is a larger hernia, an outward bulge may be visible. This bulge can be pushed back in many cases. The person concerned also suffers from pain. These symptoms also subside again as soon as the patient rests or lies down. If there is a hernia extending to the testicles, a swollen scrotum is a typical sign of this condition. Severe pain can be observed in patients where tissue or organs have become trapped due to the resulting hernia. In connection with this, fever, nausea and [[vomiting9]] may be observed. In such a case, it is imperative that medical assistance be provided, as the intestine may become stuck or affected tissue may die due to insufficient supply. Surgery is vital. The condition can also occur in children. Parents recognize signs in the form of a swollen scrotum or swollen labia minora. Furthermore, the child may complain of pain. Here, a doctor should also be consulted immediately, as internal organs may also be affected.

Complications

Complications rarely show up with a hernia. In principle, however, sequelae are possible, which can have serious effects on the health of the affected person. One of the most common and worrisome complications of inguinal hernia is the entrapment of the hernia sac contents within the hernia gap.This leads to an interruption of the blood supply to the visceral region in the hernia sac, which is caused by strangulation. In the further course, this threatens the death of the visceral part. Another serious consequence is the development of peritonitis (inflammation of the peritoneum), which can assume life-threatening proportions. However, if surgical intervention takes place in time, this danger can be prevented. In the case of emergency surgery, the mortality rate is five to ten percent. However, complications can also be caused by inguinal hernia surgery. For example, it is possible that the vas deferens may be damaged. In addition, a narrowing of the inguinal canal vessels is conceivable. As a result, the testicle regresses in men. If a leg vein is narrowed, there is a risk of thrombosis. Other possible sequelae of inguinal hernia surgery include damage to nerves, chronic pain, injury to the urinary bladder or bowel, inflammation, and wound infections. However, due to modern surgical methods, these after-effects rarely show up. After inguinal hernia surgery, there is a risk of recurrence, which depends on the particular surgical procedure and the condition of the connective tissue. A recurrence of the inguinal hernia affects approximately five to ten percent of all patients.

When should you go to the doctor?

If a hernia is suspected, a doctor should be consulted immediately. If typical symptoms such as nausea and vomiting or pain in the groin area occur, this must be clarified by the family doctor or a gastroenterologist. When the characteristic bump appears, it is best to consult a medical professional immediately. Parents who notice a bulge in the groin area in their child should consult the pediatrician. If there are warning signs, such as stabbing pain or blood in the stool, that indicate bowel obstruction, emergency medical services should be called. The affected person must then receive intensive medical care to avoid serious complications. Early treatment can usually rule out tissue and organ damage. Overweight people, pregnant women and boys with undescended testicles are particularly susceptible to a hernia. Athletes and people with a congenital weakness of the connective tissue also belong to the risk groups and should confer with a specialist if they have the aforementioned complaints. Patients who have already suffered an inguinal hernia once, inform the responsible physician in case of recurring symptoms.

Treatment and therapy

To prevent incarceration, even an asymptomatic inguinal hernia is operated on at a discretionary (elective) time. The much courted alternative therapy with a hernia band is only useful if surgery cannot be performed for a variety of reasons. The problem is that the hernia ligaments take away additional holding work from the muscles, weakening them. Consequently, the counterforce that holds the viscera in the abdominal cavity decreases. Different surgical techniques are possible depending on the demands on the load capacity. If the affected person wishes a minimally invasive procedure (by means of laparoscopy), a plastic mesh is always inserted in adult patients. The operation can be performed in two ways. Either the peritoneum is not opened (TEPP) or surgery is performed through the abdominal cavity (TAPP). The greatest advantage of these so-called “tension-free techniques” is, above all, the early ability to bear weight. Incisional surgeries can be performed with or without insertion of foreign material. Classic procedures are the Lichtenstein operation (in which a plastic mesh is also inserted) and the Shouldice operation (closure of the hernia gap by a direct suture. For more stability, the muscle fascia is also doubled in this technique). The greatest advantage here is that these procedures can be performed under local anesthesia. Elderly people in particular can benefit from reduced surgical risks.

Outlook and prognosis

The prognosis depends mainly on whether or not surgery is performed in a timely manner. If the symptoms are ignored or not treated, the inguinal hernia will enlarge. There is no chance of self-healing. Life-threatening complications may occur. Surgeons have now accumulated a great deal of knowledge about hernia surgery. There are three proven procedures to choose from. Surgery is usually uncomplicated, so that the patient is subsequently free of symptoms.This favorable prognosis may worsen in elderly patients and a difficult situation. Possible complications mainly relate to incarcerated viscera. Extension of the disease to the entire abdominal cavity or damage to the reproductive organs may result. However, such conditions are very rare. In five to ten percent of all successful operations, the hernia occurs again, which doctors call recurrence. However, there is an equally favorable outlook after a repeated operation. Patients prevent a recurrence of a hernia by not lifting heavy and eating a diet that is easy to digest for up to six months after surgery. European-standard medical treatment promises a lifetime of freedom from symptoms.

Prevention

Since congenital connective tissue weakness cannot be changed, direct prevention is difficult. Only through exercise can the muscle mantle be strengthened. Alternating showers are able to tighten the connective tissue somewhat. The emphasis in prevention is on avoiding increased pressure in the abdominal cavity. This can be realized, for example, through weight reduction, stool-regulating measures or proper lifting of heavy loads.

Follow-up care

Because an inguinal hernia is treated with surgery, careful follow-up care is necessary. Even after successful surgery, the patient must perceive numerous control examinations, which serve the aftercare. As a rule, the condition of the groin as well as the abdominal cavity is examined. Scar care is also part of these examinations. However, a hernia that has been treated once and with success is no guarantee that it will not occur again. Therefore, follow-up care for this condition also includes actively preventing another inguinal hernia. These aftercare measures include minimizing risk factors, and medical monitoring is sometimes appropriate. For example, if the affected person suffers from severe obesity, a medical professional can supervise weight loss and monitor the patient’s health. A general element of follow-up care for inguinal hernia is to discuss sports activities with the doctor. Certain types of sports, movements and stresses increase the pressure that exists in the abdominal cavity and thus favor an inguinal hernia. These factors must be reduced as part of aftercare to prevent a recurrence of the inguinal hernia. After surgical treatment of the first inguinal hernia, it is also advisable to give up smoking or at least severely limit nicotine consumption. Medical supervision is also recommended in this case. Quitting smoking also reduces the likelihood of another inguinal hernia.

What you can do yourself

A weakly developed inguinal hernia does not necessarily require surgery. In most cases, it is possible to prevent the extension of the hernia by an adapted behavior. Those affected should not lift heavy loads and avoid high-impact sports such as soccer or weight training. In addition, patients should not squeeze too hard when defecating. If accompanied by attention to a normal weight, the inguinal hernia can be kept at the original level. However, pain may still occur and is best relieved by bed rest and relaxation. Cramping and entrapment can be reduced by walking upright and stretching regularly. Complementary cold in the form of cold packs, ice packs or frozen vegetable packs from the freezer will help. For tension, hot water bottles and cherry pit pillows help. If the hernia is very pronounced, it is necessary to see a doctor and make an appointment for surgery. After the operation, rest is indicated. Children should spend at least a few days in bed, for adults a break of two to three days is recommended. After that, major exertion should be avoided for the time being. Both classic painkillers and natural remedies such as valerian or passionflower help against pain. Accompanying symptomatic treatment, the causes of the inguinal hernia must be determined and specifically addressed in order to prevent a recurrence.