Inguinal Hernia: Causes

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

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