Pain with a hernia

An inguinal hernia (also inguinal hernia or hernia inguinalis) is the displacement of components of the so-called inguinal channel through the abdominal wall to the outside. A so-called hernial sac is formed, which is filled with the hernia contents and whose wall is covered with peritoneum. The inguinal hernia is the most common form of hernia in both the female and the male sex.

However, the majority of inguinal hernias occur in men. Swelling and pain in the groin area can be an important symptom of an inguinal hernia, but they can also have other causes. Often, an existing hernia is also accompanied by no or only very little pain in the groin region. If the pain in the groin region is severe, persistent or recurrent, a doctor should be consulted to rule out a hernia or other important causes of pain.

Symptoms

For the layman a hernia is not always recognizable as such. Often a swelling occurs in the groin area. In men, this swelling can also appear in the scrotum, in women in the labia.

However, a swelling can also be completely absent or not recognizable at rest. Pain in the groin may occur, but it is not always present, so that a hernia cannot be excluded in the absence of pain. However, recurrent pulling pain in the groin region may indicate an inguinal hernia, even if swelling is absent or not recognized by the layman.

The pain of an inguinal hernia does not necessarily have to be in the region of the groin itself. It is therefore also possible that the pain radiates into the area surrounding the groin. Pain can therefore also be felt in the area of the thigh, the lower abdomen, the testicles, or the female sexual organs.

In some cases, the localization of the pain is also not easily possible. If there is pain, it is usually felt as pulling. Even a small inguinal hernia can lead to severe pain, but even a large inguinal hernia can cause no pain at all.

If there is pain, it is particularly noticeable when standing and during activities that increase the pressure in the abdomen. Thus, pain in the groin region, for example during bowel movement, coughing, or when lifting loads, can be an indication of an inguinal hernia. It is important to take pain seriously and to have a doctor find the cause.

Painless swelling in the groin region, in the area of the scrotum or the labia should also be examined by a doctor as soon as possible. Special attention should be paid to strong and sudden pain in the groin region or its surroundings (including the abdomen), as this can be an indication of incarceration of the contents of the hernia. If this is the case, it is necessary to act quickly, as it is an emergency that requires immediate surgery.

Otherwise, tissue may die off. In the case of an inguinal hernia, part of the abdominal organs in a hernia sac is pushed outwards through a muscular weak point in the region of the groin (transition from abdomen to thigh). However, this does not necessarily have to be accompanied by pain.

In many of the mainly male patients, an inguinal hernia even goes unnoticed for a longer period of time, because the hernia sac can often move back into the abdominal cavity itself. However, if there is an increase in pressure in the abdomen (e.g. due to pressing during defecation, coughing, sneezing or when lifting heavy objects), it is possible that a small, plum-sized bulge appears in the region of the groin. Some patients then describe a pulling pain that reaches into the scrotum or the labia majora.

Walking is usually not restricted by an inguinal hernia. This type of movement does not usually cause any particularly strong pressure in the abdominal cavity and thus not on the hernia sac. However, if already relaxed walking causes severe pain, it is recommended to consult a physician, as there is a risk that part of the hernia sac may be trapped.

This is one of the worst complications of a hernia, because a persistent low blood supply can lead to the death of the trapped intestinal section and must be operated on immediately. Often the pain of an incarceration is accompanied by nausea and vomiting as well as fever. Even when sitting down, a hernia does not necessarily cause pain.

Many patients describe a completely normal, unaffected everyday life despite a diagnosed inguinal hernia. However, it can also be different.When sitting, bend the hips and bring the thighs a little closer to the belly. This reduction in the angle between the belly and thighs results in a kind of folding of the groin area.

In the case of inguinal hernias, which can be pushed back into the abdominal cavity without any problems, even sitting tends to cause no problems. In this case, the hernia sac usually moves back into the abdomen when sitting. However, if the hernia sac is permanently outside the abdominal cavity, the folding of the groin area can cause a kind of trapping when sitting.

This can feel like a foreign body sensation, but can also cause ischemic pain. An extension of the hip (e.g. by standing up or lying down) should in any case lead to an alleviation of the symptoms. In most cases, an inguinal hernia is successfully treated with a surgical mesh inlay to strengthen the abdominal wall.

This can be done either by laparoscopy or open surgery. Depending on the surgical procedure, the size of the surgical scar and thus the possible associated pain varies. There is constant movement in the area of the abdominal wall.

Almost every movement causes tension or stretching of the abdominal skin and thus irritation of the surgical scars, which causes some patients to complain of pain after a hernia operation. In order to alleviate this pain, it is important to keep as much bed rest as possible and thus give the tissue the opportunity to heal optimally. Another possible cause of pain after hernia surgery can be injury to vascular or nerve cords.

In most inguinal hernias, the hernia sac with parts of the intestine moves through the inguinal canal and only bulges out through the abdominal wall behind it. This is called an indirect inguinal hernia. In men, the inguinal canal contains the spermatic cord, in women the uterine ligament and several blood vessels and nerve cords.

If these structures are injured during the surgical repositioning of the hernia sac, severe pain can develop after the operation. An injury to the peritoneum by the surgeon could also cause similar symptoms. However, these are rather rare complications.