Inguinal Hernia

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Jan 8, 2015/ 0 Comments / in General Medical Posts / by
Inguinal Hernia

Inguinal Hernia

Inguinal Hernia is a condition that refers to protrusion or expulsion of a part of your gut or the omentum (membrane that surrounds and protect your intestines) from a potential weakness in the abdominal wall.  This herniation is usually painless in uncomplicated cases, and becomes prominent on straining (or any gesture that increases intra-abdominal pressure like coughing or weight lifting).

Inguinal hernias comprises of more than 97% cases of groin hernias (1). It is imperative to keep in mind that the risk of life-threatening complications increases if inguinal hernia is left untreated.


Symptoms of Inguinal Hernia

Most cases of inguinal hernia are asymptomatic and are only diagnosed during a general physical exam. Some individuals are able to feel a bulge or reducible swelling on standing and straining.

Most cases of inguinal hernia presents as:

  • A swelling on the groin region (mostly unilateral but can occur at both sides).
  • Dull, throbbing pain over the swelling, but most uncomplicated hernias are painless.
  • Feeling of discomfort, heaviness and dragging sensation in the groin region.
  • The pushed contents can cause swelling of the testicles and may interferes with the sexual functions.

Signs and Symptoms of Inguinal Hernia in Children

male sexual organ imageInguinal hernia is often congenitally present in children due to developmental defect in the descent of testes in the intrauterine life. It appears mostly on straining like crying or coughing.

In a younger child, it becomes prominent during bowel motion or prolonged standing.

When to see a doctor

When your bulge is easily noticed and painful on standing, seek assistance. Seek emergency medical care if the swelling turns red or purple.

What are Complicated Hernias or Incarcerated Hernias?

Uncomplicated hernias are reducible (i.e. contents of swelling such as gut can be pushed back in the abdominal cavity if abdominal pressure is normalized). If the contents are somehow irreducible i.e. the swelling is permanent, the condition is referred to as incarcerated hernia. Long standing incarcerated hernia can hamper blood supply to the gut and leads to gangrene or tissue death. Therefore strangulation of blood flow to the gut or incarcerated hernia is a surgical emergency and can prove fatal in the absence of interventions.

Signs and symptoms when strangulation occur are characterized by:

1- Vomiting or Nausea.

2- Fever

3- Fast heart rate.

4- Intense abrupt and colicky abdominal pain

5- Purple or red swelling


Primary Causes of Inguinal Hernia

Most cases of inguinal hernia are multi-factorial (i.e. more than one cause is responsible). Some statistically proven causes are:

  • Persistently raised abdominal pressure (such as morbid obesity, pregnancy, fluid in abdomen etc.)
  • Site of potential weakness in the wall of abdomen (such as inguinal triangle, previous scar of surgery, umbilicus)
  • Chronic history of forceful defecation or urination (prostatic hyperplasia, gut motility issues)
  • History of weight lifting
  • Long-standing cough (such as tuberculosis, chronic bronchitis, chronic smokers etc.)

Inguinal hernia may occur at birth due to improper closure of the abdominal wall, or in old age due to long standing cough or weight lifting as a result of acquired muscle weakness.

Why are Inguinal Hernias More Common in Men?

The development and maturation of male reproductive system predisposes males to develop hernias more frequently as compared to females. The descent of testicles is achieved through inguinal canal which closes soon after birth. The closure allows spermatic cord to traverse but involutes (closes) after the descent of testicles in the scrotum. In few cases this canal remains patent and serves as a site of potential weakness and future inguinal hernias.


Risk factors

Reasons for Testicular Pain ImageRisk factors for inguinal hernia are:

  • Gender: Males are more likely to develop hernias and most childhood cases of hernia occur in boys.
  • Positive Family History.You’re most likely to develop inguinal hernia if you have a positive family history of this condition.
  • Medical Diseases: Hernia is strongly associated with cystic fibrosis ( a genetic condition of an enzyme deficiency)
  • Occupational Hazard: Job that requires you to stand for long hours or strenuous labour then you are at risk.
  • Premature Delivery: Prematurely delivered infants are at risk of developing hernia.
  • Past History of Hernias:Recurrence of hernia is very much common in already operated individuals mostly on the contralateral side.

Complications of Untreated Inguinal Hernia

Inguinal hernia can lead to following complications:

  • Larger hernias compress adjacent structures causing tenderness and inflammation.
  • The herniated content can stay restricted in the weak spot; thereby hampering the blood supply and causing symptoms of sickness such as vomiting or inability to pass stool or gas.
  • The hindered blood supply can cause death of the tissue, leading to gangrene (a surgical emergency). Such hernias are referred to as strangulated hernia.
  • A lot of individuals also develop sexual dysfunction due to cosmetic issues and other physical causes. Unfortunately, more people develop erectile issues or related problems after the repair of hernia (due to chronic pain syndromes, nerve damage or vascular injury).

Prevention Of Inguinal Hernia

Prostate Cancer Prevention ImageCongenital hernia can’t be prevented but adopting certain preventive measures can decrease the chances of developing acquired hernias.

  • Develop a habit of consuming a balanced, high fiber diet.
  • Regular exercise and workout helps in losing excessive body weight. Since obesity is a significant risk factor in the pathogenesis of inguinal hernia, moderate weight loss (via natural methods) is usually helpful in minimizing the risk.
  • When lifting weights, be careful to use your knees and do not use your abdominal muscles.
  • It is highly recommended to quit smoking because toxins in cigarette smoke can increase your risk of developing hernia.

It is imperative to mention that using abdominal support belts or bands is a sole therapeutic choice can increase the risk of so many complications. It is highly recommended to seek urgent and emergent medical care if you have developed hernia swelling.


References:

  1. Burcharth, J., Pedersen, M., Bisgaard, T., Pedersen, C., & Rosenberg, J. (2013). Nationwide prevalence of groin hernia repair. PloS one, 8(1), e54367.
  2. Powell, R., Johnston, M., Smith, W. C., King, P. M., Chambers, W. A., Krukowski, Z., … & Bruce, J. (2012). Psychological risk factors for chronic post‐surgical pain after inguinal hernia repair surgery: A prospective cohort study. European journal of pain, 16(4), 600-610.
  3. Lundström, K. J., Sandblom, G., Smedberg, S., & Nordin, P. (2012). Risk factors for complications in groin hernia surgery: a national register study. Annals of surgery, 255(4), 784-788.
  4. Montupet, P., & Esposito, C. (2011). Fifteen years experience in laparoscopic inguinal hernia repair in pediatric patients. Results and considerations on a debated procedure. Surgical endoscopy, 25(2), 450-453.