A groin hernia is a condition where part of an organ, often the intestine, protrudes through a weak spot in the abdominal muscles and into the groin area. This can cause discomfort, pain, and other symptoms. In this blog, we will discuss groin hernias in more detail, including their causes, symptoms, diagnosis, and treatment options.
TYPES OF GROIN HERNIA:
- Inguinal hernias (most common)
- Femoral hernias (rare)
- Obturator hernias (very rare)
CAUSES OF GROIN HERNIAS:
Up to 75% of all hernias are inguinal hernias. Around 25% of all males will have an inguinal hernia during their lifetime, compared to 2% of all females.
There are several factors that can contribute to the development of a groin hernia, including:
- An opening or weak spot that’s present at birth.
- Congenital differences in the strength of your connective tissue (collagen)
- Weakness in the abdominal muscles: This can be caused by a variety of factors, including genetics, aging, pregnancy, previous surgery (esp. open appendicectomy), smoking and substance abuse.
- Straining during bowel movements and urination: This can put pressure on the abdominal muscles and increase the risk of a hernia.
- Heavy lifting: Lifting heavy objects can also put pressure on the abdominal muscles and increase the risk of a hernia.
- Chronic coughing: Coughing can also put pressure on the abdominal muscles, leading to a hernia.
- Intrabdominal pressure from chronic obesity.
SYMPTOMS OF GROIN HERNIAS:
Most groin hernias are asymptomatic initially. Sometimes, symptoms come and go. A hernia may slide in and out of the opening, or you may only feel it during standing or certain activities and may disappear when lying down. In children, you may see a lump in their groin area that appears bigger when they cry. It may go away when they sleep. The most common symptom of a groin hernia is a bulge or lump in the groin area. Other symptoms of a groin hernia may include:
- Pain or discomfort in the groin area, especially when bending over, coughing, or lifting.
- A feeling of weakness or pressure in the groin.
- A dragging or aching sensation in the groin.
- Nausea, vomiting or constipation of intestines are involved.
HOW SERIOUS IS AN INGUINAL HERNIA?
Hernias aren’t always serious, but serious complications can develop. Hernias do tend to worsen over time. As the opening becomes weaker and wider, more tissue can push through it. The more tissue pushes through, the more likely it is to become trapped. This can be painful, and in extreme cases, can be dangerous. Once trapped, a piece of your intestine could become pinched and blocked, or the tissue could become cut off from your blood supply.
If your hernia already causes you discomfort, your doctors will probably recommend fixing it in surgery before it becomes worse. If you don’t have symptoms yet, they may just wait and watch it for a while, but most inguinal hernias will become symptomatic with time. Pediatricians generally recommend treating children with inguinal hernias immediately, as their risk of complications is greater.
WHAT ARE THE POSSIBLE COMPLICATIONS OF AN INGUINAL HERNIA?
- Enlargement over time. The pressure of an existing hernia on weakened tissues can have a snowball effect, making things worse. In those AMAB, an enlarged testicular hernia that moves down into your scrotum can cause painful swelling.
- Incarceration. An incarcerated hernia is one that can’t be “reduced” — physically moved back into place. A trapped hernia is more likely to become pinched as it grows bigger, causing pain and other complications.
- Intestinal obstruction. If part of your small intestine is herniated and becomes trapped and pinched, it can cause a blockage. It may stop you from being able to poop or pass gas, causing severe abdominal pain, nausea and vomiting.
- Strangulation. A strangulated hernia has been cut off from blood supply. This can lead to inflammation and infection of the tissue, and eventually tissue death
(gangrene). Strangulation is a medical emergency requiring emergency surgery.
DIAGNOSIS OF GROIN HERNIAS:
A groin hernia can often be diagnosed through a physical examination by a doctor. During the examination, the doctor will look for a bulge or lump in the groin area and may ask the patient to cough or strain to see if the bulge becomes more noticeable. In some cases, additional tests such as an ultrasound or CT scan may be needed to confirm the diagnosis.
*it is important that you do not self-diagnose any groin swelling as hernia, as there can be other sinister and serious conditions masquerading as hernias and any mis-diagnosis can be disastrous.
TREATMENT OPTIONS FOR GROIN HERNIAS:
The objective of hernia repair surgery is to move the hernia contents back into your abdominal cavity and close the gap with adjacent tissues. This is also called herniorrhaphy. Most of the time, surgeons reinforce the weak spot with a fine synthetic mesh. This is called hernioplasty.
The treatment options for groin hernias depend on the severity of the condition. In some cases, the hernia may not require treatment and can be monitored over time. However, if the hernia is causing discomfort or is at risk of becoming strangulated (when the blood supply to the hernia is cut off), surgery may be necessary to repair the hernia. There are two main types of surgery for groin hernias:
- Open hernia repair: This is the traditional method of hernia repair, where the surgeon makes an incision in the groin and repairs the hernia through the incision.
- Laparoscopic hernia repair: This is a minimally invasive procedure where the surgeon makes small incisions in the abdomen and repairs the hernia using laparoscopic instruments.
Majority of hernia repairs can be managed by minimally invasive surgery methods (Laparoscopic/ robotic), but hernias that are more complicated/large may require open surgery. Around 5% of hernia repair surgeries are emergencies. The type of surgery you have will depend on your condition, prior surgical history, and the experience and judgment of your surgeon.
HOW SHOULD I TAKE CARE OF MYSELF WHILE LIVING WITH A HERNIA?
If you have a hernia and aren’t having it repaired, or not yet, you’ll want to try to prevent it from worsening. Your surgeon may advise you to adjust your habits or the nature of your work to avoid straining the hernia. In some cases, they might recommend wearing a special restraining belt to hold it in during certain activities. Pay attention to your symptoms and any changes you experience.
WHEN SHOULD I CALL MY HEALTHCARE PROVIDER ABOUT MY HERNIA?
Contact your surgeon right away if you experience any of these complications before or after surgery:
- Fever or chills.
- Nausea and vomiting.
- Difficulty urinating.
- Difficulty in passing motions.
- Increasing pain, swelling or redness.
- Your hernia looks bigger or can’t be pushed back inside.
HOW CAN I REDUCE MY RISK OF GETTING AN INGUINAL HERNIA?
There’s no way to prevent a congenital inguinal hernia (one you’re born with), but you can reduce your risk of acquiring an inguinal hernia by reducing wear and tear on your lower abdominal wall. For example:
- Lift heavy objects from your legs, not your stomach or back.
- If you lift weights, have an expert check your technique.
- Seek treatment for conditions that cause chronic coughing or sneezing.
- Seek treatment for chronic constipation. Diet and lifestyle changes often help. Avoid urinary straining, seek medical help.
- Reduce weight in your abdomen.
- Exercise to build core strength and keep your abdominal muscles fit.
- Avoid smoking and tobacco ingestion in any form.
In conclusion, groin hernias are a common condition that can cause discomfort and pain. If you are experiencing symptoms of a groin hernia, it is important to speak with a surgeon to determine the best course of treatment. With proper diagnosis and treatment, most people with groin hernias can experience relief from their symptoms and avoid complications.
DR. SUYOG ANIL BHARAMBE
MBBS, MS, FNB (MAS)
ADVANCED LAPAROSCOPIC AND GENERAL SURGEON
WITH OVER 12 YEARS OF SURGICAL EXPERIENCE