Inguinal Hernias: Next Steps after Diagnosis

An inguinal hernia (a hernia in the groin area) occurs when fatty or intestinal tissues push through the lower abdominal wall. “Inguinal” refers to the inguinal canal, a passage on either side of the lower abdomen. For men, the Inguinal canal functions to transport sperm to the testicles, and from the testicles to the penis. For women, ligaments supporting the uterus pass through the inguinal canal.

There are two types of inguinal hernias: indirect and direct. Indirect inguinal hernias are a result of abdominal abnormalities existent since birth, whereas direct inguinal hernias occur only in males with weak abdominal wall muscles. Direct inguinal hernias are also more common in the young or middle aged. Many times, it as a result of a chronic cough brought on by bronchitis alveoli, a lung aneurysm or a pulmonary disease.

The following are symptoms of an inguinal hernia:

• Pain or discomfort in the groin region (increased when bending or exerting yourself)
• A noticeable bulge taking place on either side of the pubic bone
• Weakness or persistent pressure in the groin
• A pulling, straining feeling within the groin
• An aching or burning sensation taking place in the groin where the bulge protrudes

Inguinal hernias are diagnosed by a doctor through:

1. Examination of the patient’s medical history (and their family medical history)
2. Performing a physical exam
3. Performing imaging tests such as an x-ray or ultrasound

A complete medical history for yourself and your family will help a medical practitioner determine the likelihood of your having an inguinal hernia. During a physical exam, the practitioner will examine the patient’s body, maybe having them perform actions such as standing and coughing to feel whether or not there is a noticeable moving bulge. In some cases, this bulge can simply be massaged back into it’s rightful place. Imaging tests are generally used only when the doctor is unable to diagnose the hernia through the physical exam, or it is necessary to visually confirm the presence of a hernia. Imaging tests also help the doctor determine whether or not there are any complications with the hernia.

It is important to be mindful to diagnose an inguinal hernia as soon as possible, as lack of treatment can lead to serious complication such as incarceration or strangulation.

Incarceration occurs when fat or intestinal tissue becomes dislodged from the abdomen and reside in the groin or scrotum. Strangulation occurs when an inguinal hernia is left untreated. When the blood supply to the intestine is cut off, the parts of the intestine that do not receive blood, can die. Both of these conditions require the attention of a medical professional. A diagnosis is achieved through taking a thorough medical history (including a family history), a physical exam and, if necessary, imaging tests such as an ultrasound or x-ray.

There is only one option for treatment of an inguinal hernia,which is surgery. Surgery is necessary in preventing incarceration and strangulation. There are two types of surgery that a surgeon may perform: Open Hernia Repair or Laparoscopic Hernia Repair.

Open hernia repair entails providing the patient with anesthesia and making an incision in the groin so that the hernia may be placed back into the abdomen, with stitching in the abdominal wall to strengthen the barrier. A laparoscopic hernia repair is a minimally invasive surgery (MIS) in which the patient is given anesthesia and the doctor makes three small incisions. A laparoscope is inserted and a camera provides a magnified image of the hernia. The size of the incision for camera insertion via the abdomen is a mere centimeter. The doctor uses this improved image and a monitor system to view the surrounding tissues and repair the hernia with a synthetic mesh. The incision for the tools with which to perform this treatment is only 0.5 centimeters.

With MIS technology, incisions are smaller, cause less postoperative pain, less blood loss and a faster recovery for the patient.  In many cases, a patient can undergo surgery one day and return to work the following day. The chances of infection are extremely low, reducing the need for further treatment and enhancing patient safety.

Though inguinal hernia repair surgery is quite safe, and complications are uncommon, one should contact their healthcare provider if any of the following symptoms appear:

• Elevated body temperature
• Bleeding from the incision site
• Inflamed incision site
• Drainage from the incision site
• Persistent pain, despite the help of medication

Learn more about minimally invasive surgery by clicking here. 

If your hernia is not causing you any discomfort or adversely impacting your life, immediate action is not required. In fact, there are those can live with a hernia for some time without experiencing any noticeable symptoms. However, it is important to be very aware of your body and to look out for symptoms of pain or discomfort. It should be noted that if you are someone who lives a very active life, more immediate action should be taken, as the added strain to the body can worsen the hernia.

As mentioned above, strangulation and incarceration are real risks, but there are other ramifications to be considered:

• Worsening of symptoms. Left untreated, symptoms such as pain will only worsen, affecting your day-to-day life, leaving you unable to work or enjoy yourself in the ways in which you are accustomed.
• Once these symptoms inevitably worsen, complications arise, making eventual surgical repair that much more difficult. The required surgery can become more intense or more invasive than when surgery is performed soon after diagnosis.
• In the case of strangulation, the situation becomes an emergency, meaning that your life is at risk.

In other words, simply waiting and hoping that symptoms will disappear, or that they will lessen over time, is a dangerous thing to do. When minimally invasive surgery is so quick and with so many benefits, letting a condition worsen is the wrong course of action to take.  So many complications can arise and the hernia can become very dangerous. Though immediate action is not always required, it should be considered.

Though there is no way to prevent weakness in the abdominal wall, certain measures can be taken to lead a healthier lifestyle, lessening the chances of developing a direct Inguinal hernia. One can also keep an inguinal hernia from recurring after surgery by:

• Avoid lifting heavy objects
• If you must lift, lift with your leg;  do not put strain on your back.
• Stay within your healthy BMI
• Do not smoke

If you suspect you may have an inguinal hernia, seek medical counsel immediately.