Inguinal hernia describes a medical condition in which contents of abdominal cavity (like intra-abdominal fat or part of small intestine called small bowel) bulge out through weak area of lower abdominal cavity. Pressure on that area can push the tissue through and bulge out consequently. The bulge is pretty painful especially when you cough, bend or lift heavy objects or it can continue to hurt all the time if you are overweight. It is one of the most common hernias to occur in people (risk of occurring 27% in men and 3% in women in entire lifespan).
However it can occur at any point of life, soon after the birth or later in life. Women are prone to inguinal hernia in times of pregnancy when there is too much pressure on the belly wall. The remedy for them is performing surgical operations, however elective surgery is no more preferred since it poses risk of incarceration (<0.2% per year) and the very high risk (10–12%) of post herniorraphy pain syndrome.
Types of inguinal hernia
Direct inguinal hernia
With ageing the abdominal muscles may get degenerated or may be pressurized. Consequently the abdominal wall muscles are under continuous stress and get ruptured or weakened. The fat or small intestine then slides through this weakness into the groin. Direct inguinal hernia is found in males only. The hernias if massaged gently can go back into the abdomen (Reducible hernia). The ones which cannot be pushed back are known as Irreducible hernias.
Indirect inguinal hernia
When the inguinal canal is not closed properly at the inguinal ring, a weakness is left in the abdominal wall. Part of the small intestine grows through this weakness into the inguinal canal, giving rise to a hernia.
In case of males, the spermatic cord and testes develop through inguinal canal before reaching the scrotum. So if the inguinal canal is not closed then the fat or small intestine can easily extend in the groin, making you suffer from hernia. This is the reason why males are more prone to this ailment. Infants who have not attained full maturity are at high risk of suffering from indirect inguinal hernia. It is because the inguinal canal has had lesser time to close. In case of females, inguinal hernia develops cause of female organs or simply due to weakness in abdominal wall.
Factors responsible for inguinal hernia
- Failure of inguinal ring to develop and hence inguinal canal remains open. This provides an easy passage to small intestine muscles to slide into the groin.
- Heavy weight lifting.
- Due to constipation you apply force to push the feces out of anus which may further weaken your muscles of intestine.
- Putting on weight, higher the fat content in your body more is the matter available to slide into your groin.
- Suffering from cough since a long time (due to bad habits like smoking). It stresses your body muscles. Or if you have a typical suffering like cystic fibrosis then God forbids, but yes you can easily develop inguinal hernia.
- Fever, nausea, vomiting.
- Rapid heart rate.
- Extreme redness or softness in the area of bulge.
- Inheritance – Yes this might be the disease from which almost all of your ancestors might have suffered and now it's your turn (not necessarily but the chances are many).
- Nature of occupation – you may be in a job which requires long standing hours or heavy physical exercise. This can be one of the various risk factors of inguinal hernia.
- Pregnancy – This is a period of extreme stretching of abdominal walls for the females and the walls may get easily weakened, proving to be a ground for the development of hernia.
- If you have suffered earlier from the hernia then there are quite a many chances that you may have to suffer another time, may be on the other side the hernia can develop.
Symptoms of inguinal hernia
- Bulge can be seen in the area between abdomen and thighs (groin). It can be visible on only one side or on both the sides. Its size may increase depending upon the duration since it is present in your body. It may also disappear while lying down. In case of males, it is quite often visible as a prominent swelling in the scrotum. In case of females, bulge can be seen in labia (skin surrounding the vagina).
- While lifting or exercising, strenuous pain in the abdomen can point the onset of hernia. For kids pain can be experienced when the cry or run around.
- Pain or discomfort in the groin.
- The bulge may develop further complications like burning sensation or aching.
Complications of surgery for inguinal hernia
Pre and post surgery certain issues of concern may arise, although the surgery is generally regarded safe. These can be:
- Bleeding – There may be excess bleeding in the incised area, or blackish-bluish discolouration of the skin. This needs the incision to be opened again and stop the flow of blood. Well this hardly occurs in less than 2% cases.
- Recursion – There is a very high chance of hernia inflicting your body again, if once you had suffered from it! Then you have to undergo a second operation. But if you go for hernioplasty then you can be on a safer side.
- Infection – The hernia may become a breeding ground for infection. Though, this is hardly seen in 2% cases and that too in adults. The infection will lead to fever, redness, tenderness, swelling in the incised area. It can be cleared with the use of antibiotics or operating again the incision area to cut-off the infection.
Effects of untreated inguinal hernia
In case the hernia is not able to subside back on pressing or on lying down, this denotes an alarming situation. There is an immediate need of surgical operation of the hernia. The hernia may apply pressure on the surrounding tissues. Or with increasing size the hernia will push into the other body parts like scrotum. There may be a further severe condition of "incarcerated" and "strangulated" inguinal hernias.
In incarcerated inguinal hernias, the hernia gets adhesive with the scrotum or groin and cannot be massaged back into the abdomen. This may further get aggravated and blood supply to the incarcerated small intestine can get stopped. This is known as strangulated inguinal hernias. However there can be one more state of "obstructed hernia" in which the blood supply to the hernia sac is not stopped but lumen cannot reach the hernia sac.
In case the hernia is left untreated for a large span of time then the affected portion of the intestine can die due to lack of oxygen and the patient's life can be at risk. And because of this the infection will start spreading to other parts of the body.