An inguinal hernia does not resolve on its own and does not respond to medication or exercise. The treatment is surgery, and the choice of method depends on the type and size of the hernia and on the patient's health. Below we describe the symptoms, causes, the course of diagnosis and the differences between surgical methods.
What an inguinal hernia is
An inguinal hernia occurs when part of an organ or tissue from the abdominal cavity moves towards the groin and enters the inguinal canal — a passage a few centimetres long in the lower abdomen. This site is naturally more vulnerable, so even slight weakening of the muscles or abdominal wall can allow the contents of the abdomen to move out of place.
Inguinal hernia is more common in men, which is related to anatomy. In physically active people it more often results from insufficient stabilisation of the abdominal muscles; in older people, from the weakening of tissues that progresses with age. At first it may cause no clear symptoms; over time a palpable bulge or a dragging sensation in the groin appears.
Types of inguinal hernia
Two basic types are distinguished:
- indirect hernia — lies laterally to the inferior epigastric vessels, enters the inguinal canal and in men may descend into the scrotum, in women into the labia; it may be congenital or acquired and is more often incarcerated (about 20% of cases)
- direct hernia — develops medially to the inferior epigastric vessels and passes through Hesselbach's triangle; it is always acquired, usually following weakening of the abdominal wall, overload or a chronic rise in intra-abdominal pressure; it is less often incarcerated
Causes and contributing factors
A hernia develops when a weaker point appears in the abdominal wall and rising pressure inside the abdomen pushes tissue towards the groin. This is favoured by intense physical effort, frequent lifting of heavy loads and sudden overload leading to micro-damage of muscles and fascia.
Anatomy also matters — a wide inguinal canal is an easier route for displaced organs. The risk rises with a chronic cough, constipation and work that requires constant tensing of the abdomen.
Diagnosis
Diagnosis starts with an examination of the groin — the doctor assesses it in both standing and lying positions. The Valsalva manoeuvre, a deliberate tensing of the abdominal muscles, is also performed to reveal even small bulges. In many cases this examination is enough to confirm a hernia.
When the size of the lesion and the contents of the hernial sac need to be assessed, the doctor orders an ultrasound. In more complex cases — before extensive reconstructive surgery or in an atypical course — computed tomography or magnetic resonance imaging is performed.
Does a hernia have to be operated on
A hernia does not resolve on its own and does not respond to medication or exercise, so the treatment is surgery. A hernia truss is used only temporarily — while waiting for surgery or when health temporarily rules out an operation.
The date and mode of surgery are set by the surgeon after an examination. An incarcerated hernia is a condition requiring urgent care.
Surgical methods
Open surgery
The surgeon exposes the weakened area, separates the contents of the hernia from the surrounding structures and secures them so that the organs do not move again. The area is reinforced with a mesh that stabilises the abdominal wall and reduces the risk of recurrence.
Laparoscopic surgery
The mesh is placed from inside the abdominal cavity through small incisions. This method requires general anaesthesia and a short hospital stay. It is used particularly for bilateral and recurrent hernias and for femoral and inguinal hernias in women.
The choice of method is made by the surgeon after an examination and a discussion with the patient about the clinical picture, previous procedures and general health.
This content is educational and does not replace medical advice. It is not intended for diagnosing or treating illness on your own. If you have worrying symptoms, contact a doctor.
