Inguinal Hernia

Inguinal hernias don’t improve by themselves. They usually worsen. You won’t necessarily have complications, but the risk does increase over time. The risk is highest for children because they’re still growing and their hernias will enlarge at a faster rate. Children also tend to have indirect hernias, which are more likely to go into their scrotum. An inguinal hernia in a child shouldn’t be left untreated.

Groin hernias in women are rarer but tend to be more serious. A woman with an inguinal hernia is likely to also have a hidden femoral hernia behind it, which will only be found through surgery. Femoral hernias have a higher risk of complications, and 50% of hidden femoral hernias in women require emergency surgery.

• 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.
• Small bowel 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.

• Direct inguinal hernia: A direct inguinal hernia penetrates directly through the wall of your inguinal canal. This type of hernia occurs in adults over time, from a combination of weakening abdominal muscles and chronic pressure on the muscle wall.
• Indirect inguinal hernia: An indirect inguinal hernia enters your inguinal canal through the top. This usually occurs because of a birth defect. In some fetuses, the opening to their canal doesn’t close all the way during development in the uterus.

An inguinal hernia occurs when there’s a weakness or opening in your lower abdominal wall that allows abdominal tissue to push through. Many things can contribute to this, including:

• An opening or weak spot that’s present at birth.
• Congenital differences in the strength of your connective tissue (collagen).
• An opening or weak spot from previous abdominal surgery.
• Chronic coughing or sneezing.
• Chronic straining to pee or poop.
• Frequent strenuous exercise or manual labor.
• Years of pregnancy and carrying small children.
• Jobs that require standing for many hours at a time.
• Intrabdominal pressure from chronic obesity.
• Normal age-related tissue degeneration.

Not all inguinal hernias have symptoms. Sometimes, symptoms come and go. A hernia may slide in and out of the opening, or you may only feel it during certain activities. In children, you may see a lump in their groin area that appears bigger when they cry. It may go away when they sleep. An indirect inguinal hernia may not be palpable (able to be felt) to the touch because it may be tucked behind muscle fibers.

You might notice:

• A bulge in your groin area on either side of your pubic bone. It can go into your scrotum or labia.
• A feeling of pressure or heaviness in your groin.
• Pain in your groin, especially when straining, lifting, coughing or bending over.
• A burning or pinching sensation that may radiate through your pelvis or down your leg.

A physical examination is usually enough to diagnose an inguinal hernia. Your healthcare provider will try to see and feel the hernia. They may ask you to cough or to bear down as though you were pooping to make the hernia emerge. They’ll also want to know if the hernia can be massaged back into place, or if it’s stuck (incarcerated).

If they can’t see the hernia from the outside, they may order an imaging test to see it from the inside. An ultrasound will usually do the trick, but in rare cases, they may need to use something more specific, such as a CT scan.