Inguinal Hernias

An inguinal hernia is defined as a condition where a portion of the soft tissues in the abdomen protrudes through a weakness in the lower abdominal wall, forming a bulge in the groin area. Inguinal hernias refer to the protrusion of tissues and organs, such as intestinal fat and the small intestine, which normally reside within the abdomen, out from under the skin. Inguinal hernias are three times more common in men than in women. They typically manifest with pain and swelling. Additionally, factors such as advanced age, obesity, weakening of connective tissues, smoking, and constipation can contribute to the development of an inguinal hernia. The only effective treatment for an inguinal hernia is surgery, which can be performed using either a closed (laparoscopic) or open surgical method. Op. Dr. İbrahim Çolhan, serving patients in Adana, explains what an inguinal hernia is, its types, symptoms, diagnosis, and treatment methods for you.

What is an Inguinal Hernia?

An inguinal hernia is defined as the protrusion of tissues and organs from inside the abdomen through weak points in the abdominal wall, creating a bulge under the skin. Simply put, an inguinal hernia is when intra-abdominal organs and tissues bulge outwards from under the skin and become noticeable. The swelling caused by an inguinal hernia often leads to severe pain, especially during coughing, straining, lifting heavy objects, and bending over.

Generally rarer in women, inguinal hernias are three times more common in men. Factors contributing to the development of inguinal hernias include chronic cough, weakening of connective tissue, smoking, constipation, obesity, advanced age, and pregnancy. Individuals with these or similar problems have a higher likelihood of developing an inguinal hernia.

A noticeable bulge on either side of the pubic bone causes severe pain and burning when the person coughs. A feeling of looseness and pressure in the groin is among the most prominent and characteristic symptoms of an inguinal hernia. As the most common type of hernia, an inguinal hernia may require different treatment approaches depending on its stage and severity. However, definitive treatment is only possible through inguinal hernia surgery. Inguinal hernia surgeries can be performed using laparoscopic or open surgical methods.

What are the Types of Inguinal Hernias?

Inguinal hernias are categorized into indirect, direct, and femoral hernias. Indirect hernias are a common condition in society. They can occur in people of all ages and carry the risk of descending into the testicles.

Direct hernias, on the other hand, are hernias that protrude through a weak point in the abdominal wall. The risk of direct hernias increases significantly with age.

Femoral hernias are a much rarer type of hernia. They are more common in women compared to men. The risk of strangulation for femoral hernias is particularly higher than other types of hernias.

What Causes an Inguinal Hernia?

An inguinal hernia is defined as a protrusion of intra-abdominal fatty tissue or a portion of the small intestine. As a result of the degeneration of connective tissue in the abdominal muscles, the muscles significantly weaken. This is the primary cause of an inguinal hernia. This weakness or tear, which allows the tissue in the lower abdominal wall to protrude, leads to the development of an inguinal hernia. The causes of inguinal hernias include chronic cough complaints, straining due to constipation, excessive and intense exercise, advanced age, weakening of connective tissues, pregnancy, and smoking. Additionally, an opening present at birth or working in jobs that require standing for long periods can also result in an inguinal hernia.

In most people, the abdominal wall weakness that leads to an inguinal hernia is due to the abdominal wall muscles not closing properly before birth. Other inguinal hernias arise from the weakening and deterioration of muscles as a result of physical activities requiring intense exertion, advancing age, and chronic coughs caused by smoking.

Abdominal wall weaknesses can also occur as a result of injuries sustained in old age or surgical operations performed in the abdominal area. In men, the weakest point is often the inguinal canal where the spermatic cord enters the scrotum. In women, the inguinal canal carries a ligament that helps hold the uterus in place. A hernia can form at the point where the connective tissue of the uterus connects with the tissue surrounding the pubic bone.  

What are the Symptoms of an Inguinal Hernia?

The most common symptom of an inguinal hernia is a bulge in the groin area, especially noticeable during coughing, sneezing, and straining. This bulge can also appear when standing upright. Burning, pain, and pressure felt in the bulge area may also be accompanied by symptoms such as nausea, fever, and vomiting.

Inguinal hernia symptoms generally include:

• A noticeable bulge on either side of the pubic bone, especially prominent during coughing, straining, and sneezing
• Burning and pain felt in the protrusion on the pubic bone
• Severe pressure and heaviness felt in the groin
• Abdominal bloating
• Fever
• Bruising and redness in the hernia area
• Inability to pass gas
• Nausea
• Vomiting

What are the Symptoms of Inguinal Hernia in Children?

In newborns and children, an inguinal hernia occurs due to a weakness in the abdominal wall at birth. In some cases, the hernia may only appear when the baby cries, coughs, or defecates. For this reason, the baby may be listless, restless, and irritable. In childhood, it may become prominent during bowel movements when straining or during prolonged standing.

How is an Inguinal Hernia Diagnosed?

Most cases of inguinal hernia can be diagnosed following a physical examination performed by specialist doctors. The patient's reported complaints also guide physicians in the diagnosis process. Ultrasonography is used to diagnose small hernias.

How is an Inguinal Hernia Treated?

Inguinal hernias will not shrink or heal on their own if left untreated. Furthermore, treatment with any medication is not possible. Therefore, after an inguinal hernia is diagnosed, the only option for treatment is surgical operation. In hernia surgeries, the hernia sac is repaired and repositioned into its natural place within the abdomen or removed.

The main goal is to close and repair, or patch, the partial defect that causes the herniation. Before inguinal hernia surgery, the patient is anesthetized with local or general anesthesia. If deemed necessary, spinal anesthesia can also be used to numb the patient from the waist down. Inguinal hernia surgeries can be performed using laparoscopic (closed) or open surgical methods, depending on the patient's condition and needs.

Inguinal Hernia Surgery

To treat inguinal hernias, surgery is performed to push the bulge back into place and repair and strengthen the weakness in the abdominal wall. This repair can be carried out in two different ways through inguinal hernia surgery.

In the open surgical method, an incision is made to push the bulge back into the abdomen. Closed surgery is a less invasive method. Several minimal incisions are made, and a lighted camera and surgical equipment are inserted through these incisions. The operation is performed in this manner. Both methods have their own advantages and disadvantages. The choice of method for inguinal hernia surgery is made based on the individual's characteristics, needs, and the surgeon's opinion.