Groin Hernias

A hernia occurs when an organ protrudes through the wall of muscle that encircles it. There are a few different types of hernias that can occur in the area of the groin. For more information on inguinal and femoral hernias, and the symptoms and treatment methods associated with these hernias, please see below.

Inguinal Hernias

Inguinal hernias, also known as groin hernias, occur when a bit of tissue protrudes through a weak spot in the muscles between the upper thigh and the lower abdomen.

Inguinal hernias are usually caused by an opening in the muscle wall that should have closed before birth but instead remained open. Because of that abnormality, there is a weak spot in the abdomen.

When tissue pushes through that weak spot, it creates a bulge, or lump, that tends to be painful, though not necessarily dangerous.

Symptoms

The primary symptom of an inguinal hernia is a lump or bulge in the area of the groin. That bulge may appear all of a sudden, after you have been coughing, laughing, lifting heavy weights, or otherwise straining, or it may develop over a longer period of weeks or even months.

You may experience pain or general discomfort in the area of the groin, particularly when straining. Inguinal hernias can cauase significant discomfort, and may also be associated with an aching or burning feeling in the area of the bulge. You may also experience a sensation of dragging, pressure, or weakness in the groin.

Some male patients may experience swelling and pain around the testicles, if the protruding tissue descends into the scrotum.

Causes

Inguinal hernias can be caused by any one of the following, or by a combination of factors:

  • Chronic coughing
  • Chronic sneezing
  • Increase of pressure in the abdomen
  • Pregnancy
  • Straining during bowel movements
  • Strenuous activity
  • Weak spot in the abdominal wall

The cause of an inguinal hernia, however, is not always immediately apparent.

Many people develop inguinal hernias later in life, when their muscles have weakened with age, or when they are more vulnerable following abdominal surgery or an injury. Many others, however, experience a weakening in the abdominal wall during birth, when the peritoneum (abdominal lining) doesn’t close as it should.

In men, that abdominal weak spot usually develops in the inguinal canal, which is where the spermatic cord enters the scrotum. Women, on the other hand, have a ligament in their inguinal canals that helps to hold the uterus in place. Hernias can develop in the place where connective tissue from the uterus is joined to the tissue surrounding the pubic bone.

Risk Factors

Certain populations seem to be at greater risk of developing inguinal hernias than others. Risk factors include the following:

  • Aging: Muscles grow weaker with age.  
  • Being male: Men are more likely to develop inguinal hernias than women.
  • Chronic constipation, which usually causes excessive straining during bowel movements.
  • Chronic cough, particularly when caused by smoking.
  • Family history: If you have had a parent or sibling with an inguinal hernia, you may be at greater risk of developing one yourself.
  • Premature birth and low birth rate are both associated with greater incidences of inguinal hernias.
  • Previous inguinal hernia or hernia repair: Those who have already suffered an inguinal hernia are at greater risk of developing another one.

Complications

In some cases, an inguinal hernia can result in additional complications. These may include:

  • Incarcerated hernia: A hernia can grow to obstruct the bowel if its contents become trapped in the weak area of the abdominal wall. An obstructed bowel will result in nausea, vomiting, an inability to pass gas or have a bowel movement, and severe pain.
  • Increased pressure on surrounding tissue: If not treated promptly with surgery, most inguinal hernias will grow larger over time. In men, this means that a hernia may extend into the scrotum, resulting in swelling and pain.
  • Strangulation: An incarcerated hernia may block the flow of blood to part of your intestine. That strangulation can result in the death of the affected bowel tissue. A strangulated hernia requires immediate surgery; it is life threatening.

Femoral Hernias

Femoral hernias occur when a bit of tissue bulges through the lower belly and into the upper thigh, in the area just below the groin crease. Femoral hernias are sometimes mistaken for inguinal hernias because they occur in a nearby location.

Femoral hernias are relatively uncommon. In fact, fewer than 5% of all hernias turn out to be femoral hernias.

Femoral hernias occur more commonly in women than in men.

Symptoms

Femoral hernias may not present any symptoms at all, especially if they are of a small or medium size.

Larger hernias may become visible as a lump or bulge in the area of your upper thigh. That bulge may cause discomfort or pain when you try to stand up, lift a heavy object, or strain in another way. Because femoral hernias are in many cases located in close proximity to the hip bone, they may cause pain in the hip.

Causes

As with inguinal hernias, the cause of a femoral hernia is not always clear. While the area of the femoral canal may have weakened over time, you may also have simply been born with a weakened femoral canal.

It does seem clear that straining can cause the muscle walls to weaken, thereby increasing the chances of developing a femoral hernia. Activities that may contribute to straining include:

  • Being overweight
  • Childbirth
  • Chronic coughing   
  • Chronic constipation
  • Difficulty urinating caused by an enlarged prostate
  • Heavy lifting

Complications

When left untreated, a femoral hernia can result in additional complications, some of them severe. These complications may include:

  • Incarcerated hernia: A hernia can grow to obstruct the bowel if its contents become trapped in the weak area of the abdominal wall. An obstructed bowel will result in nausea, vomiting, an inability to pass gas or have a bowel movement, and severe pain.
  • Strangulation: An incarcerated hernia may block the flow of blood to part of your intestine. That strangulation can result in the death of the affected bowel tissue. A strangulated hernia requires immediate surgery; it is life threatening.

Diagnosis

In most cases, your doctor will be able to determine whether you are in fact suffering from a hernia, whether it is an inguinal or a femoral hernia, simply by looking and by gently palpating the affected area.

If for some reason a diagnosis isn’t immediately apparent, your doctor may decide to order an imaging test, such as an abdominal ultrasound, CT scan, or MRI. These imaging tests can help to show the hole in the muscle wall, along with the tissue protruding from it.

Treatment

Inguinal and femoral hernias that have no symptoms may not require any treatment at all.  Your doctor will discuss  your options with you regarding surgery or watchful waiting.
Hernias that are causing discomfort or have incarcerated, usually require surgical repair to relieve  the discomfortas well as to prevent complications.

There are two types of surgical hernia repair: open and minimally invasive surgery. The type of surgery chosen will depend on the severity and type of hernia you’ve developed, the anticipated recovery time, your medical and surgical history,, and your surgeon’s expertise.

Open Surgery

During this procedure, your surgeon will make a small incision into your groin, and then push the protruding tissue back into your abdomen. Your surgeon will then sew up the weakened area. In some cases, your surgeon will use a synthetic mesh to reinforce that weakened area.

Open surgery can be performed either with general anesthesia or with sedation or local anesthesia.

After your surgery, it might be several weeks before you’re able to fully resume your normal activities. However, it’s still important that you begin moving about again as soon as possible for a healthier recovery.

Minimally Invasive Surgery

Minimally invasive surgery is performed under general anesthesia.

During this procedure, your surgeon will make a few small incisions in your abdomen. Your surgeon will then inflate your abdomen, using a special gas, in order to make your internal organs easier to see.

Your surgeon will then insert a small, narrow tube into one of the incisions in your abdomen. This tube has a tiny camera, or laparoscope, at the end of it. That camera serves as a kind of guide for your surgeon, who is then able to insert surgical instruments through the other incisions in your abdomen. Your surgeon will repair the hernia using  mesh .

Because minimally invasive surgery allows the surgeon to avoid scar tissue from earlier hernia repairs, it may be an especially good option for people who have had their hernias recur following traditional hernia surgery. It may also be a good option for people with bilateral hernias, or hernias on both sides of the body.

Patients who choose  minimally invasive surgery may experience less scarring and discomfort following surgery than those who choose open surgery. Patients may also be able to return more quickly to their normal activities.

Your doctors will speak with you in detail about all of your treatment options and will recommend a course of action best suited to your individual needs.

Make an Appointment

To discuss a potential hernia surgery, contact the Surgery Call Center at (734) 936-5738.