Inguinal Hernia

An inguinal hernia is bulging of a loop of intestine through an opening in the wall that surrounds the organs in the abdomen (abdominal wall).

See the figure What Is an Inguinal Hernia?

The loop bulges into the inguinal canal. The inguinal canal surrounds the vas deferens, the tube that carries sperm from the testes to the urethra. The loop may bulge into the groin and often extends into the scrotum.

The opening in the abdominal wall may be present from birth. Or it may develop later in life, when the tissues eventually tear after years of being stretched.

If the loop of intestine can be easily pushed back through the opening into the abdomen, the hernia is said to be reducible. A reducible inguinal hernia may slide back and forth as pressure on the abdomen changes. Rarely, the loop of intestine swells and becomes too large to slide back through the opening. Then the loop is trapped outside of the abdomen (incarcerated). If a hernia is incarcerated, the loop may be so tightly wedged in the opening that its blood supply is cut off. Such a hernia is said to be strangulated. The affected tissues are deprived of oxygen, which is carried to tissues by blood. Without oxygen, the tissues die within hours, and the intestine is damaged. Gangrene can result. Intestinal gangrene can cause severe infections in the abdomen (peritonitis) and in the blood (sepsis).

Symptoms and Diagnosis

An inguinal hernia usually produces a painless bulge in the groin or scrotum. If the hernia can slide back and forth, the bulge may enlarge when a man stands or strains. The bulge may get smaller or disappear when the man lies down. If the hernia is incarcerated, the bulge does not get smaller or disappear. Strangulated hernias usually become very painful within minutes or hours.

To diagnose an inguinal hernia, a doctor examines the groin and the area around it. For the examination, a man may have to stand and cough or strain. Coughing or straining produces pressure in the abdomen and makes a hernia more obvious. To determine whether the hernia is reducible or incarcerated, the doctor usually tries to push the loop of intestine back into the abdomen by pushing on the upper part of the scrotum with a gloved finger.

Treatment

If the loop of intestine cannot be readily pushed back into the abdomen, the doctor may try another maneuver to temporarily relieve symptoms. The man lies with his head lower than his body. Sometimes an ice pack is placed on the hernia. The doctor then tries to push the loop of intestine back again. The pushing may be continued for what seems to be a long time.

For some hernias, surgery is needed. If a reducible inguinal hernia causes bothersome symptoms, surgery can be done to close the opening in the abdominal wall. Large hernias are often surgically repaired because they are likely to become incarcerated. Incarcerated hernias are almost always repaired because they can become strangulated. For these procedures, men who are in good general health may need only a local anesthetic. They can usually go home the same day.

If a hernia is strangulated, surgery is needed immediately. Damaged parts of the intestine are usually removed. Then the healthy parts are connected.

Outlook

Most inguinal hernias are merely a nuisance, causing an embarrassing bulge in the groin and mild discomfort. However, the bulge and discomfort may gradually worsen. If a hernia becomes strangulated, life-threatening infections can develop within hours.