What is an inguinal hernia?

An inguinal hernia is a condition in which parts of the intestinal tract protrude from the abdominal cavity into the inguinal canal. One of the most visible signs of an inguinal hernia in children and adults is a large swelling in the groin. Interestingly, the hernia may disappear from view when the patient lies down.

Statistically, the condition is far more common in men, regardless of age. Women are affected less often because of differences in anatomy. In men, the inguinal canal is shorter than in women. It is also supported by fewer muscles and tendons, which makes it more vulnerable.

An inguinal hernia may develop as a result of heavy strain and increased intra-abdominal pressure in the groin. A defect forms in this area — the so-called “hernial orifice”. Organs then protrude through it, and an inguinal hernia forms.

Types of inguinal hernia

There are three main types of inguinal hernia: direct, indirect (oblique) and combined.

  • Direct inguinal hernia.

    In this type, the organs protrude directly into the inguinal canal, passing alongside the spermatic cord rather than through it. A direct inguinal hernia is always acquired. Statistically, most patients with this condition are older, as it develops when muscles and ligaments weaken with age.

  • Indirect (oblique) inguinal hernia.

    In this type, the hernia passes directly through the inguinal canal together with the spermatic cord in men and the round ligament in women. An indirect inguinal hernia may be acquired with age or present from birth.

  • Combined inguinal hernia.

    This type shows features of both direct and indirect inguinal hernias at the same time. Several hernial sacs may form. As a rule, they are not connected to one another and develop on both sides at once. This is known as a bilateral inguinal hernia.

  • Inguinoscrotal hernia.

    Occurs only in men, when an indirect hernia gradually enlarges and descends into the scrotum.

Causes: why an inguinal hernia develops

An inguinal hernia can be hereditary. If a close relative has had one, the patient may be predisposed to developing the condition.

The most common cause is weak muscles and ligaments combined with sudden pressure on the area — for example, when lifting a heavy object. It is always wise to assess your body’s capabilities realistically. Without his superpowers, even Superman would surely have acquired more than one inguinal hernia. Calling in a team of removal men is a better idea than moving a chest of drawers on your own.

According to statistics, excessive physical strain is the main factor in hernia development, mostly in men. This concerns both unjustified strain on the muscles and muscles that are unprepared for exercise and heavy lifting. According to the figures, this route accounts for 70% of cases.

Inguinal hernias of one form or another occur in women who have given birth several times in fairly quick succession. The changes the body undergoes during pregnancy can cause part of the intestine to protrude from the abdominal cavity into the groin. Pregnancy is the most common cause of inguinal hernia in women. In one in ten female patients, the hernia develops because the vaginal process (processus vaginalis) has failed to close.

Excess weight, in both men and women, can also trigger an inguinal hernia.

Other, less obvious causes include a chronic cough and frequent constipation.

In children, an inguinal hernia may result from abnormal anatomical development in the womb. Premature birth is also one of the main causes of the condition in children.

Signs of an inguinal hernia

An inguinal hernia is hard to miss. Its symptoms, however, are often confused with those of a hydrocele or a spermatic cord cyst. To tell them apart, let us look at the symptoms of an inguinal hernia in more detail.

One of the most common symptoms of a mild inguinal hernia in men and children is a bulge in the groin accompanied by discomfort.

A swelling that changes in size appears in the groin. For example, when patients lie down, the hernia seems to disappear.

Even before a visible bulge appears, the patient may feel a nagging or dull pain in the abdominal muscles during physical exertion. The condition is usually accompanied by regular pain on movement, whether when walking or during other activities.

A feeling of heaviness in the abdomen or a sharp tingling in the area may also indicate an inguinal hernia.

Other typical symptoms include hiccups, vomiting and nausea together with abdominal pain.

When treatment is needed

Signs that call for urgent medical attention:

  • sharp, cramping abdominal pain;
  • a severely distended abdomen;
  • frequent vomiting;
  • a rapid deterioration in the patient’s condition and severe weakness.

Risks of an inguinal hernia

An inguinal hernia is a serious condition that will not resolve on its own. If treatment is delayed for a long time, the condition progresses and complications follow.

A complicated inguinal hernia leads to inflammation in the groin. Strangulation of the hernial sac is the most dangerous development: pressure increases and the blood vessels narrow.

This anatomical disruption is accompanied by rapid growth of the hernia over just a few days, a scenario that leads to emergency surgery.

At the first symptoms, therefore, contact your doctor straight away, obtain a referral to a surgeon and have the necessary diagnostic tests.

How an inguinal hernia is diagnosed

First, the surgeon assesses the severity of the condition. The patient is examined in person, after which diagnostic tests are arranged.

The classic diagnostic methods are ultrasound and contrast X-ray.

An ultrasound scan of the inguinal canal and scrotum shows the extent of the hernia. It also helps to identify which organs are inside the hernial sac.

A contrast X-ray assesses the hernia more precisely than ultrasound. During this procedure, a contrast agent is introduced into the area of the hernia.

The exact type of hernia is determined during the operation itself.

Treating an inguinal hernia: is surgery necessary?

To remove an inguinal hernia successfully and effectively, surgery is required.

The operation removes the hernial sac completely and prevents the condition from progressing further.

Surgical repair of the hernia rules out the complications that can arise when other treatments fail.

Some patients put off surgery and try various alternative treatments instead. Self-treatment is best avoided: it only costs time and can make the situation worse.

Inguinal hernia surgery is performed under general anaesthesia. On average, the operation takes 30 to 60 minutes in men and just 15 minutes in women, owing to differences in anatomy.

When inguinal hernia surgery is urgent

The most important factor here is how long the hernial sac has been present.
There is no point waiting for the hernial sac to “go away” by itself. The longer you wait, the higher the risk of inflammation. Once inflammation sets in, a planned operation becomes an emergency one.

If the hernial sac becomes strangulated, surgery should take place within 10 hours.

Surgical methods for inguinal hernia repair

There are several ways to repair an inguinal hernia. The surgeon always chooses the method individually, based on the clinical findings and the patient’s particular circumstances, and may offer the patient a choice of several methods.

Endoscopic surgery

Endoscopic equipment allows the least traumatic form of surgery. The surgeon makes small incisions and inserts special instruments through them.

After endoscopic surgery, the patient stays in the clinic for around one day on average and can then go home.

The operation removes the hernia with maximum precision while keeping the trauma of the procedure to a minimum.

Lichtenstein repair

The Lichtenstein method also uses small incisions, about 6 cm long. It is suitable for patients who tolerate general anaesthesia poorly or for whom endoscopic surgery is not advisable.

To reduce the risk of recurrence, a special abdominal implant — a mesh — is used to support the organs. The Lichtenstein repair keeps the risk of recurrence to a minimum: statistically, the hernia returns in only 1% of patients. The method is particularly effective for older patients.

Shouldice repair

Most specialists regard this as the most effective method that uses no implant. No mesh — the prosthesis that helps to hold the abdominal wall in place — is used.

It is worth noting that this method is not suitable for patients diagnosed with diabetes or those on steroid therapy.

Laparoscopic repair

The laparoscopic method is recognised as the least invasive way to treat an inguinal hernia. It is used in the earlier stages of the condition.

The operation is performed with a laparoscope, a special instrument that allows the surgeon to operate through small openings rather than larger incisions.

In most cases, inguinal hernias recur because the surgeon underestimated the extent of the condition. Finding a skilled specialist is therefore key to successful treatment.

Many private clinics in Switzerland treat inguinal hernias of every type and level of complexity. Patients can also recover with exceptional service, amid pristine nature and the beauty and serenity of the Swiss landscape.

Recovery recommendations

After any type of operation, alcohol and coffee are strictly off-limits for the first 7 days. Sweets and fried food should also be avoided during this time.

The recovery period after inguinal hernia surgery is determined individually. It depends on the severity of the condition, the surgical method used and the patient’s individual characteristics.

If you follow all of your doctor’s instructions, a full return to normal will take up to six months on average.

Take good care of yourself.