About Groin and Abdominal Hernias
A hernia occurs when part of your body protrudes through an abnormal opening in the groin or abdominal wall.
A groin or abdominal hernia can be present at birth, develop over years, or come on suddenly.
The underlying causes of hernias are increased pressure within the abdomen and generalized weakness of connective tissues. Since these conditions affect both sides of the groin or abdomen equally, people who have one hernia often have more, even if they are only experiencing pain on one side. Consequently, both sides will be carefully examined for hernias. This is important since an additional asymptomatic hernia may affect the type of repair your surgeon decides to perform.
Although hernias aren’t dangerous themselves, they can have life-threatening complications. They certainly can cause pain, even when not dangerous.
Facts About Groin and Abdominal Hernias
Groin and abdominal wall hernias are a common problem. The National Center for Health Statistics estimates that about 5 million people in the United States have such a hernia.
Most hernias contain only fat and membranes. A small percentage contains bowel and/or the fluid that surrounds the gastrointestinal organs.
Types of Groin & Abdominal Hernias
There are several types of groin and abdominal hernias.
|Inguinal||Develops in the groin area.||Accounts for 75% of abdominal wall hernias and most often occurs in men.|
|Femoral||Appears in the upper thigh, just below the groin crease.||Less common hernia that usually occurs in women, probably because of increased intra-pelvic pressure during pregnancy.|
|Spigelian||Occurs at the edge of the rectus muscles (the ones used to sit up), near the level of the navel.||This rare type of hernia that usually occurs in middle-age.|
|Incisional||Occurs through a surgical scar in the abdomen.||Most often occurs in obese patients or when the surgical site was infected. May occur months or years after surgery.|
|Midline||Includes umbilical (around the navel), epigastic (above the navel), and hyogastric (below the navel) abdominal hernias.||Umbilical hernias often occur in infants and usually heal on their own. All midline hernias can be acquired or congenital. The majority are prone to being nonreducible.|
When the tissue creating the bulge can be pushed back into the abdomen, or completely flattened, it is reducible. If the tissue cannot be pushed back into the abdomen, the hernia is non-reducible. A hernia can be completely reducible, incompletely reducible, or non-reducible.
Non-reducible hernias are more likely to cause pain and are more likely to become strangulated. Strangulation results when the blood and lymphatic vessels that supply the contents of the hernia become “pinched” as they pass through the neck of the hernia. This interferes with the blood supply to the hernia contents, potentially leading to the death of those tissues. Strangulated hernias that contain only fat can cause severe pain, but are not life-threatening. However, when a hernia that contains bowel becomes strangulated, life threatening complications such as bowel obstruction and bowel death (infarction) can occur.
By diagnosing hernias early, they can be surgically repaired before strangulation can occur.
Risk Factors and Symptoms
Risk Factors for Groin and Abdominal Hernias
Anyone of any age can develop a hernia. Some hernias have no apparent cause. Many occur because of a pre-existing weak spot in the abdominal wall and/or too much pressure on the abdomen.
The following factors can increase your risk for developing a hernia:
- Family history of hernias
- Personal history of hernias
- Chronic coughing
- Chronic constipation
- Occupation that requires heavy lifting or long periods of standing
Reducing the Risk
Many hernias are not preventable. However, adults may be able to prevent some hernias, or the recurrence of a hernia, by following these guidelines:
- Maintain a healthy weight
- Eat a healthy, high-fiber diet
- Stop smoking
- Avoid lifting heavy objects or lift them using proper form (lift with the legs, not the back)
- Avoid straining during bowel movements and urination
- Get regular aerobic exercise
Symptoms of Groin and Abdominal Hernias
A hernia usually becomes noticeable as a bulge in the abdomen, groin, scrotum or upper thigh (depending on the type of hernia). If the hernia is reducible, it may change size based on your position. Sometimes hernias do not cause a bulge and may not be noticed unless other symptoms occur.
Following are additional symptoms of hernias:
- Pain that becomes more pronounced when straining – such as during bowel movements, urination, bending over, or lifting a heavy objects
- Pain that gets worse after long periods of standing
- Pain that’s relieved when lying down
- Tenderness directly over the hernia
- Heavy or dragging sensation in the groin
- In men, pain and swelling in groin and/or the scrotum
- In women, pain and/or swelling in the groin and/or labium majorum
- In infants and children, nausea, vomiting, refusal to eat
Diagnosis and Treatment
Diagnosing Groin and Abdominal Hernias
Your physician may order an ultrasound to diagnose a hernia or to determine the contents of a hernia and its reducibility. Ultrasound is the ideal exam for evaluating this condition because it is performed in real time showing live motion. It can be performed while the patient is lying on his or her back or standing upright; while breathing quietly or straining vigorously. Also, the hernia can be compressed during the exam. All these factors enable ultrasound to more accurately identify the type, number, and character of hernias. Ultrasound can also identify small hernias, allowing them to be repaired before strangulation occurs.
Learn more about why ultrasound is better than CT and MRI scans for diagnosing hernias.
Treating this Condition
There are currently no radiology procedures for treating hernias.
Strangulated hernias require immediate surgical repair. Nonangulated hernias generally can undergo elective surgical repair. Small “incidental” hernias that contain only fat may not require surgery. The decision to have surgical repair of a hernia (herniorrhaphy), and the type of repair, must be decided by the patient with advice from his or her primary care physician and/or a surgeon.