WHAT IS AN INGUINAL HERNIA?
An inguinal hernia is a protrusion of bowel or fat through a weakening or hole in the groin. In both men and women, there is a natural weakening at this point. An inguinal hernia may occur on either side or on both sides at the same time. The lump can be quite small but some hernias become so big that they extend well down into the scrotum or labia.
They occur more commonly in men because the descent of the testicles through the groin leaves the area weak. Women also get hernias, but much less often.
Hernias occur at any age from newborns to the very elderly.
WHO IS MOST AT RISK TO GET AN INGUINAL HERNIA?
Anything that increases the pressure in the abdomen will increase the chance of the natural hole in the groin getting larger. Some common reasons are:
- Being overweight.
- People who lift heavy weights.
- Smokers and people with chronic coughs.
- People with constipation and prostate problems, because of straining.
- You may be born with an inguinal hernia.
- Patients with abdominal cancer like bowel, ovary or pancreas.
- Patients with cirrhosis of the liver.
If you have any symptoms of a change of bowel habit, I will also recommend that you have a colonoscopy. (A telescope passed around the bowel to ensure there is no cancer present.)
WHAT ARE THE SYMPTOMS OF AN INGUINAL HERNIA?
Most people will describe a lump in the groin. It is usually something that develops slowly, but some people notice a lump appearing suddenly after heavy lifting. The lump usually gets bigger after a day of standing up and goes away when you lie down. Big hernias can be very uncomfortable when trying to use your bowels. It is common that you will be able to push the hernia back in and there may be discomfort when you do this. Sometimes hernias cannot be pushed back in at all and there is always a lump present.
Some hernias become so large that a long length of the bowel will be contained in the hernia. This may make it difficult to have a bowel movement and may interfere with urination.
If the lump suddenly becomes painful, then it is possible that the hernia has become trapped. If this occurs, you should lie down immediately, try to relax and gently press over the lump to make it go back in. If the lump goes back in, you should contact me immediately and let me know what has happened. The hernia should be fixed as soon as possible. If the lump does not go back in, or remains painful in any way, you should urgently attend the Emergency Department. The risk is that if the hernia remains stuck for more than a few hours there is a chance that the bowel could die. This can be life threatening.
WHY SHOULD A HERNIA BE REPAIRED?
Once you have a hernia, there is nothing you can do to make it go away. As time goes on, it will become progressively larger and more uncomfortable.
Groin support garments or trusses do not work and can make the hernia worse.
Hernias are fixed for comfort and to prevent the serious complication of entrapment and strangulation of the bowel.
WHAT IF I HAVE GROIN PAIN?
Most hernias are uncomfortable but not painful. To diagnose a hernia, a lump should be present. Groin pain is very common and is rarely caused by a hernia. The most common reasons for groin pain are ligament problems of the hip and pelvis, back problems and groin strain. Patients who have groin pain will very frequently have an ultrasound to investigate this pain. It is usual that the ultrasound will find a very small inguinal hernia. This is because everyone has a natural weak point in the groin. Just because the ultrasound may detect a small hernia, does not mean it is responsible for the pain in the groin. Caution should be exercised in attempting to fix a tiny hernia for the symptom of pain because it is very common that the pain has been caused by something else.
DO I NEED ANY TESTS TO HAVE AN INGUINAL HERNIA REPAIRED?
All that is needed to diagnose a hernia is a physical examination. Most patients will have already had an ultrasound, but this is not needed.
You will need blood tests and an ECG if you have other medical problems as part of a routine work up for surgery.
HOW IS AN INGUINAL HERNIA REPAIRED?
A hernia is repaired by returning the bowels to the abdominal cavity and then covering the hole that the hernia has come through. This is done by inserting a soft nylon “mesh”. A good way to think about fixing a hernia is to liken it to patching a hole in a plaster wall. The edges of the hole are difficult to pull together, so a patch or mesh is placed behind the defect. This reinforces the weakened tissue and muscle. This mesh acts like a frame, for your body to grow strong fibrous tissue into and repair the defect. The mesh is very soft and you will not feel it.
There are many types of mesh on the market and the choice will often boil down to surgeon preference and experience in using that type of mesh. The most common type of mesh used in inguinal hernias is one that partially dissolves over time.
There are two ways to fix an inguinal hernia:
- Open technique
- Laparoscopic or “Key-hole” surgery technique (not suitable for everyone)
In my experience and in the literature, there is very little difference in recovery between the two techniques. Both methods are currently very acceptable.
In open inguinal hernia repair, a small cut is made over the lump. The contents of the hernia lump are placed back in the abdomen. In laparoscopic repair, a 10mm incision is made just below the belly button. Two more 5mm incisions are made below this in the midline. A camera and long instruments are then placed in the abdominal wall behind the hernia and a mesh is placed over the hernia. In both techniques the patient can go home the same day if they wish.