The main symptom of an inguinal hernia (Figure 6) is a bulge in the groin or scrotum. It often feels like a round lump. The bulge may form over a period of weeks or months. Or it may appear suddenly after you've been lifting heavy weights, coughing, bending, straining, or laughing. The hernia may be uncomfortable or painful. Some cause no pain.

A hernia also may cause swelling and a feeling of heaviness, tugging, or burning in the area of the hernia. These symptoms may get better when you lie down.

In babies, a hernia may bulge when the child cries or moves around.

Strangulated hernias, which happen when part of the intestine gets trapped in the hernia, are more common in babies and children than in adults. They can cause nausea and vomiting and severe pain. A baby with a strangulated hernia may cry and refuse to eat.

Figure 6 - Inguinal hernia

An inguinal hernia occurs when a small portion of the bowel bulges out through the inguinal canal and into the groin. (The inguinal canal is a passage or opening through the muscles of the abdominal wall.) The bulge usually contains tissue lining the inside of the abdomen (belly) as well as fatty tissue from inside the belly. Or it may contain a loop of intestine.

There are two types of inguinal hernias:

• Direct inguinal hernias. These occur when a weak spot develops in the lower belly muscles. Often the cause of the hernia is not known. But the cause is often thought to be lifting, straining, or coughing. Or it may be being obese, pregnant, or constipated.
• Indirect inguinal hernias. These occur when the inguinal canal fails to close before birth. The hernia may appear in a male's scrotum or in the fold of skin at the opening of a female's vagina. This is the most common type of inguinal hernia. And it may occur at birth or later in life. Indirect hernias are more common in males.

Current as of: October 19, 2023

Author: Ignite Healthwise, LLC Staff
Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.

Inguinal hernias typically flatten or disappear when they are pushed gently back into place or when you lie down. Over time, hernias tend to increase in size as the abdominal muscle wall becomes weaker and more tissue bulges through.

If you can't push your hernia back into your belly, it is incarcerated. A hernia gets incarcerated when tissue moves into the sac of the hernia and fills it up. This is not necessarily an emergency.

But if a loop of the intestine is trapped very tightly in the hernia, the blood supply to that part of the intestine can be cut off (strangulated), causing tissue to die. In a man, if tissue is trapped, the testicle and its blood vessels can also be damaged.

A strangulated hernia is a medical emergency that requires immediate surgery.

Call a doctor now if:

• Your child has an inguinal hernia that can't be pushed back into the belly with gentle pressure.
• You or your child has an inguinal hernia and symptoms of strangulation, such as nausea, vomiting, fever, tenderness, and severe cramping pain in the groin area. These symptoms mean that the intestine has lost blood supply.

Call a doctor if:

• Your infant has a definite lump in the groin area.
• You or your child has a tender bulge in the groin or scrotum, even if the bulge disappears when lying down.
• You or your child has increasing groin discomfort or pain. The discomfort may be increased by bending or lifting. It may extend into the scrotum.

Talk with your doctor before wearing a corset or truss for a hernia. These devices are not recommended for treating hernias. They sometimes can do more harm than good.

Watchful waiting

Watchful waiting is a wait-and-see approach. If you aren't sure if you have a groin muscle strain or a hernia, watchful waiting with home treatment for 1 to 2 weeks is okay to try. If you have pain that is increasing or severe, an obvious lump, or evidence of bowel blockage or urinary symptoms, call your doctor to be checked.

Watchful waiting is not okay for infants and children who have inguinal hernias.

You and your doctor can decide whether you should have surgery to fix your hernia or if you can wait. If your hernia doesn't bother you, you can probably wait to have surgery.

Your doctor can usually diagnose an inguinal hernia (Figure 7) by asking questions about your health and doing a physical exam. Tests such as ultrasound and CT scans are not usually needed. In most cases, a doctor can find an inguinal hernia during the physical exam.

Other tests may be needed if you need to have surgery. These tests check the status of any current health problems, such as lung, heart, or bleeding problems.

Figure 7 - Inguinal hernia

An inguinal hernia occurs when a small portion of the bowel bulges out through the inguinal canal and into the groin. (The inguinal canal is a passage or opening through the muscles of the abdominal wall.) The bulge usually contains tissue lining the inside of the abdomen (belly) as well as fatty tissue from inside the belly. Or it may contain a loop of intestine.

There are two types of inguinal hernias:

• Direct inguinal hernias. These occur when a weak spot develops in the lower belly muscles. Often the cause of the hernia is not known. But the cause is often thought to be lifting, straining, or coughing. Or it may be being obese, pregnant, or constipated.
• Indirect inguinal hernias. These occur when the inguinal canal fails to close before birth. The hernia may appear in a male's scrotum or in the fold of skin at the opening of a female's vagina. This is the most common type of inguinal hernia. And it may occur at birth or later in life. Indirect hernias are more common in males.

Current as of: October 19, 2023

Author: Ignite Healthwise, LLC Staff
Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.

Only surgery can repair an inguinal hernia (Figure 8). But if the hernia does not bother you and it causes no other problems, you may not need treatment right now.

Many people with hernias have surgery to repair them when more symptoms develop. It is very uncommon for a hernia to become strangulated, a serious problem that happens when part of your intestine gets trapped inside the hernia.

Some people wait to have surgery. Waiting to have surgery does not increase the chance that part of your intestine or belly tissue will get stuck in your hernia. Waiting will also not increase your risk for problems.

The two types of surgeries to repair inguinal hernias are:

• Open inguinal hernia repair.
• Laparoscopic inguinal hernia repair.

Hernias in babies and young children can be more dangerous and often need to be repaired with surgery right away because of the increased risk of incarceration and strangulation.

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Figure 8 - Inguinal hernia

An inguinal hernia occurs when a small portion of the bowel bulges out through the inguinal canal and into the groin. (The inguinal canal is a passage or opening through the muscles of the abdominal wall.) The bulge usually contains tissue lining the inside of the abdomen (belly) as well as fatty tissue from inside the belly. Or it may contain a loop of intestine.

There are two types of inguinal hernias:

• Direct inguinal hernias. These occur when a weak spot develops in the lower belly muscles. Often the cause of the hernia is not known. But the cause is often thought to be lifting, straining, or coughing. Or it may be being obese, pregnant, or constipated.
• Indirect inguinal hernias. These occur when the inguinal canal fails to close before birth. The hernia may appear in a male's scrotum or in the fold of skin at the opening of a female's vagina. This is the most common type of inguinal hernia. And it may occur at birth or later in life. Indirect hernias are more common in males.

Current as of: October 19, 2023

Author: Ignite Healthwise, LLC Staff
Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.

• Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• Use proper lifting techniques, and avoid heavy lifting if you can. To lift things more safely, bend your knees and let your arms and legs do the work. Keep your back straight, and do not bend over at the waist. Keep the load as close to your body as you can. Move your feet instead of turning or twisting your body.
• Lose weight if you are overweight.
• Include fruits, vegetables, legumes, and whole grains in your diet each day. These foods are high in fibre and will make it easier to avoid straining during bowel movements.
• Do not smoke. Smoking can cause coughing, which can cause your hernia to bulge. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.

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