If you do not have an inguinal hernia, see information on common types of hernias. These include incisional, epigastric, and umbilical hernias in children and adults.
An inguinal hernia (say "IN-gwuh-nul HER-nee-uh") occurs when tissue pushes through a weak spot in your groin muscle. This causes a bulge in the groin or scrotum. The bulge may hurt or burn.
Most inguinal hernias happen because an opening in the muscle wall does not close as it should before birth. That leaves a weak area in the belly muscle. Pressure on that area can cause tissue to push through and bulge out. A hernia can occur soon after birth or much later in life.
You are more likely to get a hernia if you are overweight or you do a lot of lifting, coughing, or straining. Hernias are more common in men.
The main symptom of an inguinal hernia 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 all of a sudden after you have been lifting heavy weights, coughing, bending, straining, or laughing. The hernia may be painful, but some hernias cause a bulge without 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.
Sudden pain, nausea, and vomiting are signs that a part of your intestine may have become trapped in the hernia. Call your doctor immediately if you have a hernia and have these symptoms.
A doctor can usually know if you have a hernia based on your symptoms and a physical examination. The bulge is usually easy to feel.
Hernias don't go away on their own. Only surgery can repair one. But if yours doesn't bother you and it causes no problems, you may not need to treat it 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. Strangulation needs surgery right away, although the condition is rare in adults.
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, if you decide to have surgery later.
Hernias in babies and young children can be more dangerous and generally need to be repaired with surgery right away because of the increased risk of incarceration and strangulation.
A hernia may come back after surgery. To reduce the chance that this will happen, stay at a healthy weight. Do not smoke, avoid heavy lifting, and try not to push hard when you have a bowel movement or pass urine.
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Inguinal hernias, which occur when tissue bulges through the abdominal (belly) muscles and into the groin, are caused by:
Conditions that increase pressure within the abdominal cavity, such as frequent coughing or being overweight, may contribute to the development of hernias.
A femoral hernia, sometimes mistaken for an inguinal hernia, occurs when tissue bulges from the lower abdomen into the upper thigh, just below the groin crease. The cause of a femoral hernia is often difficult to determine.
If you do not have an inguinal hernia, you may have one of the other common types of hernia. These include incisional, epigastric, and umbilical hernias in children and adults.
Symptoms of an inguinal hernia may include:
You may have sudden pain, nausea, and vomiting if part of the intestine becomes trapped (strangulated) in the hernia.
Other symptoms of a hernia include:
In infants, a hernia may bulge when the child cries or moves around.
Strangulated hernias, in which part of the intestine becomes trapped in the hernia, are more common in infants and children than in adults. They can cause nausea and vomiting and severe pain. An infant with a strangulated hernia may cry and refuse to eat. A strangulated hernia is a medical emergency that requires immediate surgery.
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.
In adults, a hernia that can be pushed back into the abdomen can be surgically repaired at a convenient time. This is because strangulation is rare in adults. A hernia that cannot be pushed back can be repaired when surgery is convenient unless you have increased pain, redness of the overlying skin, fever, nausea and vomiting, or abdominal bloating. If any of these symptoms occur, the hernia may need to be fixed sooner.
Inguinal hernias can come back after surgical repair. But in women it is rare for inguinal hernias to recur.
Infants or children with an inguinal hernia need to have surgery as soon as possible because of the increased risk that a part of the intestine will become trapped and blood supply will be cut off, leading to tissue death.
Incarceration, when intestinal or abdominal tissue fills up the sac of a hernia, occurs in about 2 or 3 out of 10 infants younger than 6 months who have hernias. Most incarcerated hernias occur before the infant is 1 year old.footnote 1 Female infants face a higher risk of incarceration.
Many things can increase your risk for having an inguinal hernia.
In children, risk factors for inguinal hernia include:
Call a doctor immediately if:
Call a doctor if:
Talk with your doctor before wearing a corset or truss for a hernia. These devices are not recommended for treating hernias and sometimes can do more harm than good.
Watchful waiting is a period of time during which you and your doctor observe your symptoms or condition but you do not receive medical treatment. If you are not sure whether you have groin muscle strain or a hernia, watchful waiting with home treatment for 1 to 2 weeks is appropriate. If you have pain that is increasing or severe, an obvious lump, or evidence of bowel blockage or urinary symptoms, call your doctor for an evaluation.
Watchful waiting is not appropriate 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 does not bother you, you can probably wait to have surgery.
An emergency room doctor, your family doctor, general practitioner, or your child's pediatrician can diagnose an inguinal hernia.
A general surgeon or pediatric surgeon with experience in inguinal hernia repair will be needed to perform hernia repair surgery.
The diagnosis of inguinal hernia is usually based on your medical history and a physical examination. Tests such as ultrasound and CT scans are not usually needed to diagnose an inguinal hernia. In most cases, a doctor can identify an inguinal hernia during a physical examination.
If surgery is planned, other tests may be needed to evaluate the status of any current health problems, such as lung, heart, or bleeding problems.
Hernia repair is one of the most common surgeries done in Canada.
Many people with hernias have surgery to repair them when more symptoms develop. It is very uncommon for a hernia to become strangulated. This happens when a loop of intestine is trapped tightly in a hernia and the blood supply is cut off, which kills the tissue. Strangulation needs surgery right away, although the condition is rare in adults.
In a child, a hernia that is incarcerated may be pushed back into the abdomen by a doctor. But surgery is still needed because of the increased risk of strangulation.
A surgeon's experience plays an important role in the risk of a hernia recurring. If you are thinking about having hernia surgery, ask the surgeon how many of these surgeries he or she has done and about his or her recurrence rates. Recurrence rates for adults tend to be higher for surgeries that do not use mesh (a synthetic patch).
Some people with other medical conditions may choose not to have surgery or may not be able to have hernia surgery.
Most inguinal hernias cannot be prevented, especially in infants and children. Adults may be able to prevent a few hernias or prevent a hernia from recurring by following some of these suggestions:
Surgery has generally been recommended for all inguinal hernias to avoid complications such as strangulation, in which a loop of intestine becomes tightly trapped in a hernia, cutting off the blood supply to that part of the intestine.
If a hernia in an adult can be pushed back (reduced), surgery can be done at the person's convenience. If it cannot be pushed back, surgery must be done sooner. But surgery may not be needed if the hernia is small and you do not have symptoms. Consult with your doctor to decide if you need hernia repair surgery.
In most cases, a child with an inguinal hernia will need surgery to correct it.
Infants 6 months of age and younger who have inguinal hernias have a much higher risk of strangulation than older children and adults. So surgery for inguinal hernias in infants is not delayed like it can be for adults.
One of the major decisions concerning infants and children is whether to explore the opposite groin area for a hernia during a hernia repair. A hernia develops in the other side of the groin in about 30 out of 100 children who have had hernia surgery.
Things to think about in deciding whether the other side should be explored include the overall health of the child, the risk of incarceration of a hernia, and the experience level of the surgeon (how many of these surgeries the doctor has done and his or her recurrence rates).
Two types of surgery are done to repair inguinal hernias:
Laparoscopic surgery may not be possible for a person who has tissues that have grown together (adhesions) from previous abdominal operations.
Most hernias that will recur do so within 5 years after surgery.
The risk of a hernia coming back after surgery varies depending on a surgeon's experience, the type of hernia, if mesh is used, and the person's age and overall health.
There are some considerations before having inguinal hernia repair surgery, such as what kind of hernia repair is done most at the hospital or clinic. Talk with your doctor so that you make the best decision for your condition.
Recurrent inguinal hernias are harder to repair and pose more risks than initial hernia repairs. The risks linked with recurrent hernia surgery are more scar tissue, numbness and pain after surgery, and a greater chance of injury to a testicle or the spermatic cord.
Conditions that might increase the risk of recurrence include abdominal muscles that are not strong or healthy enough to "hold" the stitching (suture) material and bleeding or infection that weaken the repair.
Fertility is usually not affected by an inguinal hernia or hernia surgery. But in males there is a chance that surgery or an incarcerated hernia can cause injury to the vas deferens, the tube that carries sperm from the testicles to the urethra. It is not yet known how often or to what degree this affects a man's ability to father a child. In rare cases, surgery or an incarcerated hernia may injure the blood vessels that supply one or both testicles with blood, which may cause the affected testicle to shrink.
Aiken JJ, Oldham KT (2011). Inguinal hernias. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 19th ed., pp. 1362–1368. Philadelphia: Saunders Elsevier.
Harmon JW, Wolfgang CL (2007). Hernias of the groin and abdominal wall. In NH Fiebach et al., eds., Principles of Ambulatory Medicine, 7th ed., pp. 1673–1681. Philadelphia: Lippincott Williams and Wilkins.
Deveney KE (2010). Hernias and other lesions of the abdominal wall. In GM Doherty, ed., Current Diagnosis and Treatment: Surgery, 13th ed., pp. 724–736. New York: McGraw-Hill.
Current as ofMarch 27, 2018
Author: Healthwise StaffMedical Review: E. Gregory Thompson, MD - Internal MedicineBrian O'Brien, MD, FRCPC - Internal MedicineKathleen Romito, MD - Family MedicineAdam Husney, MD - Family MedicineKenneth Bark, MD - General Surgery, Colon and Rectal Surgery
Current as of: March 27, 2018
E. Gregory Thompson, MD - Internal Medicine & Brian O'Brien, MD, FRCPC - Internal Medicine & Kathleen Romito, MD - Family Medicine & Adam Husney, MD - Family Medicine & Kenneth Bark, MD - General Surgery, Colon and Rectal Surgery
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