Inguinal hernia

An inguinal hernia occurs when tissue, such as part of the intestine, protrudes through a weak spot in the abdominal muscles. The resulting bulge can be painful, especially when you cough, bend over or lift a heavy object.

An inguinal hernia isn’t necessarily dangerous. It doesn’t improve on its own, however, and can lead to life-threatening complications. Your doctor is likely to recommend surgery to fix an inguinal hernia that’s painful or enlarging. Inguinal hernia repair is a common surgical procedure.

Symptoms

  • Inguinal hernia signs and symptoms include:
  • A bulge in the area on either side of your pubic bone, which becomes more obvious when you’re upright, especially if you cough or strain
  • A burning or aching sensation at the bulge
  • Pain or discomfort in your groin, especially when bending over, coughing or lifting
  • A heavy or dragging sensation in your groin
  • Weakness or pressure in your groin
  • Occasionally, pain and swelling around the testicles when the protruding intestine descends into the scrotum

Signs and symptoms in children

Inguinal hernias in newborns and children result from a weakness in the abdominal wall that’s present at birth. Sometimes the hernia will be visible only when an infant is crying, coughing or straining during a bowel movement. He or she might be irritable and have less appetite than usual.

In an older child, a hernia is likely to be more apparent when the child coughs, strains during a bowel movement or stands for a long period.

Signs of trouble

If you aren’t able to push the hernia in, the contents of the hernia may be trapped (incarcerated) in the abdominal wall. An incarcerated hernia can become strangulated, which cuts off the blood flow to the tissue that’s trapped. A strangulated hernia can be life-threatening if it isn’t treated.

Signs and symptoms of a strangulated hernia include:

  • Nausea, vomiting or both
  • Fever
  • Sudden pain that quickly intensifies
  • A hernia bulge that turns red, purple or dark
  • Inability to move your bowels or pass gas

When to see a doctor

Seek immediate care if a hernia bulge turns red, purple or dark or if you notice any other signs or symptoms of a strangulated hernia.

See your doctor if you have a painful or noticeable bulge in your groin on either side of your pubic bone. The bulge is likely to be more noticeable when you’re standing, and you usually can feel it if you put your hand directly over the affected area.

Causes

Some inguinal hernias have no apparent cause. Others might occur as a result of:

  • Increased pressure within the abdomen
  • A pre-existing weak spot in the abdominal wall
  • Straining during bowel movements or urination
  • Strenuous activity
  • Pregnancy
  • Chronic coughing or sneezing
  • In many people, the abdominal wall weakness that leads to an inguinal hernia occurs at birth when the abdominal lining (peritoneum) doesn’t close properly. Other inguinal hernias develop later in life when muscles weaken or deteriorate due to aging, strenuous physical activity or coughing that accompanies smoking.
  • Weaknesses can also occur in the abdominal wall later in life, especially after an injury or abdominal surgery.
  • In men, the weak spot usually occurs in the inguinal canal, where the spermatic cord enters the scrotum. In women, the inguinal canal carries a ligament that helps hold the uterus in place, and hernias sometimes occur where connective tissue from the uterus attaches to tissue surrounding the pubic bone.

Risk factors

Factors that contribute to developing an inguinal hernia include:

  • Being male. Men are eight times more likely to develop an inguinal hernia than are women.
  • Being older. Muscles weaken as you age.
  • Being white.
  • Family history. You have a close relative, such as a parent or sibling, who has the condition.
  • Chronic cough, such as from smoking.
  • Chronic constipation. Constipation causes straining during bowel movements.
  • Pregnancy. Being pregnant can weaken the abdominal muscles and cause increased pressure inside your abdomen.
  • Premature birth and low birth weight.
  • Previous inguinal hernia or hernia repair. Even if your previous hernia occurred in childhood, you’re at higher risk of developing another inguinal hernia.

Complications

Complications of an inguinal hernia include:

Pressure on surrounding tissues. Most inguinal hernias enlarge over time if not repaired surgically. In men, large hernias can extend into the scrotum, causing pain and swelling.

Incarcerated hernia. If the contents of the hernia become trapped in the weak point in the abdominal wall, it can obstruct the bowel, leading to severe pain, nausea, vomiting, and the inability to have a bowel movement or pass gas.

Strangulation. An incarcerated hernia can cut off blood flow to part of your intestine. Strangulation can lead to the death of the affected bowel tissue. A strangulated hernia is life-threatening and requires immediate surgery.

Prevention

You can’t prevent the congenital defect that makes you susceptible to an inguinal hernia. You can, however, reduce strain on your abdominal muscles and tissues. For example:

  • Maintain a healthy weight. Talk to your doctor about the best exercise and diet plan for you.
  • Emphasize high-fiber foods. Fruits, vegetables and whole grains contain fiber that can help prevent constipation and straining.
  • Lift heavy objects carefully or avoid heavy lifting. If you must lift something heavy, always bend from your knees — not your waist.
  • Stop smoking. Besides its role in many serious diseases, smoking often causes a chronic cough that can lead to or aggravate an inguinal hernia

Diagnosis

A physical exam is usually all that’s needed to diagnose an inguinal hernia. Your doctor will check for a bulge in the groin area. Because standing and coughing can make a hernia more prominent, you’ll likely be asked to stand and cough or strain.

If the diagnosis isn’t readily apparent, your doctor might order an imaging test, such as an abdominal ultrasound, CT scan or MRI.

Treatment

If your hernia is small and isn’t bothering you, your doctor might recommend watchful waiting.

Enlarging or painful hernias usually require surgery to relieve discomfort and prevent serious complications.

There are two general types of hernia operations — open hernia repair and laparoscopic repair.

Open hernia repair

In this procedure, which might be done with local anesthesia and sedation or general anesthesia, the surgeon makes an incision in your groin and pushes the protruding tissue back into your abdomen. The surgeon then sews the weakened area, often reinforcing it with a synthetic mesh (hernioplasty). The opening is then closed with stitches, staples.

After the surgery, you’ll be encouraged to move about as soon as possible, but it might be several weeks before you’re able to resume normal activities.

Laparoscopy

In this minimally invasive procedure, which requires general anesthesia, the surgeon operates through several small incisions in your abdomen. Gas is used to inflate your abdomen to make the internal organs easier to see.

A small tube equipped with a tiny camera (laparoscope) is inserted into one incision. Guided by the camera, the surgeon inserts tiny instruments through other incisions to repair the hernia using synthetic mesh.

People who have laparoscopic repair might have less discomfort and scarring after surgery and a quicker return to normal activities.

However, hernia recurrence may be more likely with laparoscopic repair than with open surgery. Having a surgeon who is very experienced in the laparoscopic procedure may reduce this risk.

Laparoscopy allows the surgeon to avoid scar tissue from an earlier hernia repair, so it might be a good choice for people whose hernias recur after open hernia surgery. It also might be a good choice for people with hernias on both sides of the body (bilateral).

As with open surgery, it may be a few weeks before you can get back to your usual activity level.

Umbilical Hernia

An umbilical hernia occurs when part of the bowel or fatty tissue pokes through an area near the belly button, pushing through a weak spot in the surrounding abdominal wall.

There are different types of hernia. A true umbilical hernia happens when there is a defect in the anterior abdominal wall that underlies the umbilicus, or navel.

They are common in newborns and infants, but they can affect adults, too.

Although umbilical hernias are easily treatable, they can become a serious condition on rare occasions.

Fast facts on umbilical hernia

  • Umbilical hernias are common in babies born preterm.
  • They are not normally painful, but if they become sore, a doctor should be consulted.
  • Obesity is a risk factor for umbilical hernias.
  • Diagnosis of an umbilical hernia can normally be confirmed by a physical examination alone.

What is an umbilical hernia?

In young infants

Umbilical hernias are common in young infants, but the exact rate is not known because many cases go unreported and resolve themselves without the need for treatment.

They are particularly common in infants born preterm. Up to 75 percent of newborns with a birth weight of less than 1.5 kilograms (kg) have an umbilical hernia.

While the developing fetus is in the womb, the umbilical cord passes through an opening in the abdominal wall. This should close soon after birth.

However, the muscles do not always seal completely, leaving a weak spot through which an umbilical hernia can push.

In most cases, an umbilical hernia experienced by an infant closes on its own by the age of 3 to 4 years. If a hernia is still present by the time the child is 4 years old, a doctor may recommend surgery.

Among infants, the risk is about the same for males and females.

In adults

Umbilical hernias can also develop in adults, especially if they are clinically overweight, lifting heavy objects, or have a persistent cough. Women who have had multiple pregnancies have a higher risk of developing an umbilical hernia.

In adults, hernias are much more common in females.

Symptoms

An umbilical hernia looks like a lump in the navel. It might become more obvious when the infant is laughing, crying, going to the toilet, or coughing. When the child is lying down or relaxed, the lump may shrink.

It is not usually painful in children and infants. However, adults may feel pain or discomfort if a hernia is large.

When to see a doctor

  • Visit a physician in the following cases:
  • The bulge becomes painful.
  • Vomiting occurs, accompanied by a bulge.
  • The bulge swells up more or becomes discolored.
  • You used to be able to push the bulge flat against the abdomen, but now it cannot be reduced without significant pain or tenderness.

Risk factors

The major risk factors for umbilical hernias are:

Age: Infants, especially those born preterm, have a higher risk of an umbilical hernia than adults.

Obesity: Children and adults with obesity face a significantly higher risk of developing an umbilical hernia, compared with individuals of normal weight for their height and age.

Coughing: Having a cough for a long period of time can increase the risk of hernias, because the force of coughing applies pressure to the abdominal wall.

Multiple pregnancies: When a woman is carrying more than one baby as part of a pregnancy, the risk of an umbilical hernia is higher.

Causes

The causes of umbilical hernia are different across age groups.

Infants: As the fetus develops in the womb, a small opening forms in the abdominal muscles. This opening allows the umbilical cord to pass through. This connects the woman who is pregnant to the baby.

Around the time of birth, or shortly after, the opening should close. If this does not happen completely, fatty tissue or part of the bowel can poke through, causing an umbilical hernia.

Adults: If there is too much pressure on the abdominal wall, fatty tissue or a part of the bowel can poke through a weak section of abdominal muscle. Individuals at high risk are more likely to experience higher-than-normal pressure in areas where fatty tissue or parts of the gut can protrude.

Diagnosis

A doctor will be able to diagnose an umbilical hernia during a physical examination. They may also be able to determine what type of hernia is it. If it involves the bowel, for example, there may be a risk of obstruction.

If the doctor wants to screen for complications, they may request an abdominal ultrasound, X-ray, or blood tests.

Complications

Complications of umbilical hernia are rare in children.

If the protrusion becomes trapped and cannot be pushed back into the abdominal cavity, the primary concern is that the intestines might lose blood supply and become damaged.

If the blood supply is completely cut off, there is a risk of gangrene and life-threatening infections. Incarceration is rare in adults and even less common in children.

For adults, there is a possibility that the hernia will grow in size with time and advancement of age.

Treatment

Treatment is not always required, as some instances of umbilical hernia self-resolve. However, this may not always be the case, especially for adults.

Infants and children: For the majority of infants, the hernia closes without treatment by the age of 12 months. Sometimes, the doctor may be able to push the lump back into the abdomen. It is important that only the doctor attempts this.

Surgery may be requested if:

the hernia grows after the child is 1 to 2 years old

the bulge is still present by the age of 4 years

the intestines are within the hernial sac, preventing or reducing intestinal movement

a hernia becomes trapped

Adults: Surgery is usually recommended for adults. This can prevent potential complications, especially if the hernia increases in size or starts to hurt.

Surgery

Umbilical hernia surgery is a small, quick operation to push the bulge back into place and to strengthen the abdominal wall.

In most cases, the person receiving surgery will be able to go home on the same day.

According to the American College of Surgeons, either open or laparoscopic surgery may be used.

Surgery involves makes an incision at the base of the bellybutton and pushes either the fatty lump or bowel back into the abdomen.

In open surgery, the surgeon will open the site and repair the hernia by using mesh and stitching the muscle together.

In laparoscopic surgery, or keyhole, surgery, mesh and sutures will be pass through small incisions.

Muscle layers are stitched over the weak area in the abdomen wall, fortifying it.

Dissolvable stitches or special glue are used to close the wound. The surgeon will sometimes apply a pressure dressing on the hernia, which remains in place for 4 to 5 days.

An umbilical hernia operation usually takes about 30 to 45 minutes.

What are the complications of an umbilical hernia surgery?

  • Wound infection
  • Pneumonia
  • Blood clots
  • Bleeding
  • Fluid collection under the skin (seroma)
  • Hematoma
  • Bowel injury
  • Paralysis of the intestinal muscles (paralytic ileus)
  • Reoccurrence of hernia.

Recovery

  • After surgery to repair your hernia, you are likely to have pain for a few days.
  • You should feel better after a few days and will probably feel much better in 7 days.
  • For several weeks you may feel twinges or pulling in the hernia repair when you move. You may have some bruising around the area of the repair. This is normal.

How can you care for yourself at home?

Activity

  • Rest when you feel tired. Getting enough sleep will help you recover.
  • Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation.
  • If your doctor gives you an abdominal binder to wear, use it as directed. This is an elastic bandage that wraps around your belly and upper hips. It helps support your belly muscles after surgery.
  • Avoid strenuous activities, such as biking, jogging, weight lifting, or aerobic exercise, until your doctor says it is okay.
  • Avoid lifting anything that would make you strain. This may include heavy grocery bags and milk containers, a heavy briefcase or backpack, cat litter or dog food bags, a vacuum cleaner, or a child.
  • Ask your doctor when you can drive again.
  • Most people are able to return to work within 1 to 2 weeks after surgery. But if your job requires that you do heavy lifting or strenuous activity, you may need to take 4 to 6 weeks off from work.
  • You may shower 24 to 48 hours after surgery, if your doctor okays it. Pat the cut (incision) dry. Do not take a bath for the first 2 weeks, or until your doctor tells you it is okay.
  • Ask your doctor when it is okay for you to have sex.

Diet

  • You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
  • Drink plenty of fluids (unless your doctor tells you not to).
  • You may notice that your bowel movements are not regular right after your surgery. This is common. Avoid constipation and straining with bowel movements. You may want to take a fibre supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.
  • Other instructions
  • Hold a pillow over your incision when you cough or take deep breaths. This will support your belly and decrease your pain.
  • Do breathing exercises at home as instructed by your doctor. This will help prevent pneumonia.
  • If you had laparoscopic surgery, you may also have pain in your left shoulder. The pain usually lasts about a day or two.

Diet

You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.

Drink plenty of fluids (unless your doctor tells you not to).

You may notice that your bowel movements are not regular right after your surgery. This is common. Avoid constipation and straining with bowel movements. You may want to take a fibre supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.

Other instructions

Hold a pillow over your incision when you cough or take deep breaths. This will support your belly and decrease your pain.

Do breathing exercises at home as instructed by your doctor. This will help prevent pneumonia.

If you had laparoscopic surgery, you may also have pain in your left shoulder. The pain usually lasts about a day or two.