A groin hernia is an external bulge in the groin area that contains fat, connective tissue, and/or a portion of intestine. There are two main types of groin hernias:

Inguinal Hernia–occurs when there is a weak spot in the area where the abdomen meets the thigh on both sides (most common type)

Femoral Hernia–occurs much less frequently and is located in the upper thigh

A groin hernia that pushes through the abdominal wall can become trapped. This may lead to dangerous complications such as intestinal obstruction or strangulation. Both require immediate surgery.

Causes

Anything that causes weakness or tears in the abdominal wall can cause a groin hernia, including:

• Defects at birth

• Prolonged wear and tear such as lifting, straining or coughing

• Age-related weakness of the abdominal wall

• History of previous surgery in the area

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

• Advancing age

• Sex: Male (Groin hernias are about 10 times more common in men, but the less common type, femoral hernias, are more common in women.)

• Lack of exercise

• Increased pressure within the abdominal cavity due to:

• • Lifting heavy objects

• • Straining to urinate or pass stools

• • Severe or prolonged coughing

• • Obesity

• • Pregnancy

Symptoms

Symptoms include:

• A bulge in the groin area when standing or straining

• Pain in the groin area when straining

• A bulge that may extend into the scrotum in men

• Pain, a heavy feeling or discomfort, or sometimes no pain, in the groin

More serious symptoms associated with a groin hernia that may require immediate medical care include:

• Severe pain in the groin or abdomen

• Fever

• Rapid heart beat

• Abdominal swelling

• Nausea

• Vomiting

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam.

Treatment

Most inguinal hernias eventually require surgery. For small hernias that can be pushed back into place, a truss or external pad against the weak spot may temporarily provide support. If the hernia bulge can be pushed back in place, surgery may not be needed right away. However, even small hernias eventually need to be repaired. After surgery, hernias sometimes recur in the same place or on the opposite side. Hernia repair can cause irritation of inguinal nerves leading to pain post-surgery. This complication causes significant disruption in quality of life, but is fortunately rare.

Surgeries include:

Herniorrhaphy–surgery to repair the defect in the abdominal wall

Hernioplasty–reinforcing the weak area with steel mesh or wire

Bowel Resection–removal of a section of the intestine. This procedure may be used when part of the intestine becomes twisted or blocked or turns gangrenous and dies.

Laparoscopic Hernia Repair–surgery done through several tiny incisions in the groin or abdomen. Recovery may be faster and patients can often resume physical activity earlier.

Prevention

The following strategies may help to prevent a groin hernia:

• Lose weight, if you are overweight.

• Exercise regularly.

• Warm up before exercising to avoid straining your muscles.

• Learn to lift properly and ask for assistance with heavy weights.

• Always wear a protective belt when lifting heavy weights or moving heavy objects

• Eat more fiber to prevent constipation.

• Stop smoking, especially if you have a chronic cough.

• Seek medical care if you:

• • Strain when passing stools or urine

• • Cough or sneeze a lot

RESOURCES:

American College of Physicians
http://www.acponline.org

National Institute of Diabetes and Digestive and Kidney Diseases
http://www.niddk.nih.gov

References:

American College of Physicians Complete Home Medical Guide. DK Publishing; 1999.

Hawn MT, Itani KM, Giobbie-Hurder A, McCarthy M Jr, Jonasson O, Neumayer LA. Patient-reported outcomes after inguinal herniorrhaphy. Surgery. 2006 Aug;140(2):198-205.