Types of Hernia

Inguinal Hernia

What is an inguinal hernia?

An inguinal hernia occurs when tissue, usually part of the intestine or abdominal fat, pushes through a weakened area in the groin. It is the most common type of hernia, accounting for around 70% of all hernias, and is more common in men than women.

Why does an inguinal hernia occur?

They occur through the inguinal canal, a conduit where the testicle comes through on its way to the scrotum during the development of males. Men and women develop from the same basic pattern so there are anatomical similarities between men and women, meaning that women also have the inguinal canal.

But in women the inguinal canal is much smaller, and as a result inguinal hernias are much more uncommon than in men. A hernia develops when tissue pushes through weak areas in the abdominal muscles or surrounding connective tissue. Factors such as ageing, previous injury, or conditions that increase pressure inside the abdomen can contribute to the development of a hernia. Conditions such as chronic cough or chronic constipation can also increase the risk of developing an inguinal hernia due to repeated strain.

Inguinal hernia symptoms

The symptoms of an inguinal hernia can vary from person to person. You may see or feel a lump, bulge or swelling under the skin. You may notice a bulge in your groin that becomes more obvious when standing, coughing, sneezing, or straining.

It may be a bit uncomfortable and the swelling will often disappear completely when you lie down, as the contents of the hernia sac slip back through the hole into the abdominal wall. It may also be aggravated by coughing, sneezing, etc.

Sometimes there is hardly any swelling to see, but you may be conscious of a strange feeling in the groin area when you are standing or walking for any period of time.

Many hernias cause no pain at all, but that does not mean they are not there or that they are not in need of attention.

How is an inguinal hernia diagnosed?

See a doctor to confirm an inguinal hernia diagnosis. The doctor will examine you (normally very simply) to confirm and will refer you to see a surgeon, ideally one who specialises in hernia. If there is an obvious swelling that disappears when you lie down, it is pretty conclusive that you have an inguinal hernia. You shouldn’t need any special tests.

See also Diagnosis & Treatment.

Types of inguinal hernias

Inguinal Hernia - This is the most common hernia, accounting for around 70% of all hernias. An inguinal hernia occurs in the groin, the small area of the lower abdomen on each side just above the line separating the abdomen and legs.

Bilateral Hernia - A bilateral hernia occurs when hernias are present on both sides of the groin. Essentially, it’s an inguinal hernia that affects the left and right sides simultaneously.

Inguinoscrotal Hernia - An inguinoscrotal hernia is a type of inguinal hernia that extends into the scrotum in men. This can result in a visible swelling in the groin and scrotum and often develops over time if the hernia is left untreated.

Indirect inguinal hernia - Another type that follows the pathway of the inguinal canal and is often related to the natural anatomy of the area.

These distinctions of an inguinal hernia help patients and clinicians understand the location, severity and treatment approach for different inguinal hernias.

Inguinal hernia treatment

Treatment for an inguinal hernia depends on the size of the hernia, the symptoms it causes and your overall health. Some inguinal hernias cause little or no discomfort and may be monitored, while others may require surgical repair.

When is treatment needed?

If an inguinal hernia is small and not causing significant symptoms, your doctor may recommend monitoring it rather than having immediate surgery. However, an inguinal hernia will not usually heal or disappear on its own.

Surgery may be recommended if the hernia is causing pain or discomfort, is becoming larger, is affecting your everyday activities or has become difficult to push back into the abdomen.

An inguinal hernia that becomes trapped or strangulated requires urgent medical attention. This can happen when the blood supply to the trapped tissue is compromised and may cause severe pain, nausea, vomiting or a painful lump that cannot be pushed back in.

Inguinal hernia repair

The main treatment for a symptomatic inguinal hernia is surgical repair. The aim is to return the protruding tissue to the abdomen and strengthen the weakened area of the abdominal wall to reduce the risk of the hernia returning.

There are two main approaches to inguinal hernia repair:

Open inguinal hernia repair: This involves making an incision in the groin to access and repair the hernia. The weakened area is usually reinforced with surgical mesh, although other techniques may be appropriate in certain circumstances.‍
Laparoscopic or keyhole inguinal hernia repair: This involves making several small incisions in the abdomen. A camera and specialist instruments are used to repair the hernia, usually with mesh placed behind the weakened area of the abdominal wall

The most appropriate technique depends on factors including the type and location of the hernia, whether it has been repaired before, whether one or both sides are affected and your individual circumstances.

What happens after inguinal hernia surgery?

Most people can return home on the day of surgery and gradually resume normal activities as they recover. Some discomfort, bruising and swelling around the groin can be expected initially.

Your surgeon will advise you when it is appropriate to return to work, exercise, lifting and other activities. Recovery varies between individuals and can also depend on the type of repair performed.

Testicular involvement

In rare cases, an inguinal hernia or its repair can affect the blood supply to the testicle, potentially causing testicular atrophy. This is uncommon but can be a more significant risk when surgery is required for a recurrent inguinal hernia, where scar tissue can make the blood vessels and surrounding structures more difficult to identify.

When is an inguinal hernia an emergency?

Seek urgent medical attention if the hernia becomes painful, cannot be pushed back, becomes firm or tender, or is associated with nausea, vomiting, or changes in bowel movements. These may be signs of an incarcerated hernia or strangulated hernia, which require prompt assessment.

Why choose a specilaist hernia centre?

‍The British Hernia Centre is the UK’s only dedicated specialist hernia centre, backed by over 30 years of expertise. With a proven track record, it now performs more hernia and inguinal hernia operations than any other surgical unit in the world. Contact our team today for more information or to book a consultation.

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Frequently Asked Questions

Practical answers to the things patients ask us most.

Can an inguinal hernia cause testicular pain?

Yes, an inguinal hernia can sometimes cause pain, aching or discomfort that extends into the testicle or scrotum. This can occur when the hernia puts pressure on structures passing through the inguinal canal. However, testicular pain can have many causes, so persistent or sudden pain should be assessed by a medical professional.

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Can an inguinal hernia go away by itself?

An inguinal hernia will not usually heal or disappear by itself. The weakness in the abdominal wall remains, meaning the hernia may stay the same size or gradually become larger. If it is not causing significant symptoms, your doctor may recommend monitoring it. If it becomes painful, larger or difficult to push back in, surgical repair may be recommended.

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How long does inguinal hernia surgery take?

Inguinal hernia repair is usually a relatively short operation, although the exact time depends on the type and complexity of the repair. Many straightforward repairs take around 30 to 90 minutes. The procedure may take longer if the hernia is particularly large, complex or has returned following previous surgery. Your surgeon can provide a more accurate estimate based on your individual circumstances.

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Are hernias hereditary?

No. We all inherit an anatomical weakness as part of the design of the human body and are thus susceptible to hernias.

How can I know if hernia surgery provided at my local hospital really is the same as at The British Hernia Centre?

The easiest way to compare is to start with these simple questions. For example,

How many tens of thousands of hernia cases has your surgeon and his team performed? (Always ask that question) Is it done routinely under just local anaesthesia? Will you need overnight hospital admission at all? Will you be able to return to work and normal activities in the same amount of time? Are the risks of recurrence anything like the same? Do they have a 100% safety record and ZERO MRSA?