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Inguinal Hernia – Symptoms, Causes, Diagnosis, Treatment

The inguinal canal is a short passage that is about four to six centimeters in length located just above the inguinal ligament and extends medially and inferiorly through the inferior part of the abdominal wall. Structures pass from the abdominal wall to the external genitalia through this canal. In men, the spermatic cord passes to the testis through the inguinal canal. In women, the ligament that supports the uterus is present in the inguinal canal.

Inguinal hernia is a condition that occurs when abdominal tissues, such as part of the intestine, protrudes through a weak spot of the inguinal canal. Inguinal hernia can occur in both men and women. The resultant bulge caused by the inguinal hernia can lead to pain and discomfort during movement especially when you cough, bend, or lift a heavy object.

Inguinal Hernia - Occurs when abdominal tissues, such as part of the intestine, protrudes through a weak spot into the inguinal canal.

Picture showing intestine protruding into the inguinal canal

The inguinal hernia can be classified into following:\

Indirect inguinal hernia: commonly found hernia in new born babies. The hernia will be formed lateral to the blood vessels when the inguinal canal is not fully developed.
Direct inguinal hernia: Direct inguinal hernia is found in adults in the middle from the blood vessels.
Incarcenated hernia: When the abdominal get stuck in the groin, then the hernia is known as incarcerated hernia.
Strangulated hernia: Strangulated hernia is more severe and stops the blood flow to the small intestine and has to be treated immediately.

Symptoms of inguinal hernia

Inguinal hernia symptoms include:

Bulge : A bulge in the groin area on either side of the pubic bone. This can be more obvious couging or straining.
Burning Sensation : Burning or aching sensation at the bulge
Groin Pain and Discomfort : Pain or discomfort in the groin especially when bending over, straining, coughing or lifting
Dragging Sensation : Heavy, dragging sensation at the groin
Groin Weakness : Groin weakness or pressure
Pain and swelling : Protruding intestine that descends into the scrotum causes occasional pain and swelling around the testicles.

Incarcerated Hernia

A hernia can become incarcerated. This happens if the hernia becomes trapped in the abdominal wall. This can lead to bowel obstruction that leads to severe pain, inability to have bowel movement, nausea, vomiting.

Strangulated Hernia

Strangulated hernia occurs when the incarcerated hernia becomes strangulated and blood flow to the tissue that is trapped is cut. Unless treated, a strangulated hernia can be life threatening and is a surgical emergency.

Symptoms of an incarcerated or strangulated hernia include:

Nausea and vomiting.
Fever
Sudden Pain and tenderness that quickly intensifies
Bulge that turns red, purple or dark
Inability to move the bowels or pass gas

Causes of inguinal hernia

Some of the factors that lead to inguinal hernia are discussed below:

Increased pressure within the abdomen
Weak tissues and muscles in the abdominal wall
Straining during bowel movements
Strenuous activity
Pregnancy
Chronic coughing or sneezing

Treatment for inguinal hernia

Laparoscopic hernia surgery can be performed that is minimally invasive with less pain and discomfort. The surgeon initiates the surgery by administering a dose of general anesthetic to relax the muscles and to put the patient in sleep like state. The surgeon makes a small incision in the abdomen and is inflated with air to get a clear view of the internal abdominal cavity. A laparoscope (a thin long tube with a camera attached to its end) is inserted through the incision that allows the surgeon to view enlarged images of the organs and abdominal cavity that is connected through the monitor. After inspection, more incisions are made and other surgical repairing tools are inserted through the incisions into the abdominal cavity. A mesh is positioned in the weak spot of the inguinal canal to reinforce the abdominal wall. Later the incision are stitched and closed.

Laparoscopic Inguinal Hernia Repair - Inguinal hernia is a condition that occurs when abdominal tissues, such as part of the intestine, protrudes through a weak spot of the inguinal canal. Laparoscopic Inguinal Hernia Surgery is performed through keyhole incisions, and the advantages are less pain, faster healing, reduced hospital stay, less chance of infection, minimal scars, negligible blood loss.

Laparoscopic hernia surgery can be categorized into two techniques:

Transabdominal preperitoneal (TAPP) – In TAPP hernia surgery, a small flap of the lining is peeled back from the hernia and a mesh is placed that acts as a support to the abdominal wall. This mesh acts as a barrier and prevents further thrusting of the abdominal tissues into the inguinal canal.
Totally extraperitoneal (TEP) – TEP technique involves refurbishing the hernia without inward bounding of the peritoneal cavity.

Other Types of Hernias

Other types of Hernias include:

Hiatal hernia
Ventral Hernia
Obturator Hernia
Femoral Hernia
Umbilical hernia
Incisional hernia

Hiatal Hernia

Hiatus hernia develops when the upper part of the stomach bulges through an opening in the diaphragm. The stomach pushes through the opening in the diaphragm and bulges into the chest.

Ventral Hernia

Ventral Hernia can occur in any location of the abdominal wall as a bulge of abdominal tissues through a weak opening in the abdominal wall muscles. When the intestinal tissue gets caught up in the bulge and cannot be pushed back it is called Stangulaged Ventral Hernia.

Obturator Hernia

Obturator Hernia is a very rare type of hernia that occurs through an opening in the pelvis. The intestine bulges through the obturator foramen.

Femoral Hernia

Femoral hernia occurs in the groin junction when the tissues in the lower abdomen push through the upper thigh region.

Umbilical Hernia

Umbilical hernia occurs at the belly button (umbilicus). A loop of intestine pushes through the umbilical ring. in the groin junction when the tissues in the lower abdomen push through the upper thigh region.

Incisional Hernia

Incisional hernia occurs at the location of a previous surgical incision.

Video Talk in Malayalam

View animation – Inguinal Hernia meaning in Malayalam

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Dr. R. Padmakumar is one of the Best Hernia Surgeon in India. He has been changing lives through Keyhole Surgery. He has got more than 30 years of hands-on experience in laparoscopic Surgery in major hospitals across India and has completed more than 7000 cases of Laparoscopic Hernia Surgeries. Dr. Padmakumar has trained more than 300 surgeons from all over the world the art of laparoscopic surgery especially Laparoscopic Hernia Surgery. Dr. Padmakumar is also hailed as one of the Best Bariatric Surgeon in India & UAE. He is renowned for new and improved treatment techniques and the first in the World to perform Scarless Bariatric Surgery with Tummy Tuck / Abdominoplasty. He is also one of the very few thyroid surgeons in India doing Endoscopic Thyroidectomy (scarless thyroid surgery).