Hi it’s Dr. Parker and in this post I want to talk about inguinal (otherwise known as groin) hernias. If you are not quite familiar with what a hernia is, click abdominal hernias to see my post on that.
So now that you know what a hernia is, lets talk the inguinal hernia. This is a hernia in the groin region, but to really understand it, I’m gonna have to give you a little anatomy lesson again. In males the testicles get their blood supply (or blood vessels) from inside the abdomen. (Females have the same “canal” but without any important structures in the canal….so I’ll just stick to talking about the male anatomy). That means the blood vessels inside the abdomen branch off from some larger blood vessels and have to travel outside the abdomen somehow to then reach the testicles in the scrotum. The way these blood vessels do this, is they travel through the “inguinal canal”. It’s named that for the inguinal ligament that attaches from your pubic bone to your hip bone in the front. The blood vessels travel right next to the inguinal ligament. They are protected by a couple layers of tissue, which makes sort of a little tunnel they can travel through. This is termed the inguinal canal. (BTW, the spermatic cord ….which carries the sperm from the testicles to the penis, travels in this canal also).
So, just as all tunnels have a starting point, and a finish point, so does the inguinal canal. The canal starts on the inside of your abdomen, and ends right next to the base of the penis. This means there is a potential connection between the inside of the abdomen, and the scrotum. Normally, this canal is very small, just big enough for a few blood vessels, the spermatic cord and some very thin muscle to go through, but in an inguinal hernia, this canal can enlarge.
If the inside starting point of the canal (called the internal inguinal ring) starts to enlarge, it can then let other things besides the blood vessels through the canal. If it internal ring enlarges enough, small bowel, large bowel and in women the ovaries can start to make their way through the canal. The more things that get stuffed into the canal, the larger it gets, and the more things can be stuffed in…..and the cycle continues. The entire length of the canal can enlarge so much that in very severe inguinal hernias, a large portion of the colon can live in the scrotum! Ok, that’s a little bit extreme, but I’ve seen it happen….so it is possible.
So why does this ring and canal enlarge? It can be for many different reasons. But the bottom line is that there is enough pressure built up in the abdomen to enlarge the ring, and then canal. So things like lifting heavy objects (you know where you “bear down” and push with all your might) will increase the pressure in the abdomen, and put pressure on that ring and canal. Once it loosens enough, the abdominal contents will “take the path of least resistance” and try to sneak through that canal again….putting more pressure on the ring…..stretching it out, and more pressure on the canal, stretching it out.
Things that will make someone prone to having hernias in general are: repetitive heavy lifting, smoking, steroid use (like prednisone), obesity (increased abdominal pressure). Although these are commonly associated with inguinal hernias, not everyone who has an inguinal hernia has one of these problems. Some people develop a hernia after a one time strenuous activity where they hear a sudden “POP” or “SNAP” sound, and realize they now have a bulge in their groin.
OK, so let’s talk about the treatment. Unfortunately hernias do not “heal on their own”. Once you have a hernia, the only way to fix it is surgery.
Some people ask “well, do I have to fix it if it doesn’t bother me?”. That’s a pretty good question…..so good in fact that nobody has really answered that with any conclusive evidence.
The reason we recommend surgery for the hernia, is that once you have a hernia, you are at an increased risk for a bowel obstruction, and injury to the bowel. That’s the main reason for fixing the hernia. If you’re not sure what I’m talking about, check out my “abdominal hernias” page.
The reason I say nobody has answered the question conclusively yet is because some people NEVER have a problem with their hernia and never get it fixed. Other people may have a hernia for a short time and develop a bowel obstruction and injury to the bowel. Unfortunately there is no good research to guide us on which hernia is safe not to fix. That’s why we recommend fixing all hernias. The risk of a problem with the hernia may be low, but if you do have a bowel obstruction with gangrene of the bowel, it can be life threatening…..so you now see the issue.
There are a few different types of hernia repairs available today. There are the “open” types, and the “laparoscopic” type.
In the open type of hernia repair, the surgeon makes an incision just above the crease in the groin about 5-6 inches long. Then, either the tissues (the ring and canal) are fixed with suture only, or they are re-inforced with a mesh material. Depending surgeon, either of these types can be a good option.
The “laparoscopic” hernia repair is done with smaller incisions and fixes the ring and canal from the inside with a mesh material. The theory is that this provides a better repair of the ring and canal, and patients definitely benefit from less immediate post-operative pain. I prefer to use the laparoscopic technique whenever possible, but some patients will not be best suited for the laparoscopic technique, so you should talk to the surgeon who is doing your hernia repair for guidance on the best operation for you.
Both of these techniques can be done in an outpatient setting. You can have the surgery in the morning and go home in the afternoon. With the open type, you will definitely be pretty sore for a few days, but you should be up and doing your normal “activities of daily living” in about a week or less. You are restricted to lifting anything over about 15lbs for 6 weeks. The same goes for the laparoscopic technique, but you should be fairly comfortable after about 48 hours. Both surgeries do require a good 6 weeks of non-strenous activity so the repair can heal well and you will have a reduced chance of the hernia returning.
I hope that helped to explain a little about inguinal hernias for you. Please leave any questions or comments in the space below!