What is Hernia?

Hernia

What is a hernia?

An inguinal hernia is a bulge you can see or feel in your groin. The bulge is made up of fat and bowel that has slipped through a weak spot in the muscles in your abdomen and down into your groin. The word "inguinal" means "groin."

A hernia can be uncomfortable and feel tender, especially when you bend and lift. It may make it difficult for you to do normal activities, like shopping or having sex.

Some people can push their hernia back in, but it's likely to come out again. Surgery is the only way to repair a hernia.

Key points for people with a hernia

About 9 in 10 hernias happen in men.
An operation is the only treatment for a hernia. It can get rid of the bulge and prevent a blocked bowel.
Surgeons can operate by opening up your groin (open surgery) or by making small cuts in your groin and using a camera to see inside (keyhole surgery).
You may recover faster and get less pain and numbness in your groin with keyhole surgery than with open surgery. But not all surgeons are trained to do keyhole operations.
If you don't have surgery, your hernia may get bigger and more difficult to repair. The bowel that has slipped out of your abdomen can get trapped and lose its blood supply. This is called a strangulated hernia. It can be life-threatening.

Your abdomen

To understand how a hernia happens, it helps to know more about your lower abdomen and groin.

You're more likely to get a hernia if you're an older man.

The organs in your abdomen, such as your bowel, are covered by a film of tissue. This film is called the peritoneum.
The organs are held in place by layers of muscle. These muscles are called the abdominal wall. They run from below your ribs into your groin.
Doctors call the groin area the inguinal area.

You are born with a natural opening between the layers of abdominal muscles near your groin. This is called the inguinal canal. It's about one-and-a-half inches long, but is usually bigger in men than women.

In boys, the testicles drop through this opening into the scrotum by the time they're born or just after. The tube (vas deferens) that carries sperm from the testicles to the penis runs through the inguinal canal.
The inguinal canal usually closes just after you're born or before you're 2 years old.

What happens if you have a hernia?

Usually, the muscles in your abdomen are tight enough to keep your bowel and other organs in place. But some people have weak points in these muscles.

A hernia happens when a bit of fat and bowel slips through a weak point in the muscle and down into your groin. When the fat and bowel slip through the weak spot, a layer of the peritoneum falls with it. The hernia is like a pouch with fat, folds of peritoneum and bowel in the middle of it. Doctors call this pouch the hernia sac. The hernia shows as a bulge or swelling in your groin.

Sometimes parts of other organs, such as your bladder, can slip into the hernia.

Weak spots happen in two ways. They cause two different kinds of hernia.

Source:
Kingsnorth A, Le Blanc K.
Management of abdominal hernias.
3rd edition. Arnold, London, UK; 2003.

Source:
Abrahamson J.
Etiology and pathophysiology of primary and recurrent groin hernia formation.
Surgical Clinics of North America. 1998; 78: 953-972.

You're born with a weakness in the muscles in your abdomen. This can happen if the gap in the muscles (the inguinal canal) hasn't closed as it should. If this gap stays open, part of your bowel can fall through it and bulge in your groin.

Source:
Scott DJ, Jones DB.
Hernias and abdominal wall defects.
In: Norton JA, Barie PS, Bollinger RR, et al (editors). Surgery: basic science and clinical evidence. Springer, New York, U.S.A.; 2000.

³ Hernias that happen this way are called indirect hernias. This is the most common type of hernia.

Source:
Harford W, Jeyarajah R.
Abdominal hernias and their complications including gastric volvulus.
In: Feldman M, Friedman L, Sleisenger L, et al. Gastrointestinal and liver disease: patholophysiology/diagnosis/management. 7th edition. Saunders, St Louis, U.S.A.; 2002.

⁴ Nearly all hernias in babies, children and young adults are indirect hernias.

Source:
Deveney KE.
Hernias and other lesions of the abdominal wall.
In: Way LW, Doherty GM (editors). Current surgical diagnosis and treatment. McGraw-Hill, New York, U.S.A.; 2003.

⁵
You strain your stomach. If you cough a lot or strain when you go to the bathroom, you can damage the muscles in your abdomen. Heavy lifting can also damage the muscles. The muscles get weak or even tear, and can't keep the bowel in place. Hernias that happen this way are called direct hernias.

In men, the hernia can move into the scrotum. This is called a complete hernia.

Source:
Deveney KE.
Hernias and other lesions of the abdominal wall.
In: Way LW, Doherty GM (editors). Current surgical diagnosis and treatment. McGraw-Hill, New York, U.S.A.; 2003.

⁵ The scrotum can get very large if the hernia isn't repaired.

You may be able to push your hernia back into your abdomen, or it may go back by itself. Doctors call this a reducible hernia.

Why me?

Anyone can get a hernia. But there are some things that make it more likely. These are called risk factors. Some of these you can control, others you can't. But having a risk factor doesn't mean you'll definitely get a hernia.

You may be more likely to get a hernia if:

You're male
You're older
You strain your abdominal muscles when you go to the bathroom. People who get constipated a lot are at risk. So are men with an enlarged prostate who have to strain to urinate
You have an ongoing heavy cough. This can put pressure on the muscles in your abdomen. People who have chronic obstructive pulmonary disease (COPD) tend to cough a lot and have a risk of a hernia
You do a lot of heavy lifting

Source:
Flich J, Alfonso JL, Delgado F, et al.
Inguinal hernia and certain risk factors.
European Journal of Epidemiology. 1992; 8: 277-282.

⁶
You are very overweight.

Source:
National Institute of Diabetes and Digestive and Kidney Diseases.
Inguinal hernia.
January 2002. Available at http://digestive.niddk.nih.gov/ddiseases/pubs/inguinalhernia (accessed on 29 May 2008).

⁷ If you carry a lot of fat around your abdomen, this can strain the muscles. They may weaken or tear
Other people in your family have had a hernia
You're pregnant.

Source:
National Institute of Diabetes and Digestive and Kidney Diseases.
Inguinal hernia.
January 2002. Available at http://digestive.niddk.nih.gov/ddiseases/pubs/inguinalhernia (accessed on 29 May 2008).

⁷ Being pregnant stretches your abdominal muscles and can cause weak spots
You get a tear the muscles in your abdomen because of an injury or surgery.

Babies (especially boys) who are born early and underweight have a high risk of getting a hernia. It's most likely to happen before they're 2 years old, but they have a higher risk until they're about 8.

Source:
Kitchen WH, Doyle LK, Ford GW.
Inguinal hernia in very low birthweight children: a continuing risk to age 8 years.
Journal of Paediatrics and Child Health. 1991; 27: 300-301.

⁸

Baby boys whose testicles haven't dropped into their scrotum also have a higher risk of a hernia. This is because the opening in their abdominal muscles (inguinal canal) stays open.

Sources for the information on this page:

Kingsnorth A, Le Blanc K.Management of abdominal hernias.3rd edition. Arnold, London, UK; 2003.

Abrahamson J.Etiology and pathophysiology of primary and recurrent groin hernia formation.Surgical Clinics of North America. 1998; 78: 953-972.

Scott DJ, Jones DB.Hernias and abdominal wall defects.In: Norton JA, Barie PS, Bollinger RR, et al (editors). Surgery: basic science and clinical evidence. Springer, New York, U.S.A.; 2000.

Harford W, Jeyarajah R.Abdominal hernias and their complications including gastric volvulus.In: Feldman M, Friedman L, Sleisenger L, et al. Gastrointestinal and liver disease: patholophysiology/diagnosis/management. 7th edition. Saunders, St Louis, U.S.A.; 2002.

Deveney KE.Hernias and other lesions of the abdominal wall.In: Way LW, Doherty GM (editors). Current surgical diagnosis and treatment. McGraw-Hill, New York, U.S.A.; 2003.

Flich J, Alfonso JL, Delgado F, et al.Inguinal hernia and certain risk factors.European Journal of Epidemiology. 1992; 8: 277-282.

National Institute of Diabetes and Digestive and Kidney Diseases.Inguinal hernia.January 2002. Available at http://digestive.niddk.nih.gov/ddiseases/pubs/inguinalhernia (accessed on 29 May 2008).

Kitchen WH, Doyle LK, Ford GW.Inguinal hernia in very low birthweight children: a continuing risk to age 8 years.Journal of Paediatrics and Child Health. 1991; 27: 300-301.

This information was last updated on Jan 09, 2009

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