The inguinal hernia is a common cause of medical consultation, especially in males. An inguinal hernia manifests as an increase in volume in the form of a lump, most of the time painful, in the inguinal region. Sometimes it is usually very annoying, and can even prevent the performance of daily tasks. That is why in this article we will explain what its symptoms and causes are.

The inguinal hernia is the most common hernia in the abdomen compared to the femoral or umbilical hernias and may appear unilaterally or bilaterally. It is estimated that less than 20% of patients with inguinal hernias have bilateral hernias.

What is an inguinal hernia?

Hernias are nothing more than the exit, transitory or permanent, of the abdominal content (intestine and peritoneum) through natural or anatomical orifices in the abdomen. Specifically, in the inguinal region, the inguinal rings are found, which are holes that allow the entry and exit of structures through the inguinal canal.

In men, within the inguinal canal the spermatic cords that exit towards the testicles through the superficial inguinal ring are housed and in the case of women, it houses the round ligament of the uterus that exits through the superficial inguinal ring towards the labia majora of The vulva. In both cases, the intestine can press and enter the inguinal ducts, emerging through the inguinal rings forming a hernia.

When an inguinal hernia occurs , the abdominal contents (intestine and peritoneum) enter the inguinal canal and can be palpated through the superficial and deep inguinal rings. As an inguinal hernia grows, it is painful and can be a medical emergency if its contents become stuck or stuck in the inguinal ring.

What are the symptoms of an inguinal hernia?

The main symptoms of an inguinal hernia are pain and the sensation of a bulge or protrusion over the inguinal fold. As the hernia grows and becomes more painful, it can be accompanied by other symptoms such as nausea and vomiting.

These symptoms are often aggravated when the person performs maneuvers that increase pressure on the abdomen or groin, such as coughing and lifting heavy weights.

When the hernia grows larger and becomes stagnant in the superficial inguinal ring, it may show changes in color, turning purplish, because there is not enough blood supply to the content of the hernia. This is a surgical emergency and you should see a doctor quickly.

Why do inguinal hernias occur?

Normally, the canal and the inguinal ring are covered with a fascia that protects them and that generates some degree of support to their contents. When there are conditions that weaken the fascia that lines the inguinal wall, then there is a greater chance of developing an inguinal hernia.

The inguinal hernias occur congenital or acquired defects. Among the congenital causes (the individual is born with a condition) that cause the wall of the inguinal canal to be weakened, it is seen for example in collagen diseases or in individuals with parents or uncles who have already had inguinal hernias.

While there are acquired causes, which are conditions that generate an increase in pressure within the abdomen that displaces, in turn, its content towards the natural orifices causing hernias.

This is seen in patients with chronic cough, constant straining in situations such as constipation or rectal prolapse , heavy load workers, overweight people, prostate problems that condition urination, athletes who lift weights, patients with a history of surgery to correct hernias and critorquidea (disorder of descent of the testicle through the inguinal canal).

How are inguinal hernias treated?

Treatment will depend on your symptoms and your doctor’s evaluation. In some cases, if the hernia is small, does not cause discomfort and the risk of complications is low, the doctor may maintain a watchful eye, suggesting that the patient not do activities that increase the size of the hernia.

On the other hand, when the hernia is large and not reducible (that is, when the contents of the hernia cannot return to the abdominal cavity), then the doctor plans a surgery called “hernioplasty” (if it is done with synthetic materials such as mesh ) or “herniorrhaphy” (if performed with the patient’s own tissues, without the use of mesh), which consists of reintroducing the content of the hernia into the abdominal cavity and repairing the defect of the inguinal fold. This is usually a low-risk, outpatient surgery.

In certain cases, the inguinal hernia can become a surgical emergency, when its contents become clogged and no blood flow is perceived, which must be operated on in an emergency to avoid an intestinal perforation. It is important that if you present these symptoms you do not self-medicate and consult your doctor to define the most appropriate treatment for each case.

By Dr. Eric Jackson

Dr. Eric Jackson provides primary Internal Medicine care for men and women and treats patients with bone and mineral diseases, diabetes, heart conditions, and other chronic illnesses.He is a Washington University Bone Health Program physician and is a certified Bone Densitometrist. Dr. Avery is consistently recognized in "The Best Doctors in America" list.

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