Everything You Need to Know About Inguinal Hernia

What is an inguinal hernia?

A hernia is the protrusion of an organ from its original body cavity, through a naturally occurring orifice or anatomical canal in the body. The cavities affected by the hernia are mainly three:

• Cerebral;
• Thoracic;
• Abdominal.

Any organ or tissue that escapes from these cavities is called a hernia. Regarding the dislocation of viscera, hernias can be:

• Internal hernias: when the displacement of the viscera occurs inside the body and tends not to be visible from the outside;
• External hernias: When internal organs move towards the skin and become visible from the outside by infiltrating between the structures of the wall, particularly the abdominal wall.

Inguinal hernia is undoubtedly the most common type of hernia. It is caused by a small part of the intestine escaping from its natural position. Generally, this occurs at the level of the inguinal canal, a passage present in both sexes, men and women. It manifests as a more or less significant swelling that occupies the inner part of the groin. It can also occur in the first months of life and is statistically more frequent in men.

How does an inguinal hernia form?

Acquired inguinal hernia

The inguinal hernia makes its way into the inguinal region, a triangular area delimited

• Inferiorly by a line identified with the inguinal ligament;
• Medially by the lateral margin of the rectus abdominis muscle;
• By a third ideal line joining the anterior superior iliac spine to the edge of the rectus muscle;

This area is crossed by the inguinal canal, composed of an internal orifice, the canal itself, and an external orifice, which is crossed in men by the spermatic cord and in women by the round ligament of the uterus. The hernia in its course follows the inguinal canal, first engaging its internal orifice, then gradually the rest until it protrudes from the external orifice. As it progresses, it comes into contact with the spermatic cord, infiltrating the elements that compose it and with which it forms loose adhesions. Once past the external orifice, the hernial sac occupies the scrotal sac in men, and the region of the labia majora in women.

Congenital inguinal hernia

A particular form of inguinal hernia is the congenital hernia. It generally occurs in early childhood, but can also occur later, with a different pathogenesis. Indeed, in these hernias, the sac does not form progressively with the mechanism already described concerning adult pathology, but it is already present at birth due to the absence of obliteration of the peritoneo-vaginal canal. The latter is a duct, present in the fetal stage, which serves for the migration of the testicle from its original position near the kidney downwards, into the scrotum, and which, generally, at birth, is closed.

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Causes of inguinal hernia

The causes of inguinal hernia are generally found in a congenital anomaly, therefore present from birth, or are linked to a natural weakening of the muscle groups typical of aging or due to physical exertion, during evacuation or micturition, or even to sports or lifting heavy loads.

Here are some risk factors for inguinal hernia:

• Pregnancy;
• Obesity;
• Violent coughs;
• Excessive exertion;
• Advanced age;
• Sports;

How to recognize an inguinal hernia?

Symptoms of inguinal hernia

The most frequent symptoms of inguinal hernia are:

• Groin pain;
• Burning and sensation of weight or foreign body;
• Pain extending to the testicles, scrotum and leg;
• Difficulty standing;
• Swelling extending to the scrotum;
• Difficulty digesting;
• Stomach aches;

Discomfort and pain may increase with fatigue, exercise, long walks, prolonged standing, or intense abdominal effort (coughing, sneezing, evacuation). The pain may radiate to the leg.

Diagnosis of inguinal hernia

The diagnosis of inguinal hernia is easy when it is clearly apparent, but more difficult when it is still in the early stages. In theory, it may be impossible to diagnose it clinically in the early stages. However, even if it is not visible, a specific maneuver can reveal the hernia in the early stages. This maneuver consists of introducing the index finger into the patient's scrotum in contact with the external inguinal orifice, performed by the examiner. The patient is then asked to make an effort, a cough. This results in an increase in endo-abdominal pressure which pushes the viscera towards the hernial port and therefore towards the inguinal canal. The hernia crosses it and, even if only for a moment, protrudes from the external orifice by coming into contact with the tip of the examiner's finger. In scrotal forms, differential diagnosis with certain pathologies affecting the testicle is necessary: varicocele, hydrocele and tumors.

When should an inguinal hernia be operated on?

Each case must obviously be assessed individually, but it is considered appropriate to operate on an inguinal hernia when:

• It is symptomatic (it mainly causes pain);
• The symptoms it causes become incompatible with a normal social and sexual life;
• It presents a high risk of complications;
• It has reached a significant size;
• It continues to increase in volume;
• The skin becomes reddish;

Complications of inguinal hernia

Inguinal hernia, if not treated properly, can lead to complications. Hematoma is relatively frequent. Rarity can sometimes be problematic when it manifests as ischemia and testicular atrophy, caused by lesions of the funicular spermatic artery and poor blood circulation that can lead to infertility or sterility. The most serious complications occur when there is an incarcerated or strangulated hernia, where part of the viscus is trapped between the ligaments and muscles, causing interruption of blood circulation and tissue death. Emergency surgery is necessary in such cases.

In general, when a complication occurs, the patient tends to feel very sharp pain in the hernia area.

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