Inguinal Hernia

What is an inguinal hernia?

The inguinal canal is a short tunnel through the lower belly wall just above the crease of the groin. In men it carries the spermatic cord to the testicle; in women it carries a ligament that supports the uterus. Because it is a natural gap, it is a weak point. When pressure inside the abdomen rises, fat or bowel can push into it, forming a hernia.

Direct vs indirect inguinal hernia

Surgeons usually confirm the type during the operation, and treatment is similar for both. A femoral hernia sits just below the groin crease, is more common in women, and traps more often. Read more about femoral hernia and the broader family of hernia types.

Inguinal hernia symptoms

• A bulge on one or both sides of the pubic bone that is more obvious when standing, coughing, straining or lifting
• A lump that disappears or can be pushed back when you lie down
• Aching, heaviness or dragging in the groin, worse at the end of the day or after activity
• Burning or pinching from pressure on nearby nerves
• In men, swelling in the scrotum as the hernia extends down
• Many hernias cause no pain at all

Inguinal hernia in women

Women develop inguinal hernias less often, and they are frequently small and hard to feel. Symptoms may be vague groin pain or pelvic aching rather than an obvious lump. Ultrasound or MRI is often used to confirm the diagnosis, and guidelines recommend repair for women because a femoral hernia can be mistaken for an inguinal one.

Inguinal hernia in babies and children

Indirect hernias occur in a few percent of babies, much more often in boys and premature infants. You may see a bulge in the groin or scrotum during crying that goes away when the baby is calm. Children's hernias have a higher risk of trapping, so they are repaired soon after diagnosis rather than watched.

Causes and risk factors

• Being male: men are about 8 to 10 times more likely to develop one
• Age: muscles weaken over time
• Family history of inguinal hernia
• Previous hernia on the other side
• Chronic cough (smoking, COPD) or chronic straining from constipation or an enlarged prostate
• Heavy lifting at work, although it is more of a trigger than a sole cause
• Premature birth and low birth weight
• Collagen disorders and smoking, which weaken connective tissue
• Low body weight (counterintuitively, obesity is associated with fewer groin hernias)

Complications

• Incarceration: the contents become stuck and cannot be pushed back. This is not always immediately dangerous but needs urgent surgical assessment.
• Strangulation: the trapped contents lose their blood supply, causing severe pain, vomiting, redness over the lump and fever. This is a surgical emergency within hours, because the bowel can die.
• Bowel obstruction: trapped bowel blocks the passage of food, causing vomiting and a swollen belly.

The risk of strangulation in an adult man with a painless hernia is low, which is why watchful waiting is reasonable for some.

How an inguinal hernia is diagnosed

Most are diagnosed by examination. The doctor looks and feels for a bulge while you stand and cough, and may gently push the contents back. If the hernia cannot be felt but symptoms suggest one, or the lump might be something else, an ultrasound is the first test; MRI or CT is used in unclear cases.

Other causes of a groin lump include swollen lymph nodes, a hydrocele (fluid around the testicle), a varicocele, a lipoma, an undescended testicle and an aneurysm of the femoral artery. See our guide to a groin lump for more.

Treatment

Watchful waiting

For men with a small hernia and no or minimal symptoms, waiting is safe in the short term. Many eventually choose surgery because symptoms increase, so this is a timing decision rather than an alternative. Trusses (supportive belts) are not recommended as a long-term treatment.

Surgery

Repair pushes the contents back and reinforces the wall, usually with a flat sheet of synthetic mesh, which lowers the chance of recurrence compared with stitching alone.

Most repairs are same-day surgery. Children usually have a simple repair that closes the open sac, without mesh.

Recovery after inguinal hernia surgery

• Walking the same day, and short walks several times daily after that
• Pain relief with acetaminophen (paracetamol) and an NSAID at the label dose, unless told otherwise
• Desk work after about 1 to 2 weeks; driving once you can brake hard without pain
• Most people return to normal activity, including lifting, within 2 to 6 weeks, guided by comfort. Strict long lifting bans are no longer considered necessary
• Bruising of the groin and scrotum is common and settles within 2 weeks

Risks of surgery

• Recurrence (low, usually a few percent with mesh)
• Chronic groin pain lasting more than 3 months in a minority, usually mild
• Infection, bleeding, or a collection of fluid (seroma)
• Difficulty passing urine for a short time after surgery
• Rarely, injury to the testicle's blood supply or the vas deferens

Prevention

Hernias present from birth cannot be prevented. Reducing strain can lower the risk of acquired hernias: stop smoking to reduce coughing, treat constipation with fiber and fluids, see a doctor about straining to urinate, and lift with your legs while keeping your core engaged.

Frequently asked questions

What does an inguinal hernia feel like?

It often feels like a soft lump in the groin with a dull ache, heaviness or dragging sensation, worse after standing, lifting or coughing and better when lying down. Some people feel burning or pinching. Many hernias cause no pain and are noticed only as a bulge.

Can an inguinal hernia go away on its own?

No. The weak spot in the abdominal wall does not close by itself in adults, and most hernias slowly enlarge. Small, painless ones may be watched safely for a time, but surgery is the only way to fix the defect. In babies, hernias are repaired soon after diagnosis.

When is an inguinal hernia an emergency?

It is an emergency if the bulge becomes hard, tender or discolored and cannot be pushed back, or if you have severe pain, vomiting, a swollen belly or cannot pass gas. These suggest strangulation, where the blood supply to trapped bowel is cut off. Go to the ER immediately.

How long is recovery from inguinal hernia surgery?

Most people walk the same day, return to desk work within 1 to 2 weeks and resume full activity, including sport and heavy lifting, within about 2 to 6 weeks. Laparoscopic repair may allow a slightly quicker return. Let pain guide how fast you increase activity.

Can exercise cause an inguinal hernia?

Exercise does not usually cause a hernia in a healthy abdominal wall, but straining and heavy lifting can push tissue through a weak spot that is already there. If you have a known hernia, you can usually keep exercising; stop activities that cause pain or make the bulge larger, and talk to your doctor.

Is a sports hernia the same as an inguinal hernia?

No. A sports hernia, or athletic pubalgia, is a strain or tear of the muscles and tendons around the groin, with no actual bulge. It causes groin pain with twisting, sprinting and kicking. An inguinal hernia is a true hole with tissue bulging through it.