Inguinal Hernia

An inguinal hernia is a condition where contents from inside the abdomen protrude through the weak spot of the lower abdominal wall on either side near the groin. The inguinal canal is a passageway that houses the blood vessels and nerves at the lower abdomen; in men connecting the inside of the pelvis to the testicles in the scrotum. In women it contains some nerves and a ligament only. It follows then that men are more prone to inguinal hernia than women. An inguinal hernia can result in a bulge and pain especially when heavy lifting, straining, bending, or coughing.

Types of Inguinal Hernia

Indirect Inguinal Hernia

Indirect inguinal hernias occur in the groin of the lower abdomen. A baby may have this type of hernia when the inguinal canal openings continue to remain open even after birth. This is congenital and occurs predominantly in infants. This however is much more common in older people, where some omental fat or intestines go into the canal and can come down into the canal and can even go as far as the scrotum.

Direct Inguinal Hernia

Direct inguinal hernias occur when the tissue bulges out through the week area in the lower abdomen wall, behind and above the inguinal canal. This occurs usually in later stages of life.

Incarcerated Inguinal Hernia

The hernia that becomes stuck in the groin and cannot be pushed back into the abdomen is called an incarcerated inguinal hernia. In this hernia, the tissue cannot be moved back to its original location through massages. This not an emergency but can be if there is tenderness, nausea, vomiting or fever.

Strangulated Inguinal Hernia

When the hernia can’t be pushed back through the abdominal wall and is tender, perhaps more painful or with nausea, vomiting or fever this may be a strangulated hernia. It may have compromised blood supply or drainage of blood back to the heart. This hernia requires immediate medical attention as it can life-threatening.

Causes of An Inguinal Hernia

Several factors contribute to inguinal hernia. A common factor that accounts for 70% of inguinal hernias is the weakness in the lower abdominal wall. Other major factors include:

Genetic history - A person with a personal or family history of hernias is more susceptible.
Chronic cough – Chronic cough leads to weakening of the abdominal wall.
Overweight – The increased amounts of fat weaken the tissues themselves but also cause increased pressure from inside the abdomen.
Previous abdominal surgery – A previously performed surgery can result in a hernia due to weakness of the operated or nearby tissue. Operated on tissues are always weaker.
Multiple pregnancies – In the case of women, repeated pregnancies lead to the weakening of abdominal walls.
Repeated straining activities – Involvement in straining activities like heavy lifting or walking for a long time daily.
Chronic constipation.
Smoking is a contributor to inguinal hernia, as it weakens tissues and limits wound healing when tissues are under strain.
Premature birth – Infants, especially those born prematurely are at higher risk of inguinal hernia.
Post-surgery swelling leading to accumulation of blood known as a hematoma or accumulation of fluid, a seroma. This can weaken tissues making a hernia much later more likely.

Symptoms of An Inguinal Hernia

People with the following signs and symptoms should consult a hernia specialist:

A bulge on either side of the groin which may not be visible on lying down
Sharp pain at the groin area while straining, coughing, and lifting associated with a bulge when standing
Burning and heavy pulling sensation in the groin
Difficulty to pass gas
Abnormal swelling of the scrotum in men
Uneasiness and discomfort in the groin
Nausea and vomiting or both with intense groin pain in case of strangulated hernia. Obtain immediate medical attention at hospital.

Risk Factors and Associated Complications

When an inguinal hernia is not treated at the right time, it could lead to the following complications:

Bulging at the groin becomes bigger causing severe pain, making surgery more difficult
Infection at the groin area
Trapped tissues may get strangulated cutting the blood flow to them leading to infection or in some extreme cases death of the tissue which is life-threatening. This condition requires immediate medical attention in hospital.

Diagnosis of Inguinal Hernia

Usually, the physician will conduct a physical examination of the lower abdomen of the patient in a posture when it is visible i.e. when standing or lying down. If the hernia is not easily able to be felt or visible, then the doctor may rarely order tests.

X-ray of the lower abdomen
Computed Tomography of the lower abdomen
Abdominal ultrasound

Prevention of Inguinal Hernia

The genetic factors that contribute to inguinal hernia can’t be overlooked. But, otherwise, the occurrence or the recurrence of hernia can be prevented with conscious effort. Patients are encouraged to:

Have a diet high fiber diet to avoid constipation (and to prevent colon cancer, and hemorrhoids and….)
Quit smoking completely
Maintain an optimal weight
Refrain from straining activities

When to Seek Medical Help

In case of experiencing the following symptoms for more than 3 days, it is wise to seek medical attention.

Groin pain
heaviness at the groin
Bulge in and around the groin or abdomen
tenderness of groin of inguinal hernia

At ANSA hernia clinic, the latest Shouldice, non-mesh hernia techniques are used by the surgeons. Unlike the other places, our hernia clinic is headed by specially trained hernia surgeons who have operated over a thousand hernia cases. Learn more about our Shouldice surgery procedure.

The Shouldice repair - Natural Tissue and Hernia Repair has been refined over several decades and is the gold standard for the prosthesis, plastic free treatment of inguinal hernias. The Shouldice method is exceptionally safe, secure and reliable for hernia repair.

Ansa Health Care adheres to the Shouldice technique of repair. The incision itself depends on your size but is generally only 3-4 inches in length. It is quite comfortable for patients after surgery. We prefer this 'open' technique of surgery as it allows your surgeon the best view of all your tissues at the surgery site. We can see nerves and vessels up close to manage them properly. In the repair of groin hernias, we design a tailored (to you), hand sewn, continuous, meshwork of flexible, permanent, modern suture and is placed, in layers, into the floor of the inguinal canal. The muscles are gently placed without undue tension (pulling) into a flexible, vital, alive and reinforced framework next to each other using the inguinal ligament (forming the groin crease) at its base.

At ANSA we repair hernias of the abdominal wall (not internal hernias) directly with plastic surgery techniques using your own tissues to move them, without tension, into a new position and make the area of weakness, the hernia disappear. No fancy robots, cameras, or mesh; tried, only true natural tissue hernia repair!

ANSA Health Care Track Record

Low complication rates: For the last 1230 tissue hernia repair cases over 2.5 years there has been no recurrences (0%); one case of chronic pain (0.0008%); 2 patients with bleeding complications (1 requiring surgery); 1 possible infection.

ANSA HealthCare Hernia Surgeons

Also, at ANSA healthcare our Ontario hernia clinic is headed by Dr. Ash Maharaj, BSc MB BCh FACS, a fellow of the American College of Surgeons. Dr. Maharaj is an active member of the American College of Colorectal Surgeons/Canadian Association of General Surgeons and the College of Physicians and Surgeons of Ontario.