Inguinal Hernia

The development of a hernia in the inguinal area (“inguinal hernia”) is common, especially among males. A hernia comes as a result of abnormal relaxation of a certain area of the abdominal wall. The internal abdominal organs then push against this vulnerable point and they exert higher pressure on this already weakened spot, causing even further relaxation. When a patient develops an inguinal hernia at a young age (younger than 30 years-old), there is a high chance (30-40%) of developing another such hernia on the other side.

The first symptoms are few and scarce and may go unnoticed. Usually patients complain of a “burning sensation”, or a feeling of “fullness” in the groin, or some pain radiating towards the testicle, or the inner surface of the thigh. As the muscle relaxation progresses, there may be groin pain, especially with strenuous physical activity, and later a “bulging” develops in the groin when the patient is standing up and disappears when lying down. At this particular stage, the hernia is associated with potential complications because the opening in the muscle wall (abdominal wall defect) has now become large enough to accommodate parts of the intra-abdominal organs. These may protrude through the defect (actually this is precisely what the bulging is) and in the unfortunate case where they do not go back in, there is “strangulation” of these particular protruding intra-abdominal parts. This is a true surgical emergency.

This is why an inguinal hernia should be fixed electively, before it has time to produce all these dangerous complications. A very common misunderstanding is that the initial muscle relaxation of the abdominal wall may be “fixed” by strenuous abdominal muscle exercise, so the progression to a hernia can be stopped. The absolute opposite actually happens because with abdominal muscle exercise the intra-abdominal pressure increases very significantly and pushes against the already weakened spot even harder. This process actually expedites the worsening of a groin hernia and this is the reason that patients should avoid heavy exercise before they have their hernia fixed. The treatment of choice nowadays is the laparoscopic repair.