Inguinal hernia

A hernia is when an internal organ or body tissue pushes through a gap or weakness in a muscle or tissue. This means that the organ is or tissues is pushed into a space where it doesn't normally sit.

An inguinal hernia happens when a part of the intestines pushes through a weak spot in the belly wall into the groin area. An inguinal hernia is one type of hernia that can affect the groin.

An inguinal hernia usually looks like a lump under the skin. It is most common males, especially premature babies.

You may first notice an inguinal hernia as a painless lump in your groin. Some people feel discomfort or a 'dragging' sensation.

The lump may be more noticeable when you cough or strain. It usually disappears when you relax or lie down.

There are two main types of inguinal hernias, each with different causes.

Indirect inguinal hernias — these usually involve a gap in the lower abdominal muscles that has existed from birth. If this gap doesn't close before birth as it should, your bowel may push through the opening. This type of hernia is usually diagnosed at birth or within the first year of life. Sometimes it may be diagnosed later in life.

Indirect inguinal hernias are more common in premature babies.

Direct inguinal hernias — these usually involve a weakening of the abdominal muscles over time. Excessive straining with bowel movements or frequent coughing can increase your chance of developing a direct inguinal hernia.

All children and adults with a hernia should see a doctor, as there may be complications. You should also see a doctor if your or your child's hernia changes.

Seek urgent medical attention if you or your child have an inguinal hernia and develop:

• fever
• pain in the groin
• nausea or vomiting
• feeling bloated or not being able to pass a stool (poo) or gas
• purple, red or pale discolouration of the hernia
• a swelling that does not change in size when your child is crying

To diagnose an inguinal hernia your doctor will ask about your symptoms and perform a physical examination, including an examination of your groin. They may also refer you for an ultrasound of the groin.

If the hernia or can't be pushed back in by your doctor during a physical examination, or it is painful, it may need immediate care.

Inguinal hernias are usually treated with surgery to reduce the chance of complications. For some hernias, your doctor may suggest managing your symptoms without surgery.

Non-surgical treatment

If the hernia isn't causing significant symptoms your doctor may suggest 'watchful waiting.' This means monitoring the hernia and treating symptoms if they develop.

A special belt called a truss can help support the hernia, if you don't want or can't have surgery.

Surgical treatment

Surgery is the most effective treatment for inguinal hernias. There are two main types of surgery:

• Open surgery — the surgeon makes a cut in the groin and pushes the bulging tissue back into place. They will use stitches or a piece of mesh to strengthen the area. For more information, see:
  • Inguinal hernia repair (child)
  • Open inguinal hernia repair (female)
  • Open inguinal hernia repair (male)
• Laparoscopic surgery — the surgeon makes small cuts in your abdomen and uses a tiny camera to guide the repair. Mesh is also often used to strengthen the area.

Most people can go home the same day after surgery. Full recovery usually takes a few weeks. You should avoid heavy lifting during this time to minimise the chance of complications.

Surgical treatment is generally effective and has a low risk of complications, but as with any surgery, there are some risks. You should discuss potential risks and likely benefits with your surgeon.

If you have an inguinal hernia, there are ways to manage it at home, especially if it's not causing severe symptoms:

• Avoid straining — try not to lift heavy objects or strain during bowel movements. This can make the hernia worse.
• Wear a truss — a truss is a supportive device that can help keep the hernia in place. It's not a long-term solution but may provide temporary relief.
• Maintain a healthy lifestyle — maintaining a healthy weight can help manage symptoms. Gentle exercise, such as walking, can also be helpful.
• Monitor symptoms — watch for any changes in your hernia. If you notice your symptoms become severe, contact your doctor immediately.

The main complication of an inguinal hernia is if it becomes strangulated. This is when the bowel loop in the hernia gets stuck outside the muscle wall, cutting off its blood supply. This is a medical emergency.

Inguinal hernias present from birth are not preventable. Adults are less likely to develop an inguinal hernia if they maintain a healthy weight and don't smoke.

If you have an inguinal hernia, you can reduce the chance of symptoms by quitting smoking and managing constipation, such as with a high fibre diet.

Visit The Royal Children's Hospital Melbourne website for more information on inguinal hernias in children.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available 24 hours a day, 7 days a week.