Inguinal hernia is the most common type of hernia and accounts for 70% of all hernias occurrences, whilst being one of the most common procedures in general surgery. It can be found in the groin area, located at the pubic bone between the lower abdomen and the leg. Inguinal hernias occur through the inguinal canal, an area where the testicle comes through on its way to the scrotum during the development of males.
An inguinal hernia will occur through weakening of abdominal muscles around the inguinal canal allowing the pressure of internal organs to create a swelling or lump in the groin. The inguinal canal is a passageway between the abdomen and the genitals that is much larger in men than women. As a result this condition is far more common in males.
You will see or feel a lump or swelling under the skin that may be uncomfortable, painful and sensitive to the touch. The swelling will often disappear completely when you lie down, as the ‘contents’ of the hernia sac slip back through the hole into the abdomen. Sometimes there is hardly any swelling to see, but you may be conscious of a strange feeling in the groin when you are standing or walking for any period of time.
Pain from coughing, during physical activity Burning sensations Feelings of heaviness or full sensation in the groin Swelling of the scrotum (men)
Generally hernias are painless but occasionally patients may feel slight discomfort when bending, lifting or standing for long periods of time. There is a very high chance you have an inguinal hernia if there is a bulge or swelling under the skin at the groin that disappears when the patient lies down and the pressure is taken away from the weak area of the abdomen. It is important to see your GP to confirm the diagnosis even if the hernia causes no pain. Your GP will then refer you to a specialist hernia surgeon.
It is preferable to be examined standing rather than lying. If there is an obvious swelling that
disappears when you lie down, it is very likely to be an inguinal hernia and no further or more
specialists tests should be required.
More specialist tests or x-rays are available but are not usually needed. Situations where they might be used are as below.
There is pain or discomfort in the groin with no obvious swelling The swelling is not reducible and does not go back when you lie down
Surgery is the recommended option and the repair method will vary based on each individual case. We offer the latest techniques that ensure you a quick recovery and the highest quality of repair. Repair methods that are available are listed below.
Open mesh or tension free mesh is an advanced technique with successful results. It involves positioning a piece of fine mesh at the opening and allowing the body to heal naturally around it for a successful and enduring repair carried out in minutes under General or Local anaesthetic.
This process involves four small incisions made through the abdominal wall through which a small thin telescope and surgical instruments are positioned to examine and deal with the hernia internally. This minimally invasive technique uses carbon dioxide gas to inflate the cavity to allow space for the surgeon to work remotely. The hernia hole is located and covered with mesh, which is stapled into place.
Many hernias do not hurt so the temptation is to leave them and get on with life. But failing to get medical advice can be damaging and is not recommended. If left the hernia will grow and discomfort and pain, even if negligible to start with, will intensify
In most cases the cause of femoral hernia are unknown. You may be born with a weakened area
of the femoral canal, or the area may become weak over time.
Straining can contribute to the weakening of the muscle walls which include childbirth, chronic coughing, constipation and obesity.
A femoral hernia will appear as a small swelling, very low down your body, next to the groin or near
the top of your thigh.
Often femoral hernias cause very little pain or other symptoms, so it is important to visit your GP if you suspect you have a hernia.
If left untreated, a femoral hernia could strangulate, where your bowel becomes trapped in the hernia and its blood supply is cut off. If strangulation occurs, the lump will become hard and tender, you will experience severe local and abdominal pain, nausea and vomiting.
The reason so many femoral hernias are discovered as emergencies is probably that the femoral canal, through which the hernia appears, is narrow with most of its entrance is rigid and unyielding.
It is important to see your GP to confirm the diagnosis even if the hernia causes no pain. Your GP will then refer you to a specialist hernia surgeon.
Femoral hernias should be repaired early and not left until they become a problem. The aim of surgery is to close off the femoral canal. Before ‘mesh’ was introduced this was done with stitches – stitching the front and back of the opening together. The problem is that there is not much give here – you are trying to sew two rigid structures to each other.
This is probably still the standard method, certainly in the UK. There is quite a lot of pain and the recurrence rate can be high, but accurate or reliable figures are just not available.
This is our preference to place a soft mesh cone plug in the femoral canal. This sits in the femoral canal where it remains, stopping anything going through. This can be done with General or Local anaesthetic through a short cosmetically placed incision just above the groin crease.
The procedure can also be performed laparoscopically, covering the entrance to the femoral canal with mesh. The success rate is quite good.
Many hernias do not hurt so the temptation is to leave them and get on with life. But failing to get medical advice can be damaging and is not recommended. If left the hernia will grow and discomfort and pain, even if negligible to start with, will intensify.