Inguinal or Groin Hernia - Topic Overview

What is an inguinal hernia?

An inguinal hernia (say "IN-gwuh-nul HER-nee-uh") occurs when tissue pushes through a weak spot in your groin muscle. This causes a bulge in the groin (direct hernia) or scrotum (indirect hernia). The bulge may hurt or burn.  See a picture of an inguinal hernia.

What causes an inguinal hernia?

Most inguinal hernias (indirect type) happen because an opening in the muscle wall does not close as it should before birth. That leaves a weak area in the lower abdominal or belly muscle. Pressure on that area can cause tissue to push through and bulge out. A hernia can occur soon after birth or much later in life.

You are more likely to get a hernia if you are overweight or you do a lot of lifting, coughing, or straining. Hernias are more common in men. A woman may get a hernia while she is pregnant because of the pressure on her belly wall.

What are the symptoms?

The main symptom of an inguinal hernia is a bulge in the groin or scrotum. It often feels like a round lump. The bulge may form over a period of weeks or months. Or it may appear all of a sudden after you have been lifting heavy weights, coughing, bending, straining, or laughing. The hernia may be painful, but some hernias cause a bulge without pain.

A hernia also may cause swelling and a feeling of heaviness, tugging, or burning in the area of the hernia. These symptoms may get better when you lie down.

Sudden pain, nausea, and vomiting are signs that a part of your intestine may have become trapped in the hernia. Call Dr Balder if you have a hernia and have these symptoms.

How is an inguinal hernia diagnosed?

Dr Balder can usually tell if you have an inguinal hernia based on your symptoms and a physical exam. The bulge is usually easy to appreciate on his examination.

How is it treated?

If you have a hernia, it will not heal on its own. Surgery is the only way to effectively treat a hernia and the potential complications from not repairing the problem.

Most people with hernias have surgery to repair them, even if they do not have symptoms. This is because many doctors believe surgery is less dangerous than strangulation, a serious problem that occurs when part of your intestine gets trapped inside the hernia.  If a patient waits and presents with "strangulation" the associated risks (morbidity - complications, and even mortality - death) drastically increase.  

Is there more than one type of hernia repair?

Generally hernia repair can be broken down into open (old fashioned) or laparoscopic (newer, minimally invasive - the type that Dr Balder generally preforms).  

OPEN HERNIA REPAIR:  Open hernia repairs typically involve a large incision in the groin (or with bilateral hernias, two large incisions - one on each side of the groin).  The surgeon then cuts down thru healthy normal tissue to get to the hernia defect and then repairs the hernia defect with or without mesh - depending on his training.  The possible complications include bleeding or hematoma formation; infection - possibly involving the mesh; testicle injury (in males); chronic groin or inguinal pain or local nerve injury; and recurrence.  It generally takes eight to twelve weeks for full healing with this old fashion repair technique.  Most patients have significant pain for six to eight weeks following this type of repair.  

LAPAROSCOPIC HERNIA REPAIR:  With his advanced laparoscopic training & experience, Dr. Balder repairs these and other types of hernias with a "laparoscopic technique" - this involves a tiny 12 mm incision near your umbillicus (belly button), and 2 additional 5 mm incisions between the umbillicus and your pubic bone (total incision length is less than one inch).  There is no cutting of healthy muscle; instead a balloon is inserted and inflated by Dr Balder between the muscle layers of your lower abdomen in the area of the hernia defect.  The area is dissected out with HD magnified (x 10) visualization thru these tiny incisions and a mesh screen is placed between the muscle layers.  This non reactive screen mesh that is placed across the area of hernia has openings or like a screen window, and your muscle tissue will grow into this screened area and heal quickly.  If a patient has bilateral hernias - or bulging on both sides - both groins can be repaired through the same small incisions without additional cutting.  Most patients will completely heal within a just a few short weeks.  The post-operative pain is much less than the old fashion hernia repair and the rate or number of possible complications is much lower with this hernia repair technique.  Most U.S. hernia societies strongly recommend or consider laparoscopic inguinal hernia repair the treatment of choice for bilateral inguinal hernia repairs or recurrent hernia repairs (hernias previously repaired by the open method which have now come back).  Dr Balder is one of the most experienced laparoscopic hernia surgeons in the state of South Carolina and previously served as a teacher and proctor to other surgeons wanting to learn this minimally invasive state of the art hernia repair technique. 

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