Inguinal hernia in a nutshell: What are the risk factors and treatment options?

Patients often notice a lump in the groin, pain and discomfort may also be present. The type of hernia and the overall health of the patient will be considered in determining the best course of management. In his latest online article, esteemed consultant general and colorectal surgeon Mr Daniel Baird offers his expert insight into inguinal hernia, as well as their treatment.

What is an inguinal hernia?

An inguinal hernia presents as a bulge or swelling in the groin area. Patients may notice a lump that becomes more prominent when standing, coughing, or straining, but may retract when lying down. In male patients, it may move towards the scrotum. Once a hernia develops it will not heal itself.

Discomfort, pain, or an aching sensation, particularly during physical activity or lifting can accompany the hernia. Hernias are rarely dangerous but if they become acutely painful and or trapped this is an emergency and a patient must seek urgent medical attention.

Who gets an inguinal hernia? What are the risk factors?

Inguinal hernias can affect individuals of all ages, but they are more common in certain populations. Below is a list of risk factors associated with the condition:

• Gender: Inguinal hernias are more common in males than females. This is particularly true for indirect inguinal hernias, which are often congenital and more frequently affect males.
• Age: While inguinal hernias can occur at any age, they are more common in older adults. The risk tends to increase with age, and many hernias are diagnosed in individuals over the age of 50.
• Family history: There may be a genetic predisposition to hernias, and individuals with a family history of hernias may be at a higher risk. Patients with a family history of connective tissue or collagen disorders are at a higher risk of hernia than the general population.
• Congenital factors: Some inguinal hernias are present at birth. In males, this can be due to a failure of the inguinal canal to close properly during development, leading to a potential weakness in the abdominal wall. There is an association with an undescended testicle.
• Chronic straining or lifting: Activities that involve frequent heavy lifting, persistent coughing, or straining during bowel movements can contribute to the development of inguinal hernias by increasing intra-abdominal pressure. Stopping exercising is a controversial issue. Less fit patients with a higher BMI may have a higher surgical risk and a worse surgical outcome. Stopping all activity is often not possible or appropriate. I advise patients to undergo regular moderate intensity low-impact exercise such as swimming.
• Obesity: Excess body weight and obesity do contribute to the development of hernias, as the increased abdominal pressure puts additional strain on the abdominal muscles. Higher body weight is associated with a poor surgical outcome.
• Chronic respiratory conditions: Conditions that lead to chronic coughing, such as chronic obstructive pulmonary disease (COPD), can increase the risk of inguinal hernias.
• Pregnancy: In women, the risk of inguinal hernias may increase during pregnancy due to the added pressure on the abdominal muscles and the stretching of tissues.
• Previous abdominal surgeries: Individuals who have undergone abdominal surgeries, especially surgeries involving the abdominal wall, maybe at a slightly higher risk of developing hernias.
• Smoking: This weakens connective tissues and decreases the body's ability to heal. Smoking is also associated with coughing which increases the chance of getting a hernia.

It's important to note that while certain factors may increase the risk of inguinal hernias, they can still occur in individuals without these risk factors. Additionally, lifestyle modifications and prompt medical attention can help manage and reduce the risk of complications associated with inguinal hernias. If someone suspects they have an inguinal hernia, it's crucial to seek medical evaluation and advice for appropriate management.

How is an inguinal hernia managed?

Managing an inguinal hernia requires a comprehensive approach that focuses on both conservative and surgical interventions. A hernia management strategy will need to be patient-centred and personalised. The primary goal is to alleviate symptoms, reduce the risk of complications, and improve the overall quality of life. 

Conservative management

In some cases, especially when the hernia is small and a patient has no/minimal symptoms, a conservative approach may be recommended. This typically involves lifestyle modifications, such as avoiding heavy lifting or straining, maintaining a healthy weight, and wearing supportive garments like trusses or belts. An assessment and follow-up with a healthcare professional are essential to assess any changes in the hernia and the patient's symptoms.

Surgical management

Surgery is an effective treatment for inguinal hernias, particularly if patients are symptomatic or at risk of complications. The two main types of surgical procedures are open and laparoscopic hernia repair. An open hernia repair involves making an incision near the hernia site, repairing the weakened abdominal wall, and reinforcing it with sutures and commonly a mesh.

Laparoscopic hernia repair is a minimally invasive technique that uses small incisions and a camera to repair the hernia from the inside, with a mesh. Most patients (open and laparoscopic) can be done in a day-case fashion and can go home on the same day as the operation.

The choice of surgical approach depends on various factors, including the patient's overall health, the size and type of hernia. Both techniques have high success rates and low recurrence rates. Laparoscopic inguinal hernia repair offers advantages such as smaller incisions, less pain and quicker return to activity compared to open surgery. Laparoscopic surgery is especially useful when both sides are both left and right sides are affected (bilateral inguinal hernia).

Postoperative care

After a hernia repair pain is controlled with oral painkillers. Patients are also advised to gradually resume normal activities while avoiding heavy lifting (more than 3kgs) or strenuous exercise for six weeks. A patient should not drive until they can perform an emergency stop and should inform their insurance company.

In conclusion, the management of inguinal hernias involves a combination of conservative measures and surgical intervention. While conservative management may be appropriate for some patients, surgery is often the recommended treatment for symptomatic or complicated hernias. The choice of surgical technique depends on individual factors, and postoperative care is vital to ensure optimal recovery.

For a consultation and assessment to find out what your bespoke management plan is please book an appointment with Mr Daniel Baird via his Top Doctors profile.