A groin hernia (inguinal hernia) is a lump that you can see and feel low down in the groin to either side. One or both sides can be affected. They are soft and can usually be pushed back if lying down. They may then re-appear after standing up and moving around. They tend not to be painful unless they get stuck out and have become difficult to push back. Fairly commonly, being up and active all day can lead to a pulling and sore sensation near the lump which is relieved by lying down and gently pushing it back.
Consultant surgeon Mr James Kirby-Bott specialises in the management of hernias. Here he explains whether groin hernias can be avoided and if someone does develop a hernia whether it can be left untreated or if this can lead to further complications.
Why are femoral hernias more common in women?
Hernias are a consequence of anatomical weaknesses that exist in all of us. Femoral hernias (a lump in the thigh or groin) in both men and women are less common than inguinal hernias. Femoral hernias are more common in women due to a difference in the shape of the male and female pelvis. In women, the pelvis is shallower and wider so the femoral canal is a little bit wider, so hernias are more likely to come through.
Inguinal hernias are more common in men as the inguinal canal allows the passage of the tube that carries sperm from the testicle to the penis via the prostate gland and blood vessels to the testes from inside the abdomen. This makes the canal openings larger so inguinal hernias have more chance of developing in men.
Can you avoid groin hernias?
As these are natural anatomical weaknesses it is difficult to avoid them entirely with little you can do to prevent them from happening. They are common. Natural wear and tear can make these canals bigger so hernias more likely to occur. This occurs naturally with age. The lower abdomen also provides support to the abdominal contents. The more fatty tissue there is in the abdomen the more support is needed, so they can be more common in obese patients.
Smoking weakens connective tissue that provides strength. Smoking and being overweight are not usually thought of as causing hernias but they are linked to the failure of hernia repair and hernia recurrence, especially umbilical hernias that occur around the belly button. Not smoking and weighing a normal weight (BMI<25) might reduce the risk of forming these. Exercise and muscle conditioning might also help prevent them from happening in a small minority.
Can an untreated hernia lead to complications?
Yes, but it is not common and the vast majority don’t. However, there is a sequence of events to complications happening. Complications are referred to as 'incarceration' when the hernia and its contents get stuck and are difficult to reduce. This can then become 'strangulated' if the contents in the hernia have their blood supply cut off. If these contents lose their blood supply it can lead to an emergency. The sequence from an asymptomatic hernia; to a sore reducible hernia; to an incarcerated hernia to a strangulated hernia is a logical stepwise progression.
When your hernia becomes symptomatic but reducible it is a good time to think about repair. When incarcerated (you can no longer get the lump to push back), the repair should be performed in the next few weeks. If it is strangulated (the lump won't push back and is tender and red) then repair is more difficult and should be done as an emergency. The time it takes to go the whole way along this pathway can be years in some, down to a week or so in a few. I would recommend having a hernia that is symptomatic seen to and that an incarcerated hernia is seen very soon. It is best not to leave it till it strangulates to be checked by a doctor.
If you are concerned about your hernia, do not hesitate to have it checked by a specialist.