General Surgery · Hernia and Abdominal Wall Surgery
Inguinal Hernia
The causes and symptoms of an inguinal hernia, the risk of strangulation, the conditions for watchful waiting, and the open and keyhole operations.
Op. Dr. Güneş Tekten wrote and medically reviewed this page · · Credits and references
An inguinal hernia is the outward protrusion of tissue from inside the abdomen through a weak point in the groin. It is the commonest type of hernia. Its typical sign is a swelling that becomes obvious on standing and disappears on lying down. It does not close on its own; the treatment is surgical and the method is planned for the individual.
What is an inguinal hernia?
The abdominal wall is made up of muscles and the strong sheets of tissue that enclose them. In the groin this wall has points that are naturally weaker. When pressure inside the abdomen rises, a bulge may form through those points.
The structure that comes out is called the hernia sac. It may contain peritoneum, fatty tissue or a segment of bowel.
Two main groups are described according to where the hernia sits:
Indirect inguinal hernia. This travels along a canal that has remained open since birth. It is more common at younger ages and can descend towards the scrotum.
Direct inguinal hernia. This passes straight out through a weakened part of the abdominal wall. It is more common in later life.
There is also a subtype that descends towards the thigh. It is more common in women and carries a higher risk of strangulation.
Why does a hernia not close on its own?
The opening in the abdominal wall lies in a sheet of tissue with a limited capacity to heal. Pressure inside the abdomen strains that area with every breath and every movement. For that reason the opening widens over time rather than closing. The lasting solution is surgical repair of the area.
Why does it develop?
Two headings act together in the development of a hernia: the strength of the abdominal wall, and the factors that raise pressure inside the abdomen.
The headings associated with it are these:
- Naturally weak points in the abdominal wall
- A canal that has remained open since birth
- Work that requires heavy lifting
- A long-standing cough
- Constipation and straining at stool
- Difficulty passing urine
- Excess weight
- Pregnancy
- A family predisposition
- A fall in tissue strength with advancing age
- Smoking
- Previous operations in the area
Hernias are more common in certain conditions that affect connective tissue. In that group the repair is planned in more detail.
Some of these factors can be changed. Relieving constipation and giving up smoking also support recovery after the operation.
What symptoms occur?
The clearest sign is a swelling in the groin that can be felt by hand. The swelling becomes more obvious through the day and settles with rest.
The findings seen:
- A swelling in the groin that becomes obvious on standing
- A bulge that disappears or shrinks on lying down
- A dragging and full sensation in the groin
- Discomfort that increases on lifting and on coughing
- Pain that increases towards the end of the day
- A burning and pricking sensation in the area
- In men, a swelling that descends towards the scrotum
- Complaints that increase after standing for a long period
Small hernias may cause no complaint for a long time. They may be noticed during an examination carried out for another reason.
It is not normal for the swelling to become firm, to be irreducible, or to change colour. Those findings suggest strangulation.
When nausea, vomiting and generalised abdominal pain are added, the picture becomes urgent. Those symptoms may indicate that bowel is trapped.
When should you see a doctor?
An assessment should be made in the following situations:
- A newly noticed swelling in the groin
- A bulge that keeps enlarging
- Persistent dragging and pain in the groin
- Discomfort that increases on standing and eases on lying down
- A swelling that descends towards the scrotum
- A previous hernia repair after which complaints have started again
- A burning and pricking sensation in the area that persists
The swelling becoming firm, being impossible to push back, and the onset of severe pain call for urgent assessment. If nausea, vomiting and a failure to pass wind accompany that picture, no time should be lost.
A change in the colour of the skin over the swelling is also an urgent finding. Waiting is not the right course in that situation.
Assessment and treatment options
The assessment is made by examination. The swelling is inspected while standing and while lying down. The change in the bulge on coughing is assessed.
In most cases the diagnosis is made by examination. Where the swelling is not obvious and a distinction has to be drawn, ultrasound is used. In complex cases computed tomography or magnetic resonance imaging is added.
The approaches are these:
Watchful waiting. This may be considered for small hernias that cause no complaint. If complaints develop, the operation is planned. The signs of strangulation are explained to the person.
Reducing pressure inside the abdomen. Relieving constipation, treating a cough and managing weight are advised at every stage.
Open repair. Through an incision in the groin the hernia sac is returned to its place and the weak area is supported with a mesh.
Keyhole repair. The repair is carried out through small openings made in the abdominal wall, with a camera and fine instruments.
Emergency surgery. Where there is strangulation the operation is carried out without delay. In that picture the blood supply to the bowel may be at risk.
The choice of method is made according to the type of hernia, whether both sides are involved, previous operations and the general condition of the person.
The outcome varies from person to person and cannot be foreseen without an examination. For that reason no promise of a result is given on this page. You may request an appointment for an assessment through the contact page.
Frequently asked questions
Does a hernia resolve on its own?
No. The opening in the abdominal wall does not close on its own. It may widen over time and complaints may increase.
Is a hernia truss a solution?
A truss does not treat a hernia. In selected situations where the operation is being deferred it may give temporary support. Its use is decided on a physician’s advice.
Do I need an operation if I have no complaints?
For small hernias that cause no complaint, watchful waiting may be considered. If complaints develop during that period, the operation is planned.
What is strangulation?
It is the trapping of the contents of the hernia sac in the opening. It runs with severe pain, vomiting and a swelling that becomes firm. It requires urgent assessment.
Should it be done open or keyhole?
Both methods are used. The choice is made according to the type of hernia, whether both sides are involved, previous operations and the general condition of the person.
Is a mesh essential?
In adults, repair with a mesh is the standard approach. The mesh supports the weak area and reduces the risk of recurrence.
When can I go back to work?
Return to desk work is usually within a week. For heavy physical work a wait of four to six weeks is advised.
What is done if there is a hernia on both sides?
For bilateral hernias the keyhole method allows repair in a single session. The decision is made on the examination and the imaging.
Written and medically reviewed by: Op. Dr. Güneş Tekten — General Surgery, İstanbul
Last reviewed: · Next review: 2027-08
Site editor: mail@gunestekten.com · Our editorial policy
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The information here is general. What it means in your own case becomes clear only after a consultation and any necessary investigations. Please bring any previous test results and reports with you.