hernia is the movement of an organ or part of an organ through a natural orifice of the body. There is talk of inguinal hernia when the viscera through the abdominal wall in the groin and specifically in the inguinal canal. The tissues that pass through it are usually peritoneum (the membrane lining the abdomen) and the small intestine. Inguinal hernia is the most common hernia. Only one side of the body is usually concerned but there are bilateral inguinal hernias.
The inguinal orifice, natural, is located at the fold of the groin and lets pass the spermatic cord in the man and the round ligament of the uterus in the woman. The spermatic cord contains, among other things, the vas deferens that carries the spermatozoa.
It is surrounded by muscles of the abdominal wall (as the transverse muscle). These can relax and increase the diameter of the orifice. This is how parts of the digestive organs can rush inside the canal where a passage appeared. A mass can then be visible at the level of the groin.
An inguinal hernia, which ultimately results in a blister in the groin , is sometimes painful. It is usually more visible when standing. It can increase in volume especially when you cough, lean forward or lift a heavy object or over time. Increased pressure in the abdomen can cause part of the small intestine or bowel to come out . It can become troublesome, for example walking, and can cause transit problems (such as constipation) if it increases in volume and compresses the surrounding tissues. Sometimes, in men, there may be pain and swelling in the scrotum and around the testes if the intestine descends through the inguinal opening.
Despite these possible serious complications, the inguinal hernia is often not serious . It is said to be reducible when a simple manual pressure makes it possible to return the portion of organ moved inside the abdomen.
Types of inguinal hernia
The inguinal hernia usually occurs in humans at the extreme ages of life.
In infants, the peritoneal-vaginal canal, which exists in both sexes and disappears just before delivery, may persist and cause herniation. A small mass is visible in the groin, especially when the child is crying. It concerns more boys than girls.
Older, an inguinal hernia can develop for example in case of muscular weakness. The weakened area may leave a larger passage to the viscera.
Diagnostic of Inguinal hernia
A simple clinical examination is sufficient to diagnose an inguinal hernia. The general practitioner can detect a mass in the groin, particularly visible when his patient coughs. If the hernia is reducible, it is possible to simply go back the viscera in the abdominal wall, in its initial location. Usually, the hernia is easily reducible while lying down.
The doctor also asks his patient about his pain and symptoms.
The major complication of inguinal hernia is strangulation, which can be serious. Part of the intestine becomes trapped and can no longer be manually delivered into the abdomen. The incarcerated hernia may become red, purple or very dark. Significant pain appears, as well as nausea and vomiting. The intestinal transit does not work anymore. When part of the intestine is not properly irrigated by blockage of the bloodstream (so-called hernia strangulation), intestinal tissue can necrotize. Bowel obstruction or peritonitis may occur. A fast surgery is necessary. So a medical consultation must be scheduled as soon as possible.
Causes of Inguinal hernia
The cause of an inguinal hernia is not always known. An increase in pressure in the abdomen may be responsible, as well as overweight, muscle weakness or chronic cough.
Symptoms of inguinal hernia
Often asymptomatic, inguinal hernia can develop and cause the following symptoms:
- Swelling in the groin;
- Pain, including leaning, carrying something heavy, pushing or coughing;
- Burning sensation.
In case of strangulation:
- Very strong pains;
- Absence of stool.
People at risk for Inguinal hernia
Men are more affected than women. However, an inguinal hernia can affect both sexes, at all ages of life.
The men are more affected than women because, in the womb, the testicles are formed in the abdomen and then go through the inguinal canal. Right after birth, this channel only lets the spermatic cord pass. A zone of weakness exists therefore at this place. This fragile area may allow the peritoneum to pass and thus cause the appearance of a hernia.
The risk of developing an inguinal hernia is higher if a parent has been affected by this disease.
The factors favoring the appearance of an inguinal hernia are numerous. Overweight, constipation, work that requires heavy items, chronic cough or difficulty passing urine. Pregnancy also exerts significant pressure on the abdominal wall. Premature infants are more concerned with inguinal hernias than full-term infants. Finally, a person who has developed an inguinal hernia on one side has an increased risk of suffering from a second hernia on the other side.
Prevention of inguinal hernia
The prevention of inguinal hernia is difficult . However, it is sometimes possible to limit certain risk factors such as cough or chronic constipation by caring for them. For constipation for example, it may be advisable to consume more fiber, present in fresh fruits and vegetables or whole grains. Keeping up with one’s weight of form is also important, as is stopping smoking, which can cause chronic coughs. It is necessary when it comes to inguinal hernia prevention to limit the repeated wearing of heavy objects that increases the pressure in the abdomen.
To avoid recurrence, it is necessary not to lift heavy loads about six months after the operation.
Medical treatment of inguinal hernia
Some inguinal hernias called reducible require only a simple manipulation and monitoring. For other inguinal hernias, more advanced, the only option is the surgical operation.
Several surgical techniques exist. There are “open sky” surgeries, that is, the surgeon opens the abdomen or laparoscopy, a minimally invasive technique that requires only three incisions. Laparoscopy has several advantages: the patient recovers better, suffers less, has only a small scar and stays in hospital for a shorter time. This technique is indicated especially for bilateral or recurrent hernias. It requires general anesthesia and the recurrence rate of inguinal hernia is higher than in open abdominal surgery.
Whichever technique is chosen, this choice being made according to the patient, his age, his general condition and his other pathologies, the surgeon remits the viscera to their initial location in the abdominal cavity and then can place a kind of net, called plaque (or hernioplasty), so that they can not in the future resume the same path and thus provoke an inguinal hernia again. The inguinal orifice is thus better closed. The High Authority of Health (HAS) has evaluated the effectiveness of these plaques on the risk of recurrence and recommends their implementation whatever the surgical technique chooses.
Complications following the operation are infrequent. Physical activity can usually be resumed one month after the operation.