Patient education: Groin hernias (The Basics)

What is a hernia? — A hernia is an area in a layer of tissue that is weak or torn. Often when there is a hernia, other tissues that are normally held in by the damaged layer bulge or stick out through the weak or torn spot.

Hernias can happen in different parts of the body. When they happen in the groin (where the thigh and body meet), they are called "inguinal" or "femoral" hernias. Inguinal hernias are a bit higher on the groin than femoral hernias (figure 1). Either type of hernia can balloon out and form a sac. In some cases, the sac holds a loop of intestine or a piece of fat that is normally tucked inside the belly.

Groin hernias are more common in males than in females.

What are the symptoms of a groin hernia? — Groin hernias do not always cause symptoms. But when symptoms do occur, they can include:

●A heavy or tugging feeling in the groin area

●Dull pain that gets worse when straining, lifting, coughing, or otherwise using the muscles near the groin

●A bulge or lump at the groin

Hernias can be very painful and even dangerous if the tissue in the hernia becomes trapped and unable to slide back into the belly (figure 2). When this happens, the tissue does not get enough blood, so it can get damaged or die. This is more likely with femoral hernias than with inguinal hernias.

Should I see a doctor or nurse? — Yes. See a doctor or nurse if you:

●Feel or see a bulge in your groin

●Feel a pulling sensation or pain in your groin even if you have no bulge

In most cases, doctors can diagnose a hernia just by doing an exam. During the exam, the doctor will ask you to cough while pressing on the bulge. This can be uncomfortable, but it is necessary to find the source of the problem.

Most of the time, the contents of the hernia can be "reduced," or gently pushed back into the belly. Still, there are times when the hernia gets trapped and can't be pushed back in. If that happens, the tissue that is trapped can get damaged.

If you develop pain around the bulge or feel sick, call your doctor or surgeon right away.

How are hernias treated? — Not all hernias need treatment right away. But many do need to be repaired with surgery. Femoral hernias, in particular, usually need repair. They are more likely than inguinal hernias to cause tissue damage.

Surgeons can repair groin hernias in 1 of 2 ways. The 2 ways work equally well to fix the hernia. The best surgery for you will depend on your preferences and your surgeon's experience. It will also depend on the type and size of your hernia, whether this is the first time it is getting repaired, and your overall health.

The 2 types of surgery are:

●Open surgery – During an open surgery, the surgeon makes 1 incision near the hernia. Then they gently push the bulging tissue back into place. Next, the surgeon sews the weak tissue layer back together, so that nothing can bulge through. In most cases, surgeons will also patch the area with a piece of mesh. Mesh takes the strain off the tissue wall. That way, the hernia is not likely to happen again.

●Minimally invasive surgery – Minimally invasive surgery uses special tools to decrease the size of incisions and reduce how much the body's tissues get damaged. One type of minimally invasive surgery is called "laparoscopic." For this, the surgeon makes several small incisions. Then they insert long thin tools into the area near the hernia. One of the tools has a camera (called a "laparoscope") on the end, which sends pictures to a TV screen. The surgeon can look at the picture on the screen to guide their movements. Then they use the long tools to repair the hernia with mesh. "Robotic repair" is done in a similar way, but with the help of a machine called a surgical robot.

If your hernia has reduced the blood supply to a loop of intestine, your doctor might need to remove that piece of intestine and sew the 2 ends back together. To do this, they might need to make a separate, bigger incision in your belly.

More on this topic

Patient education: Abdominal wall hernias (The Basics)
Patient education: Minimally invasive surgery (The Basics)
Patient education: Seroma (The Basics)