Groin Hernia—Adult

(Hernia, Groin—Adult; Hernia, Inguinal—Adult; Inguinal Hernia—Adult; Hernia, Femoral—Adult; Hernia, Femoral—Adult; Femoral Hernia—Adult)

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Definition

A groin hernia occurs when abdominal tissue or fat pokes out through the abdominal wall. There are 2 main types:
  • Inguinal hernia—appears as a bulge in the groin (or scrotum area in men); this is the most common type
  • Femoral hernia—appears as a bulge in the groin, upper thigh, (or labia in women)
A hernia can trap a section of intestine, leading to blockage or problems with blood flow. This is called strangulation. It is a medical emergency and requires care right away.
Inguinal Hernias
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Causes

The abdominal wall wraps around your middle from the bottom of your ribs to your pelvis. It helps to contain and support your abdominal organs and tissue. When this area is weakened, these internal tissues can press through can create the hernia. The weakness may be caused by a problem with the abdominal wall development before birth, injuries, or wear and tear of the muscles.

Risk Factors

Inguinal hernias are more common in men and femoral hernias are more common in women.Abdominal wall weakness is more common in older adults. Factors that increase your chance of abdominal wall weakness include:
  • Obesity
  • Wear and tear on abdominal wall from frequent lifting of heavy objects, or prolonged coughing or straining
  • Previous surgery in the abdominal area
  • Family history of hernia
  • Peritoneal dialysis

Symptoms

Many times, there are no symptoms with groin hernia. In those who do have them, the symptoms may include:
  • A bulge in the groin area when standing or straining
  • A bulge in the upper thigh area
  • Pain in the groin area when straining
  • A bulge that may extend into the scrotum in men or the labia in women
  • Pain and/or a heavy feeling or discomfort in the groin area
More serious symptoms may need emergency care:
  • Severe pain in the groin or abdomen
  • Fever
  • Abdominal swelling
  • Nausea
  • Vomiting

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. Imaging studies are only done if the diagnosis in not clear by physical exam.

Treatment

Watchful waiting is an option for those with inguinal hernias who do not have symptoms. This means you and your doctor will monitor your hernia for growth or the appearance of more serious symptoms. Femoral hernias are at higher risk of strangulation. Watchful waiting is not advised, especially for women. Femoral hernias and inguinal hernias that cause symptoms are repaired with surgery. The abdominal tissue will be pushed back in and the opening will be closed. Sometimes, a mesh material will be placed to help support the area.

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Prevention

The following strategies may help to prevent a groin hernia:

RESOURCES

American College of Physicians
http://www.acponline.org

National Institute of Diabetes and Digestive and Kidney Diseases
http://www.niddk.nih.gov

CANADIAN RESOURCES

Canadian Institute for Health Information
http://www.cihi.ca

Health Canada
http://www.hc-sc.gc.ca

References

Garvey JF, Read JW, et al. Sportsman hernia: what can we do? Hernia. 2010;14(1):17-25.

Groin hernia in adults and adolescents. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated November 6, 2014. Accessed January 14, 2015.

Groin hernia: inguinal and femoral repair. American College of Surgeons website. Available at: https://www.facs.org/~/media/files/education/patient%20ed/hernrep.ashx. Updated May 2013. Accessed March 16, 2015.

Hawn MT, Itani KM, et al. Patient-reported outcomes after inguinal herniorrhaphy. Surgery. 2006;140:198-205.

Inguinal hernia. National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/inguinalhernia/inguinalhernia.pdf. Updated May 2014. Accessed January 14, 2015.

Inguinal/femoral hernia. American College of Surgeons website. Available at: http://www.facs.org/public%5Finfo/operation/brochures/hernrep.pdf. Updated May 2013. Accessed January 14, 2015.

Laurence I, Ngan-Soo E, et al. The role of multi-detector computed tomography in imaging hernias. Br J Hosp Med (Lond). 2011;72(2):72-77.

3/16/2015 DynaMed Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Fitzgibbons RJ Jr, Forse RA. Clinical practice. Groin hernias in adults. N Engl J Med. 2015 Feb 19;372(8):756-763. Available at: http://www.nejm.org/doi/full/10.1056/NEJMcp1404068. Accessed March 16, 2015.

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