An inguinal hernia is a weak spot in the groin through which fat or part of the intestine can push outward. It may show up as a visible bulge, an on-and-off feeling of pressure or pulling, or pain with activity. Some hernias need repair. Others can be observed for a period of time. The decision depends largely on symptoms, anatomy, and the individual patient.
What does an inguinal hernia feel like?
Common symptoms include a bulge in the groin, pressure, aching, burning, or discomfort that becomes more noticeable with coughing, lifting, exercise, or prolonged standing. The bulge may flatten when lying down and become more prominent when standing or straining.
In men, discomfort can extend toward the scrotum. Some patients have very little pain and notice only a lump. Others have groin pain without an obvious bulge, in which case the diagnosis deserves a more careful evaluation because not all groin pain is caused by a hernia.
How is an inguinal hernia diagnosed?
Many inguinal hernias can be diagnosed by history and physical examination. Imaging can be helpful when the examination is uncertain, when the hernia is recurrent, or when a hidden hernia is suspected. Ultrasound is often used first. MRI can be useful in selected patients when the examination and first scan do not provide an answer.
Does every inguinal hernia need surgery right away?
No. For men with a groin hernia that causes no or only minor symptoms, can be gently pushed back in, and does not limit normal activities, watchful waiting can be a reasonable option. Long-term studies also show that many of these patients eventually choose repair because pain or activity limitation develops over time.
Hernias that cause symptoms are generally treated surgically. Management is also different in nonpregnant women because a groin lump may be a femoral hernia, which has a greater risk of trapping tissue and is not generally managed with routine watchful waiting.
When to seek urgent care
Severe or rapidly increasing pain, vomiting, abdominal distention, skin discoloration, or a firm painful bulge that can no longer be pushed back can mean tissue is trapped or its blood supply is being cut off and should be evaluated urgently.
Open, laparoscopic, or robotic repair?
There is no single technique that is best for every inguinal hernia. Open repair remains an excellent option in many patients. Minimally invasive laparoscopic or robotic approaches may offer advantages for hernias on both sides, selected hernias that have returned, and certain patients when the surgeon needs to work in the layer behind the abdominal wall.
The choice should take into account whether the hernia is on one side or both sides, whether it has been repaired before, prior pelvic or abdominal surgery, the patient’s health and activity level, and the surgeon’s experience with the available techniques.
What about mesh?
Most adult inguinal hernia repairs use mesh because mesh-based techniques have low rates of the hernia returning and are the standard approach in international guidelines. Mesh is not a single product or technique, however. The mesh material, the size of its openings, how it is secured, where it is placed, and the operation used to place it all affect the discussion. A patient with concerns about mesh should have those concerns addressed specifically rather than being given a generic answer.
Think you may have a groin hernia?
A focused examination can usually clarify the diagnosis and whether observation or repair makes more sense.