A hernia occurs when part of an internal organ or tissue bulges through a weak area of muscle. There are several types of hernias, mostly in the abdomen. Hernias are named according to the site of occurrence such as inguinal (groin), umbilical (around the belly button) and incisional (through a scar). A combination of muscle weakness and strains such as heavy lifting and a chronic cough might contribute to a hernia.
Hernias can affect men, women, and children. The most common type is an inguinal hernia. Males are much more likely to develop inguinal hernias than females, as they naturally have a small hole in the groin muscles to allow the passage of blood vessels and the spermatic cord to the testicles. Approximately 25 percent of males and 2 percent of females will develop an inguinal hernia in their lifetimes. The signs and symptoms of an inguinal hernia vary as it progresses.
An inguinal hernia may first present as a small bulge on one or, rarely, on both sides of the groin that’s accompanied by discomfort. The bulge is more prominent when standing or when abdominal pressure is increased (such as coughing). It may even increase in size over time and usually disappears when lying down. It may ache but is not tender when touched. The achiness or dull pain was more prominent during straining, lifting, coughing, or exercising and improves when resting. Gardening or getting in and out of a car may also precipitate discomfort or pain. Sometimes pain precedes the discovery of the lump. It may be reduced (pushed back into the abdomen) unless if it is very large.
Irreducible or incarcerated hernias occur as part of the fat or small intestine from inside the abdomen becomes stuck in the groin or scrotum and cannot return into the abdominal cavity on its own or when pushed. It may be a chronic finding without any symptoms of pain. Signs and symptoms of bowel obstruction may occur, such as nausea and vomiting. Your health care provider who understands the internal anatomy of your groin area may attempt to reduce it back into the abdomen with a gentle massage. This is necessarily done to prevent further complication.
If an irreducible or incarcerated hernia is left untreated, it may be complicated by ‘strangulation’ (blood supply being cut off due to obstruction) of the small intestine. This lack of blood supply is an emergency situation and can cause a section of the intestine to die (gangrene). Strangulated hernia will cause pain, followed quickly by tenderness and sometimes symptoms of bowel obstruction (nausea and vomiting). The affected person may appear ill with or without fever. This condition is considered as a surgical emergency.
Besides its localized signs and symptoms, inguinal hernia may also present with genital or abdominal pain. The patients may also complain of weakness, heaviness, burning, or aching in the groin. A swollen or an enlarged scrotum in men or boys may also be found.
Inguinal hernia in women
Inguinal hernia may present with similar symptoms in women. But unlike in men, inguinal hernias that afflict women are usually small, nonpalpable and internal. This makes it difficult to detect them. Protrusion of the abdominal fat may press on nerves and cause pain. These women may be misdiagnosed multiple times for other causes of chronic pelvic pain due to the absence of obvious bulge and the rarity of this condition in women. Symptoms include pain in the lower abdomen or groin when lifting, coughing, and sneezing with radiation into other body parts that are associated with the nerves affected.
Treatment of inguinal hernia usually involves surgery to repair the opening in the muscle wall. However watchful waiting is a reasonable intervention in adults with minimal symptoms or asymptomatic inguinal hernia.
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If you are interested to learn about other diseases that are commonly found in Thailand, check out our article about Thailand's common diseases.