Groin Hernia/ Inguinal Hernia
Introduction
What is an inguinal hernia?
A hernia happens when there is a weak spot in a muscle in the body and something such as your intestine (gut) or fat pushes through. An inguinal (pronounced ING-win-ul) hernia is one that happens in the inguinal canal.
The inguinal canal is like a tunnel just above the groin. In women, it has a ligament that helps hold the uterus (womb) in place. In men, it leads to and from the testicles. It is an area that does not have much muscle and is naturally weak. Hernias will not go away on their own and normally continue to get bigger.
Everyone's hernia is different
• You might have a swelling or a ‘soft squidgy lump’ in the groin that comes back in the same place if you try to push it in.
• Sometimes the hernia seems to disappear when you lie down.
• Sometimes you have pain or discomfort or swelling.
• Sometimes your doctors find a hernia that is not causing you problems, when doing a scan.
About inguinal hernia pain
Hernias do not always cause pain but they often get bigger.
If your hernia is not causing you pain or discomfort, advice is to ‘watch and wait’ – look for changes and see your doctor if you start to have pain, discomfort or the size of your hernia starts to cause you problems.
Hernia pain can be different for everyone
You might have:
• pain or discomfort in your groin, especially when bending over, coughing or lifting
• burning or aching in the groin
• heavy or dragging sensation in your groin
• digestive problems such as constipation
How to push a hernia back in?
You should be able to push a hernia back in. Lie down or get in a resting position and gently push the hernia back in with the tips of your fingers or palm of your hand. Do not try to do it while standing.
What is an incarcerated or a strangulated hernia?
An inguinal hernia is when part of the intestines or fat poke through a ‘window’ of weakness in the inguinal canal.
If that ‘window’ suddenly clamps shut, with fat or intestine poking through, it gets stuck and can’t be pushed back in. This is an incarcerated hernia.
If the tissue that is stuck (incarcerated) contains blood vessels such as veins, it can be life threatening unless it is treated. This is a strangulated hernia.
About 2 – 3 in every 100 in the first year strangulate. This risk becomes less after 1 year.
When to go to A&E, call 111 or seek urgent medical help?
If you have a hernia and any of the following
• You are not able to move your bowels (poo) or pass gas or if you have blood in your poo.
• Nausea, vomiting, or both.
• Sudden hernia pain that gets worse quickly.
• Your hernia bulge turns red, purple or dark.
These symptoms are not specific to a hernia. They might be due to something else.
What can I do about a hernia?
Things I can do myself
Keep active – exercise can help, but it can be difficult when you have a hernia. A general rule is not to do anything which makes you feel uncomfortable or causes pain, or puts stress around the area of your hernia. You can get specialist advice from your healthcare professional. If you are finding it difficult to be active there are seated activities you can try.
Hernia belt or support clothing – some people find a hernia belt (truss) or abdominal binder helps. Put a binder or truss on while you are lying down and your hernia is reduced (pushed in). You might be able to get these on prescription from your healthcare professional.
Eating – constipation can cause pain around your hernia. Eating more fibre (wholegrains, fruit and vegetables, beans and pulses) and staying hydrated can help.
Sleeping – it can be difficult to find a comfortable sleeping position. Cushions or maternity pillows as support can help. Or put a pillow under your knees if you sleep on your back.
Pain and discomfort – hernias can be uncomfortable but shouldn’t be overly painful. It can be useful to keep the things to hand that help you when you get pain. For example ice packs, hot water bottle, warm wheat bags, cold spray, pain relief.
Being a healthy weight – weight loss can be really difficult. Your healthcare team can help you. Obesity increases pressure in the abdomen (tummy), and on the hernia, which can make symptoms worse. If you have surgery, extra weight increases pressure on the repair and can result in another hernia. Obesity can make surgery more difficult and increase the risk of infection afterwards. Look for healthy lifestyle programmes run by your local health authority.
Mental wellbeing – hernias can affect your well-being. You might want to get in touch with a support group such as the Facebook Hernia Patients Support Group where you can find people who are going through the same thing.
Some people find mindfulness or other relaxation techniques helpful.
These are all things you can change. Aim for bite-sized goals. Doing one thing consistently over time is better than doing different things for shorter periods of time. Think about which changes you are able and willing to make and what is achievable for you.
What if I’m offered surgery?
Everyone’s hernia is different. Everyone’s personal situation and health is different
If your hernia is causing you pain and affecting your life, you might choose to have surgery. The aim of surgery is to reinforce the tear in the muscle that is causing the hernia, reduce the chance of it coming back and help with pain and discomfort.
Sometimes surgery helps with pain, sometimes you still have pain after surgery.
Although you have a hernia, something else may actually be causing the pain. You might have surgery to fix your hernia but the pain doesn’t go away.
The type of surgery you will be offered will depend on
Your hernia – where it is, whether you have more than one, how big it is.
Your situation – whether you had a hernia in the past or other surgery in your abdomen (tummy), how fit and healthy you are, whether you have other health conditions.
Your surgeon – each surgeon is more experienced in one or another way of doing the surgery. How successful your surgery will be relies in part on this experience and expertise.
It’s ok to ask your surgeon about which technique they use. It’s ok to ask to speak to another surgeon who does a technique that you want to know more about.
If you want to speak to someone else you might have to wait for the appointment. You might wait longer for the surgery. You might need to travel to a different hospital. But it is fine to ask to speak to someone else.
The choices around your surgery include
• whether to have surgery or not
• type of surgery; open or laparoscopic (keyhole)
• type of anaesthetic: general (you will be asleep), or local (you will be awake)
• mesh or tissue repair (stitches) of the hernia
• type of mesh
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