Groin Hernias
What is a groin hernia?
A groin hernia is a protrusion of part of the contents of the abdomen through a weakness or defect in the abdominal wall in the groin area.
What are the types of groin hernias?
Inguinal Hernias: These are the most common type of hernia accounting for 3 out of 4 hernia cases. They occur in the inguinal canal. About 1 in 4 men and 3 out of 100 women will develop inguinal hernias at some point in their lives.
Inguinal hernias can be direct or indirect types depending on their course through the inguinal canal. 
Femoral Hernias: These are about 4 times more common in women then men. They are very close to inguinal hernias in location occurring through a weakness next to the passage of the femoral vein from the abdomen to the lower limb. They are more likely to cause serious complications and therefore they should be repaired without delay even if very small.
What are the causes of groin hernias?
Some groin hernias are present from birth but the majority are acquired later in life.
- Obesity
- Smoking
- Straining and heavy lifting
- Chronic coughing or constipation
- Pregnancy
- Previous abdominal or groin surgery
- Congenital weakness of the connective tissue
- Liver diseases
- Steroids and use of drugs that suppress the immune system
What are symptoms of groin hernias?
Sometimes a hernia does not cause any symptoms other than a bulge in the groin. Often this bulge disappears when lying down and increases in size on standing or coughing. More often a groin hernia causes pain and discomfort over the groin that may move to the testis. If neglected, a hernia can cause serious complications due to entrapment of bowel or other abdominal contents leading to strangulation or gangrene of the entrapped contents. Warning signs of strangulations are severe abdominal pain, vomiting, and redness and tenderness over the hernia site.
What tests are needed to diagnosed a groin hernia?
Majority of hernias can be diagnosed by physical examination alone. Occasionally, an ultrasound scan or a CT scan may be need for obese patients and patients with previous hernia repair. At time of the consultation the opposite side is carefully check for hernias as well as these can be repaired at the same time.
Can a groin hernia be left without repair?
Groin hernias do not heal themselves. Some inguinal hernias that are not causing any symptoms can be observed and surgery is performed if they enlarge or start to cause symptoms. Hernias tend to get bigger with time and it easier and more successful to repair hernias before they get enlarged. All femoral hernias should be repaired even if very small.
Emergency surgery to repair entrapped painful hernias is more complicated often requiring bowel resection, longer stay in hospital, more complications and more chance for the hernia to come back.
A simple rule of thumb is: "the sooner the better".
Are there any alternatives to surgery?
Patients with inguinal hernias sometimes wear a truss. This is a special belt designed to be worn first thing in the morning after pushing in the inguinal hernia. The idea is to apply a pressure over the defect in the abdominal wall and thus preventing the hernia from popping out. This does not fix the hernia just hold it in place. Most patients do not use it properly and the truss end up pushing on the bowel instead of hold in the hernia. Therefore, it should be reserved for patients who are waiting for surgery.