Inguinal Hernias

Inguinal Hernias
The term inguinal hernia describes hernias situated directly above the inguinal ligament, a tendon - like structure made out of connective tissue, which is part of the connection between abdominal muscles and the pelvis. The inguinal canal is located at this point, where under normal circumstances the female mesosalpinx of the uterus or the male spermatic cord passes through the abdominal wall.


What are the causes of inguinal hernias?
The inguinal canal represents a natural point of weakness for the abdominal wall. This affects males more often than it does females. As a result inguinal hernias are diagnosed in male patients much more frequently. In addition every man exhibits a protuberance of the peritoneum into the inguinal canal ultimately stretching as far as the testicles, before he is even born. This protuberance deteriorates in its entirety shortly before birth. This deterioration, however, is not always completed before birth and eventually forms into the hernial sac of the inguinal hernia. Other types of inguinal hernia emerge from increased pressures in the abdominal cavity, as a result of, for example, chronic coughing, frequent pressing or other strenuous physical activities.


By which symptoms is the inguinal hernia best characterised?
The most common symptom is a swelling of the abdominal skin, which occurs quite suddenly, most of the time without any pain, located next to the protuberance of the pubic bone. Most of the time, this swelling is only recognisable when the patient is either standing up or by pressing down onto the affected area. While the patient is lying down, the swelling disappears completely. A full bladder or intestines occasionally lead to slight pain. Often patients have also discovered foreign body sensations whilst sitting down. If the swelling stretches as far as the scrotum and is visible trough the patients clothing from the outside then the hernias have existed and developed for quite some time. Once the hernias have reached this stage, the swelling usually does not subside when the patient lies down. The patients then have to lie down and massage the organs that have been captured in the hernial sac, back into the abdominal cavity. These type of hernias often cause discomfort during pressing, bowel movement or passing water.


What does the term “incarcerated” hernia imply?
Those organs that have been trapped in the hernial sac (most often the small intestinal loop) cannot be brought back into the abdominal cavity, neither by the patient nor by the doctor, if the hernia is incarcerated. The patient will suffer from severe abdominal pains, which are, on the one hand, caused by the fact that the intestine is incarcerated and thus obstructed. On the other hand, however, the blood supply of the intestine is also obstructed due to the pressure from the outside. The lack of blood supply will lead to a necrosis of the part of the intestine that is captured in the hernial sac within a matter of only a few hours. Thus an emergency operation is highly necessary in such a situation.


When and how will an inguinal hernia be treated?
The only method to successfully treat an inguinal hernia is by way of surgery. In order to by-pass time, a hernia truss can also be used in exceptional cases. These method (truss), however, is useless in the long-term. If used for several years, it can even cause more difficulties during surgery at a later stage due to damage caused by pressure in the abdominal wall. The date of the operation is determined by factors such as the degree of discomfort, the size of the hernia and the tendency of incarceration. Of course each operation has to be determined individually in accordance with the patients’ needs. Other determinative factors include activities that the patient has planned, such as travelling. In addition the fact that inguinal hernias grow over time and that operations, which are scheduled, are always better than those which are carried out on an emergency basis, lead to the conclusion that the patient should undergo surgery within the space of six months of being diagnosed.