General and Gastrointestinal Surgery
Symptoms of Inguinal Hernia
The two most common symptoms of a hernia are:
- Discomfort: Inguinal hernias are usually associated with discomfort that is often described as a burning sensation, a pressure or fullness, an ache or an outright pain in the affected groin. There is an awareness that something is present in the groin that should not be there. Typically, there are no symptoms on awakening but with prolonged periods of standing, sitting or lifting the symptoms appear and often intensify. Athletes often notice the discomfort when they run.
- A Bulge: The bulge is located over the site of the hernia. In an inguinal hernia it is located in the groin. This bulge may always be present but typically goes away when the patient lays down. The reason is that the pressure pushing tissue into the hernia when the person stands is eliminated when he/she lays down, so the tissue goes back into the abdomen. People can often push in the bulge (reduce the hernia), by applying gentle steady pressure over the lump. If the lump does not go away, the tissue is stuck. This is known as an incarcerated hernia and requires immediate medical attention.
- Can groin pain be anything other than an inguinal hernia?
Although groin discomfort or pain most commonly is the result of a hernia it can also be caused by a severe muscle or groin pull, especially in an athlete. Groin pulls commonly occur when a person forcefully pushes a leg against something that gives out from underneath them. For example, this injury is common in skaters and cyclists. If a person pushes hard on the ice and slips, his/her leg goes out and pulls the ligaments and muscles in the groin. The ensuing pain can last from weeks to months. Often, heat, rest and aspirin or other anti-inflammatory medications will help.
- Can a bulge or lump in my groin be anything other than an inguinal hernia?
A hernia is the most common reason for a lump to appear in the groin. If the bulge is located beneath the crease in the leg, it most likely is also a hernia, but not of the inguinal type. Bulges beneath the crease in the leg are called femoral hernias. They do not represent protrusions through the anterior abdominal wall but beneath the inguinal ligament that forms the crease in the groin. A bulge, on rare occasions, with enlarged lymph nodes, may be caused by an infection. In that case, there is usually not one discrete lump but a few small bumps which often are tender to touch.
- Are there any tests I need to undergo to confirm that I have a hernia?
No. Physical exam and history are the two best ways to diagnose a hernia. Fortunately (or unfortunately) there is no test, including either a CAT scan or MRI, that is better than medical history and a physical examination. The reason it is unfortunate is that occasionally there are patients with a history that indicates a hernia but none can be detected during a physical exam. These patients may require a exploratory surgery to exclude the possibility of a hernia.
- Who gets an inguinal hernia?
Approximately five million Americans have a hernia, according to the National Center for Health Statistics. Although they are more common in men, women also get them. The reasons they are more common in men are two-fold:
- There is a significant anatomical difference that makes the development of hernias more common in men than women.
- There is an occupational difference. In general, men tend to have occupations that require more heavy lifting. Since hernias are related to the constant pressure placed on the inguinal area, the more a person lifts and the heavier the amount, the more likely he/she is to get a hernia. As a result, hernias are more common in men than women.
- How did I get a hernia?
There are many possible reasons to explain why an inguinal hernia occurs. As noted, men are predisposed to it because of anatomy. A job may have contributed to or caused it because of heavy lifting. Other factors that are important in the development of hernias are being overweight and smoking. The former places more pressure on the area and the latter weakens the tissues. People who noticed the hernia while they were working should report it to their employers.
- Is it related to work?
It is likely that all hernias do not result from work, since many factors can lead to a hernia. However, it is impossible to say with certainly that a hernia is not from work if the person did not have one when he/she started the job. Furthermore, even if other factors were involved in the development of the hernia, lifting, no doubt, contributed. Therefore, all hernias are usually treated as worker's compensation injuries.