Inguinal Hernia

 

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Original Editors - Lindsey Roederer and Stephanie McCauley from Bellarmine University's Pathophysiology of Complex Patient Problems project.

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Definition/Description

Prevalence

The most common hernia for males and females is the inguinal hernia.  Approximately 25% of males and 2% of females have an inguinal hernia during their lifetime.  Furthermore, indirect inguinal hernias are more common in both sexes than direct hernias.  Children can also have an inguinal hernia.  The incident rate for children ranges up to 4.5%.  

In the United States, over 1 million abdominal hernia repairs are performed each year.  Of those 1 million repairs, it is estimated that 770,000 of them are inguinal hernia repairs.  Males receive 90% of all inguinal hernia repairs.

Characteristics/Clinical Presentation

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Associated Co-morbidities

• Congenital abdominal weakness
• Chronic constipation
• Chronic cough
• Enlarged prostate
• Cystic fibrosis
• Overweight or obesity
• Ascites
• Smoking
• Overexertion
• Undescended testicles
• Any condition that increases pressure on the abdominal wall

Medications

Antibiotics are prescribed for strangulated hernias if ischemic bowel or infection is suspected. Over-the counter or prescribed medication for pain relief are utilized following surgical procedures.

Diagnostic Tests/Lab Tests/Lab Values

To diagnose inguinal hernia, the doctor obtains a thorough medical history and conducts a physical examination. The patient will be asked to stand and/or cough as the doctor palpates the suspected hernia for movement. Typically, no diagnostic tests are necessary, but an ultrasound or CT scan may be utilized in some cases or for differential diagnosis.

Etiology/Causes

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Systemic Involvement

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Medical Management (current best evidence)

If the hernia is small, it may be managed conservatively with activity modification and observation by the physician. However if the intestines become trapped inside the hernia, it can be life threatening situation. Immediate surgery will be necessary in this case. Additionally, inguinal hernias that continue to enlarge or cause symptoms are treated surgically. In children, inguinal hernias are surgically prepared to prevent entrapment of abdominal contents from occurring. Inguinal hernia repairs are typically treated on an outpatient basis and will be surgically managed by one of the following methods:

• Herniorrhaphy (Open hernia repair)- Local or general anesthesia is administered. The surgeon makes an incision in the groin, moves the hernia back into the abdomen, and reinforces the muscle wall with stitches.
• Laparoscopy- General anesthesia is administered. The surgeon inserts a laparoscope in the lower abdomen and repairs the hernia using synthetic mesh. Typically, patients experience a shorter recovery time and fewer complications.
• Hernioplasty- The area of muscle weakness is reinforced with a synthetic mesh or screen to provide additional support. This method may be utilized in open or laparoscopic repairs.

Medication is prescribed for pain management following surgery. Vigorous activity and heavy lifting are restricted for several weeks.

Physical Therapy Management (current best evidence)

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Alternative/Holistic Management (current best evidence)

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Differential Diagnosis 

It is critical to differentiate between an inguinal hernia and another condition that may mimic similar signs and symptoms.

Condition	Differentiating Signs and Symptoms
Undescended testis	• Groin mass • Underdeveloped scrotum with absent testis on affected side • Not associated with cough impulse
Enlarged lymph nodes	• May be associated with infection, trauma, or malignancy • Able to palpate above mass and may be moveable • Not associated with cough impulse
Psoas abscess	• Rare • Often accompanied with low back and buttock pain • Fever, weight loss, diaphoresis, cough • Recent contact with infection
Femoral aneurysm	• Pulsing mass
Epididymitis	• Testicular pain • Discharge • Painful urination • Fever, chills
Hydrocele	• Non-tender swollen testicle • May be seen in addition to an inguinal hernia
Femoral hernia	• Contents through femoral canal; difficult to differentiate from inguinal hernia
Athletic pubalgia	• Often no palpable mass • Testicular pain

Case Reports/ Case Studies

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Resources

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Recent Related Research (from Pubmed)

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References

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