Inguinal Hernia: Symptoms, Causes & Surgical Treatment

What Is an Inguinal Hernia?

An inguinal hernia occurs when part of the abdominal contents—usually fat or intestine—pushes through a weakness in the lower abdominal wall in the groin area. The hernia appears as a visible bulge that may come and go, often becoming more noticeable when standing, coughing, or straining.

The abdominal wall consists of multiple layers of tissue between the skin and the abdominal organs. These layers include the peritoneum (innermost lining), fat layers, one or more muscle layers, and subcutaneous fat. In a hernia, the peritoneum and abdominal contents are pushed out through the muscle layers—but not through the skin itself. The contents typically consist of fat and sometimes part of the intestine.

A pouch of abdominal contents forms under the skin in what is called a hernia sac. The contents of this sac can move in and out through the opening in the abdominal wall. This is why hernias often appear larger when standing and smaller when lying down.

Inguinal hernias can occur in either the right or left groin, and some people develop hernias on both sides simultaneously. The groin is one of the most common sites for hernias to develop because of natural anatomical weak points—particularly where blood vessels and, in males, the spermatic cord pass through the abdominal wall.

Inguinal hernias account for approximately 75% of all abdominal wall hernias. The lifetime risk of developing an inguinal hernia is approximately 27% for men and 3% for women. Over 20 million inguinal hernia repairs are performed worldwide each year, making it one of the most common surgical procedures globally.

Types of Inguinal Hernias

There are two main types of inguinal hernias, classified by how they develop:

• Indirect inguinal hernia: The most common type, occurring when abdominal contents push through the internal inguinal ring—the natural opening in the abdominal wall. In children, this occurs through a channel that should have closed before birth. Indirect hernias can extend into the scrotum in males.
• Direct inguinal hernia: Occurs when abdominal contents push through a weakened area in the posterior wall of the inguinal canal. This type develops over time due to muscle weakening and is more common in older adults.

The distinction between these types is primarily important for surgical planning, though both are treated with similar approaches.

Incarcerated Hernia: A Serious Complication

An incarcerated hernia occurs when the contents of the hernia sac become trapped and cannot be pushed back into the abdomen. This can happen when swelling develops or when the opening in the abdominal wall is narrow.

The swelling can compress both the contents and blood vessels in the hernia sac. This can cut off blood circulation, causing the trapped tissue to potentially die—a condition called strangulation. This is a medical emergency requiring immediate surgery.

An inguinal hernia can develop into an incarcerated hernia in both adults and children. Sometimes, an incarcerated hernia appears suddenly without any previous noticeable hernia.

Related Types of Hernia

Several related conditions can occur in the groin area:

• Femoral hernia: Occurs lower in the groin, below the inguinal ligament. More common in women and has a higher risk of strangulation.
• Scrotal hernia: An inguinal hernia that has descended into the scrotum.
• Hydrocele: A collection of fluid around the testicle that can resemble a hernia. Unlike hernias, hydroceles typically do not change size with activity.
• Umbilical hernia: A hernia occurring near the navel—a different location but similar mechanism.

What Are the Symptoms of an Inguinal Hernia?

Common symptoms of inguinal hernia include a visible or palpable bulge in the groin or scrotum that can be pushed back, pain or discomfort in the groin area (especially during movement or straining), a heavy or dragging sensation, and abdominal discomfort. Some hernias cause no symptoms and are discovered incidentally.

Both adults and children can have inguinal hernias without experiencing any symptoms. These are sometimes discovered during routine physical examinations or imaging for other conditions. However, many hernias do cause noticeable symptoms that prompt people to seek medical evaluation.

Typical Symptoms of Inguinal Hernia

An inguinal hernia can cause one or more of the following symptoms:

• Visible bulge: A soft, rounded protrusion under the skin in the groin or scrotum that can usually be pushed back into the abdomen (reducible)
• Groin pain: Aching, burning, or sharp pain in the groin area, especially during physical activity, lifting, or straining
• Heavy sensation: A feeling of heaviness, pressure, or dragging in the groin
• Discomfort: General discomfort or aching at the hernia site that may worsen throughout the day
• Scrotal symptoms: In males, swelling or pain in the scrotum if the hernia extends downward
• Abdominal discomfort: Vague abdominal pain or discomfort, particularly around the lower abdomen

The Bulge Changes Size

A characteristic feature of inguinal hernias is that the bulge often varies in size. It is common for the hernia to be less noticeable in the morning but become larger throughout the day. Sometimes the hernia appears only as a swelling without a distinct bulge.

The hernia typically becomes more visible and palpable during activities that increase pressure in the abdomen:

• Standing up from a seated position
• Lifting heavy objects
• Coughing or sneezing
• Straining during bowel movements
• Physical exercise or strenuous activity

In children, the hernia may be easier to see when the child is crying, straining, or coughing.

Symptoms of Incarcerated Hernia

An incarcerated hernia usually presents with obvious and alarming symptoms. Several of the following signs typically occur together:

• Severe abdominal pain: Intense pain in the abdomen, groin, or scrotum that comes on suddenly
• Non-reducible bulge: A bulge or swelling that is painful and cannot be pushed back into the abdomen
• Skin changes: The groin or scrotum may become red, warm, or discolored
• Nausea and vomiting: These symptoms suggest bowel involvement
• Inability to pass gas or stool: May indicate bowel obstruction
• Fever: Suggests tissue damage or infection

An incarcerated hernia can lead to bowel obstruction, causing severe abdominal pain. Sometimes, bowel obstruction is the first sign of an incarcerated hernia when the hernia itself wasn't previously noticed.

Children with incarcerated hernias may also become lethargic, uninterested in their surroundings, and less responsive than usual. They may also vomit.

Other Causes of Groin Lumps in Children

Not every lump in a child's groin is a hernia. Other possibilities include:

• Lymph nodes: Swollen lymph nodes from infection are common and usually resolve on their own
• Undescended testicle: May present as a groin mass
• Hydrocele: Fluid collection around the testicle

A medical evaluation can distinguish between these conditions.

When Should You See a Doctor for an Inguinal Hernia?

See your doctor if you notice a bulge in your groin that comes and goes, or if you have groin pain during activity. Seek emergency care immediately if the bulge becomes hard, very painful, cannot be pushed back, or if you develop nausea, vomiting, or fever—these are signs of incarcerated hernia requiring urgent surgery.

Contact your healthcare provider if you believe you or your child has an inguinal hernia. Most hernias can be evaluated during a routine appointment. For children, you can also consult your pediatrician.

Signs Requiring Urgent Medical Attention

Seek immediate medical care at an emergency department if you experience any of the following:

• The hernia bulge becomes hard, tender, or swollen
• You cannot push the hernia back in (it was previously reducible)
• Severe or worsening groin or abdominal pain
• Nausea and vomiting
• Fever
• The skin over the hernia becomes red or discolored
• Inability to pass gas or have a bowel movement

What Can You Do at Home for an Inguinal Hernia?

While hernias cannot be cured at home, you can manage symptoms by gently pushing the hernia back when lying down, using over-the-counter pain relievers, avoiding heavy lifting and straining, and maintaining a healthy weight. These measures provide temporary relief but do not replace surgical treatment.

Although surgery is the only permanent solution for an inguinal hernia, there are steps you can take to manage symptoms and reduce discomfort while awaiting treatment.

Try to Reduce the Hernia

Sometimes you can gently push the hernia back temporarily. To do this:

1. Lie on your back with your knees bent
2. Relax and take slow, deep breaths
3. Place your hand over the hernia
4. Apply gentle, steady pressure upward and toward the navel
5. The hernia should slip back in with gentle pressure

Pain Management

Over-the-counter pain medications can help manage hernia-related discomfort:

• Acetaminophen (paracetamol): Safe for most adults and children; follow package directions
• NSAIDs (ibuprofen, naproxen): Can help with inflammation and pain; not suitable for everyone

Ask your pharmacist or healthcare provider which medication is appropriate for you, especially if you have other health conditions or take other medications.

Lifestyle Modifications

Certain activities can make hernia symptoms worse. Consider these adjustments:

• Avoid heavy lifting: Lifting increases abdominal pressure and can worsen the hernia
• Prevent constipation: Straining during bowel movements aggravates hernias. Eat high-fiber foods and drink plenty of fluids
• Maintain healthy weight: Excess weight increases abdominal pressure
• Quit smoking: Smoking weakens connective tissue and causes chronic cough
• Treat chronic cough: If you have ongoing cough, see your doctor for treatment

How Is an Inguinal Hernia Diagnosed?

Inguinal hernia is usually diagnosed through physical examination, where the doctor checks for a bulge in the groin while you cough or strain. In unclear cases, imaging tests such as ultrasound, CT scan, or MRI may be ordered to confirm the diagnosis and evaluate the hernia's size and contents.

Your doctor will ask about your symptoms, including when you first noticed the bulge, what makes it better or worse, and whether you've experienced any pain or discomfort. Then they will perform a physical examination of your groin area to check for swelling or a bulge.

Sometimes the hernia may not be visible during the examination if it has reduced. In these cases, your description of the intermittent bulge may be sufficient for diagnosis.

Physical Examination

During the examination, your doctor will:

• Visually inspect the groin area while you stand and lie down
• Feel the groin and inguinal canal for any bulges or abnormalities
• Ask you to cough or bear down (Valsalva maneuver) to see if a hernia appears
• In males, examine the scrotum for any extension of the hernia
• Attempt to gently reduce the hernia to assess reducibility

Imaging Studies

Additional testing may be needed in certain situations:

• Ultrasound: Non-invasive imaging that can visualize the hernia and its contents. Useful for unclear cases or when examining children
• CT scan: Provides detailed images and is helpful for complex hernias, recurrent hernias, or suspected complications
• MRI: Excellent soft tissue detail; sometimes used for unclear groin pain without obvious hernia
• Herniography: A specialized X-ray where contrast dye is injected into the abdomen to highlight hernias. Rarely used today due to availability of other imaging

Occasionally, the hernia may be discovered during diagnostic laparoscopy—a minimally invasive procedure where a camera is inserted through a small incision. If a hernia is found, it can often be repaired during the same procedure.

How Is an Inguinal Hernia Treated?

Surgery is the only cure for inguinal hernia. In children, surgery is always recommended due to incarceration risk. In adults with minimal symptoms, watchful waiting may be an option, but most will eventually need surgery. Surgical options include laparoscopic (keyhole) repair and open repair, both typically using mesh reinforcement.

The only definitive treatment for an inguinal hernia is surgical repair. However, for adults with hernias that cause few or mild symptoms, a period of observation (watchful waiting) may be considered.

Watchful Waiting in Adults

Research has shown that watchful waiting is a safe option for some adults with minimally symptomatic hernias. During this approach:

• You monitor your symptoms and have regular follow-up appointments
• You learn to recognize signs of complications that would require surgery
• Most patients (about 70%) will eventually develop symptoms requiring surgery within 10 years
• Watchful waiting does not increase the risk of complications compared to immediate surgery

However, watchful waiting is not appropriate for:

• Children (always require surgery)
• Adults with significant symptoms
• Large hernias
• Hernias at high risk for incarceration
• People whose work or activities are limited by the hernia

Hernia Truss (Support Belt)

A hernia truss is a supportive undergarment with a pad that applies pressure over the hernia to help keep it reduced. While a truss can provide temporary symptom relief, it has limitations:

• Does not cure or fix the hernia
• May be uncomfortable or impractical for long-term use
• Does not prevent hernia from enlarging
• May be considered when surgery is delayed or not possible

Your healthcare provider can prescribe a properly fitted truss if needed.

Surgery Is Always Recommended for Children

In children, inguinal hernias are always repaired surgically, regardless of whether they cause symptoms. This is because:

• Pediatric hernias have a higher risk of incarceration
• The risk increases as the child grows
• Repair in childhood is straightforward with excellent outcomes

The timing of surgery depends on the child's age and symptoms. Premature infants may be scheduled for surgery before hospital discharge, while older children typically have elective surgery.

Incarcerated Hernia Requires Immediate Surgery

An incarcerated hernia usually requires emergency surgery in both adults and children. However, in some cases—particularly in children—a doctor may be able to manually reduce (push back) an incarcerated hernia using gentle pressure after administering pain medication. If successful, surgery can then be planned for a later date.

How Is Inguinal Hernia Surgery Performed?

Inguinal hernia surgery involves returning the hernia contents to the abdomen and reinforcing the weakened area of the abdominal wall. The two main approaches are laparoscopic (keyhole) surgery and open surgery. In adults, mesh is usually used to reinforce the repair, while children's hernias are repaired by closing the opening without mesh.

The surgical procedure is similar whether repairing a standard inguinal hernia or an incarcerated hernia. The surgeon pushes the hernia contents back into the abdomen, removes the hernia sac, and strengthens the abdominal wall to prevent recurrence.

Anesthesia Options

Children are always given general anesthesia (put to sleep) for hernia repair. Before anesthesia, an IV line is placed for fluids and medications.

Adults have several anesthesia options:

• General anesthesia: You are completely asleep. Required for laparoscopic surgery
• Spinal or epidural anesthesia: You are awake but numb from the waist down
• Local anesthesia with sedation: The surgical area is numbed and you receive medication to relax. Used for some open repairs

The choice depends on the surgical approach, your health status, and your preferences.

Laparoscopic (Keyhole) Surgery

Laparoscopic hernia repair is currently the most common approach. During this procedure:

• Several small incisions (about 5-10mm) are made in the abdomen
• A camera and surgical instruments are inserted through the incisions
• The surgeon views the repair on a video monitor
• A mesh patch is typically placed to reinforce the abdominal wall

There are two main laparoscopic techniques:

• TEP (Totally Extraperitoneal): The mesh is placed without entering the abdominal cavity
• TAPP (Transabdominal Preperitoneal): The surgeon enters the abdominal cavity to place the mesh

Advantages of laparoscopic surgery include less postoperative pain, smaller scars, faster recovery, and the ability to repair both sides through the same incisions if bilateral hernias are present.

Open Surgery

Open hernia repair involves a single incision (about 6-8cm) directly over the hernia. This approach:

• Provides direct visualization of the hernia
• Can be performed under local or regional anesthesia
• Is well-established with excellent long-term results
• May be preferred for large hernias or when laparoscopic surgery isn't suitable

The Lichtenstein repair is the most common open technique, using a mesh patch to reinforce the abdominal wall.

Mesh Reinforcement in Adults

In adult hernia repairs, the abdominal wall is typically reinforced to prevent recurrence. Methods include:

• Flat mesh: A patch of synthetic mesh is placed over the weakened area. Most commonly used in both open and laparoscopic repairs
• Mesh plug: A cone-shaped mesh is inserted into the hernia defect
• Tissue repair (sutures only): The surgeon's own tissues are sewn together. Rarely used today due to higher recurrence rates, but may be appropriate in specific situations

Modern mesh materials are lightweight, flexible, and well-tolerated by the body. Mesh repair has significantly reduced hernia recurrence rates to only 1-3%.

Hernia Repair in Children

In children, the abdominal wall is typically not reinforced because the hernia is usually due to a congenital opening that failed to close, rather than tissue weakness. The surgeon simply closes this opening with sutures that usually dissolve over time.

Preparing for Surgery

To optimize your surgical outcome and recovery:

• Stop smoking: Ideally 8 weeks before surgery, minimum 4 weeks. Smoking impairs wound healing and increases complication risk
• Avoid alcohol: Stop drinking 4 weeks before and after surgery
• Review medications: Discuss all medications with your surgeon. Blood thinners may need to be stopped
• Arrange help: Plan for someone to drive you home and help for the first few days
• Follow fasting instructions: Typically no food or drink after midnight before surgery

What Is Recovery Like After Inguinal Hernia Surgery?

Most patients go home the same day as surgery. Pain is usually manageable with medication and improves significantly within the first week. Recovery time varies: laparoscopic patients typically return to normal activities in 1-2 weeks, while open surgery may require 2-4 weeks. Heavy lifting should be avoided for 2-6 weeks depending on the procedure.

For planned surgeries, both children and adults typically go home the same day. If surgery was performed urgently for an incarcerated hernia, a short hospital stay of a few days may be needed for observation.

Some children experience nausea and vomiting upon waking from anesthesia. For this reason, the IV line is usually kept in place for a few hours after surgery to provide fluids if needed.

Managing Postoperative Pain

Pain at the surgical site is common during the first day or two after surgery. Your doctor may prescribe pain medication for the initial period. After a few days, over-the-counter pain relievers are usually sufficient.

Adults may notice a small, tender lump under the incision—this is normal and will gradually shrink over several weeks. If mesh was used, you may feel some firmness at the repair site, which is also normal.

Straining can be uncomfortable after surgery, such as during bowel movements. To prevent constipation:

• Drink plenty of fluids
• Eat high-fiber foods
• Consider a stool softener if recommended by your doctor

Activity Guidelines

Avoid heavy lifting for the first few days after surgery. This applies to both children and adults.

For children:

• No special bed rest needed, but take it easy for a few days
• May need 1-2 days home from school or daycare
• Avoid physical education and vigorous play for about one week
• No jumping on trampolines or contact sports for several weeks

For adults:

• Walking is encouraged, even the day after surgery
• Light activities can usually be resumed within a few days
• Return to work depends on job demands—a few days to a few weeks
• Avoid heavy lifting (more than 10-15 pounds) for 2-6 weeks
• Gradually increase activity levels as comfort allows

Wound Care

Your incision will be covered with a bandage or surgical tape. General wound care instructions include:

• Keep the wound clean and dry
• Leave bandages in place as directed (usually until the wound heals)
• Wounds typically heal within 8-10 days
• Sutures may dissolve on their own or require removal at a follow-up visit

Follow-Up Care

Most patients do not require a follow-up visit after uncomplicated hernia surgery. However, contact your healthcare provider if you experience:

• Signs of wound infection (redness, swelling, drainage, fever)
• Worsening pain
• Persistent nausea or vomiting
• Difficulty urinating
• Any concerns about your recovery

Long-Term Outcomes

Hernia recurrence is rare in children—if it does occur, repeat surgery is needed.

In adults, recurrence at the same site is uncommon with modern mesh repairs. However, a new hernia can develop in a different location. To reduce the risk of developing another hernia:

• Maintain a healthy weight
• Exercise to strengthen core muscles (start about 6 weeks after surgery)
• Use proper lifting techniques
• Avoid smoking
• Treat chronic cough or constipation

What Are the Possible Complications After Surgery?

Complications after hernia surgery are uncommon but can include bleeding, wound infection, nerve injury causing numbness or chronic pain, and rarely, testicular problems in males. Most complications are minor and resolve with conservative treatment. Discuss potential risks with your surgeon before the procedure.

The following complications can occur in both adults and children. Before you leave the hospital, you will receive instructions on what to do if any complications develop.

Bleeding and Hematoma

Bleeding can occur inside the surgical wound, beneath the skin. Signs include:

• Bluish discoloration around the incision
• Significant swelling
• Expanding bruise

Most small hematomas resolve on their own. Rarely, a large hematoma may require a return to the operating room to stop the bleeding.

Wound Infection

Wound infection typically becomes apparent 2-4 days after surgery. Signs include:

• Redness around the incision
• Swelling and warmth
• Pain or tenderness that worsens rather than improves
• Discharge or pus from the wound
• Fever

Treatment may involve opening and cleaning the wound, applying new dressings, and possibly taking antibiotics.

Testicular Complications (Males)

There is a small risk of testicular inflammation (orchitis) after inguinal hernia surgery. Symptoms include:

• Redness and swelling of the scrotum
• Pain in the groin and testicle
• Typically appears about a day after surgery

This occurs when blood flow to the testicle is temporarily disrupted during surgery. Most cases resolve with conservative treatment, though rarely it can lead to testicular atrophy.

Nerve Injury and Chronic Pain

The groin area contains several small nerves. Occasionally, these may be affected during surgery, causing:

• Numbness: Decreased sensation in the groin, thigh, or scrotum
• Chronic pain: Persistent pain in the surgical area lasting more than 3 months

Sensation usually improves within a year, though it may not fully return in some cases. Chronic pain is uncommon but can occur—it is less frequent with laparoscopic approaches.

Other Complications

Additional potential complications include:

• Urinary retention: Difficulty urinating after surgery, especially with spinal anesthesia
• Seroma: Fluid collection at the surgical site
• Mesh complications: Rare but can include mesh migration, chronic inflammation, or infection
• Hernia recurrence: The hernia returns (1-3% risk with mesh repair)

What Causes Inguinal Hernia?

In children, inguinal hernias are congenital—caused by failure of the processus vaginalis to close before birth. In adults, hernias develop when the abdominal wall weakens over time, combined with increased abdominal pressure from factors like heavy lifting, chronic cough, obesity, or straining. Genetic factors and smoking also contribute.

The causes of inguinal hernia differ between children and adults.

Congenital Hernias in Children

In boys, inguinal hernias develop during fetal development related to the descent of the testicles:

• The testicles form inside the abdomen during fetal development
• Near the end of pregnancy, they descend into the scrotum through the inguinal canal
• A portion of the peritoneum (the processus vaginalis) follows them down
• This channel should close before or shortly after birth
• If it doesn't close, a pathway remains from the abdominal cavity to the scrotum, allowing contents to herniate

Girls also have an inguinal canal and can develop hernias, though it is less common. In girls, the ovary may sometimes be found within the hernia.

When Are Pediatric Hernias Most Common?

Inguinal hernias are most common in children under age 2 but can occur at any age. They are also more common in:

• Premature infants (born before 37 weeks)
• Low birth weight babies
• Children with a family history of hernias
• Children with certain conditions affecting connective tissue

Acquired Hernias in Adults

In adults, the abdominal wall in the groin can weaken over time. When combined with increased abdominal pressure, hernias develop. Contributing factors include:

• Smoking: Weakens connective tissue (tendons, ligaments) and causes chronic cough
• Heavy lifting: Repeated straining increases abdominal pressure
• Chronic cough: From smoking, COPD, or other conditions
• Constipation: Straining during bowel movements
• Obesity: Increases pressure on the abdominal wall
• Previous surgery: Weakened tissue from prior abdominal operations
• Genetics: Inherited weakness in connective tissue
• Aging: Natural weakening of muscles and tissues

The inguinal canal—the natural opening where the spermatic cord passes in males—is a particular weak point where hernias commonly occur.

Sometimes inguinal hernias develop without any identifiable cause or risk factor.