Indirect inguinal hernia (patient information)

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 * Assistant Editor-in-Chief: Meagan E. Doherty

Overview
Indirect inguinal hernias are congenital hernias and are much more common in males than females because of the way males develop in the womb. In a male fetus, the spermatic cord and both testicles, starting from an intra-abdominal location, normally descend through the inguinal canal into the scrotum, the sac that holds the testicles. Sometimes the entrance of the inguinal canal at the inguinal ring does not close as it should just after birth, leaving a weakness in the abdominal wall. Fat or part of the small intestine slides through the weakness into the inguinal canal, causing a hernia. In females, an indirect inguinal hernia is caused by the female organs or the small intestine sliding into the groin through a weakness in the abdominal wall.

Indirect hernias are the most common type of inguinal hernia.

What are the symptoms of Indirect inguinal hernia?
Symptoms of inguinal hernia include
 * a small bulge in one or both sides of the groin that may increase in size and disappear when lying down; in males, it can present as a swollen or enlarged scrotum
 * discomfort or sharp pain—especially when straining, lifting, or exercising—that improves when resting
 * a feeling of weakness or pressure in the groin
 * a burning, gurgling, or aching feeling at the bulge


 * Epididymitis (patient information) can also present with similar symptoms.

What causes Indirect inguinal hernia?
Indirect inguinal hernia's are congenital and is caused by failure of the inguinal ring to close just after birth, leadving a weakness in the abdominal wall.

Who is at highest risk?

 * Premature infants are especially at risk for indirect inguinal hernias because there is less time for the inguinal canal to close.
 * Males are also at a higher risk for developing indirect inguinal hernias because of the way they develop in the womb.

When to seek urgent medical care?
Contact your doctor if you experience any of the symptoms associated with an indirect inguinal hernia.

Diagnosis
To diagnose inguinal hernia, the doctor takes a thorough medical history and conducts a physical examination. The person may be asked to stand and cough so the doctor can feel the hernia as it moves into the groin or scrotum. The doctor checks to see if the hernia can be gently massaged back into its proper position in the abdomen.

Treatment options
In adults, inguinal hernias that enlarge, cause symptoms, or become incarcerated are treated surgically. In infants and children, inguinal hernias are always operated on to prevent incarceration from occurring. Surgery is usually done on an outpatient basis. Recovery time varies depending on the size of the hernia, the technique used, and the age and health of the patient. The two main types of surgery for hernias are as follows:
 * “Open” hernia repair. In open hernia repair, also called herniorrhaphy, a person is given local anesthesia in the abdomen or spine to numb the area, general anesthesia to sedate or help the person sleep, or a combination of the two. Then the surgeon makes an incision in the groin, moves the hernia back into the abdomen, and reinforces the muscle wall with stitches. Usually the area of muscle weakness is reinforced with a synthetic mesh or screen to provide additional support—an operation called hernioplasty.
 * Laparoscopy. Laparoscopic surgery is performed using general anesthesia. The surgeon makes several small incisions in the lower abdomen and inserts a laparoscope—a thin tube with a tiny video camera attached to one end. The camera sends a magnified image from inside the body to a monitor, giving the surgeon a close-up view of the hernia and surrounding tissue. While viewing the monitor, the surgeon uses instruments to carefully repair the hernia using synthetic mesh.

People who undergo laparoscopic surgery generally experience a somewhat shorter recovery time. However, the doctor may determine laparoscopic surgery is not the best option if the hernia is very large or the person has had pelvic surgery.

Most adults experience discomfort after surgery and require pain medication. Vigorous activity and heavy lifting are restricted for several weeks. The doctor will discuss when a person may safely return to work. Infants and children also experience some discomfort but usually resume normal activities after several days.

Where to find medical care for Indirect inguinal hernia?
Directions to Hospitals Treating an Indirect inguinal hernia

What to expect (Outlook/Prognosis)?

 * Surgery for inguinal hernia is usually done on an outpatient basis. Recovery time varies depending on the size of the hernia, the technique used, and the age and health of the patient.
 * Complications from inguinal hernia surgery are rare and can include general anesthesia complications, hernia recurrence, bleeding, wound infection, painful scar, and injury to internal organs.

Possible complications

 * Pressure on surrounding tissues causing pain and swelling.
 * Incarcerated hernia obstruct the bowel, leading to severe pain, nausea, vomiting and the inability to have a bowel movement or pass gas.
 * Strangulation which may lead to the death of the affected bowel tissues and is life threatening.