Inguinal Hernia: Understanding the Causes and Symptoms, Debunking Myths

An inguinal hernia is a protrusion of internal organs through a weak spot in the groin area. Most often, loops of the intestine, omentum, or parts of the bladder enter the hernia sac. Patients notice a visible bulge that usually becomes more prominent during physical exertion, coughing, or laughing, and partially disappears when lying down.

It is important to understand that an inguinal hernia is not just a cosmetic defect. It signals weakness in muscles and tissues, and untreated hernias can lead to complications that require urgent surgical intervention.

The abdominal cavity is constantly under internal pressure – during walking, coughing, physical exertion, or lifting heavy objects. If the muscles and ligaments are weak, internal organs can “protrude” through anatomical openings.

Initially, a hernia may reduce on its own or remain barely noticeable, but over time the opening enlarges, and organs stay outside. This increases the risk of strangulation and tissue necrosis. In practice, patients often notice that discomfort increases in the evening or after prolonged physical activity, and the bulge becomes more pronounced.

Inguinal hernias are most common in men due to the wider inguinal canal and the passage of the spermatic cord. Women can also develop hernias, especially after childbirth or with significant physical activity. In children, inguinal hernias may be congenital due to incomplete closure of the abdominal wall canal. Other risk groups include:

• people who frequently lift heavy objects;
• patients with chronic cough or constipation;
• individuals with excess body weight;
• women after multiple pregnancies;
• people with a hereditary weakness of connective tissue.

Awareness of these factors allows timely consultation with a surgeon and helps prevent complications.

If a hernia is ignored, the following risks may arise:

• Organ strangulation – loops of the intestine or other organs get trapped in the hernia opening, requiring urgent intervention.
• Impaired blood flow to tissues, which can lead to organ necrosis.
• Chronic pain and discomfort that interfere with daily activities and quality of life.
• Enlargement of the hernia, complicating future treatment.

Most often, an inguinal hernia develops due to a constant increase in intra-abdominal pressure. This occurs during lifting heavy objects, intense physical exertion, severe coughing, or straining during constipation. Key contributing factors also include:

• Weak connective tissue – congenital or acquired, reducing the muscles’ ability to hold organs in place.
• Excess weight – creating constant pressure on the abdominal wall.
• Pregnancy and childbirth – the fetus presses on internal organs, stretching the muscles.
• Aging – in older individuals, muscles lose elasticity, making them more vulnerable.
• In men, an additional factor may be a congenital weakness of the inguinal canal; in women, frequent physical exertion or heavy labor.

Equally important are underlying medical conditions that indirectly contribute to the development of a hernia. These may include chronic cough, prostatitis, difficulty urinating, or respiratory system disorders. In such cases, constant strain on the abdominal wall creates conditions for the formation of a hernia opening.

Sometimes, injuries or postoperative scars that weaken tissues can lead to a hernia. Genetics also play a significant role – if close relatives have had hernias, the risk increases.

The most characteristic symptom is a bulge in the groin area, which increases when coughing, during physical activity, or after prolonged standing. To the touch, the bulge feels soft and may disappear when lying down. Over time, it becomes larger, causing a feeling of pressure or heaviness. In some cases, a slight “gurgling” or sensation of movement in the abdomen can be noticed – indicating that loops of the intestine are present in the hernia sac. If the hernia becomes strangulated, the bulge becomes firm, painful, and does not disappear even at rest – this is a reason to seek urgent surgical attention.

An inguinal hernia affects not only appearance but also overall well-being. Patients often report pulling pain in the lower abdomen, a feeling of tension, or burning sensations. Discomfort may occur during walking, lifting objects, coughing, or even talking if the abdominal muscles are tensed.

Sometimes, digestive issues appear – bloating, constipation, or loss of appetite. This happens because part of the intestine enters the hernia sac, disrupting the normal flow of processes in the abdominal cavity.

In men, inguinal hernias are significantly more common. They can descend into the scrotum, causing noticeable asymmetry, pain, or a feeling of heaviness. Patients often describe an uncomfortable “pulling downward,” which worsens by the end of the day. Due to the proximity of the spermatic cord, pain may radiate to the thigh or lower back. Sometimes men notice decreased potency or discomfort during sexual activity, which can also be associated with the hernia.

In women, an inguinal hernia is less pronounced but can still cause discomfort. Often, this is a mild bulge in the lower abdomen or pain during physical exertion. The bulge may be small, so women sometimes mistake it for swollen lymph nodes or gynecological issues.

Hernias can also appear after pregnancy, when muscles are stretched and the abdominal wall tissues are weakened. In such cases, discomfort may increase with coughing, laughing, or sudden movements.

In children, inguinal hernias are usually congenital. They manifest as a small bulge in the groin or scrotum (in boys), which increases with crying, coughing, or straining. The child may become restless, refuse food, or complain of abdominal pain. In most cases, the hernia is not dangerous, but the risk of strangulation remains, so doctors recommend a planned surgery even at an early age.

The first step is a consultation with a surgeon. During the examination, the doctor assesses the bulge, its size, consistency, and reducibility. To clarify the diagnosis, ultrasound of the groin area, abdominal organs, or pelvis may be prescribed, along with tests to evaluate overall health before surgery.

It is very important not to hide even minor symptoms – pulling pain, a feeling of heaviness, intermittent bulging. This helps the doctor accurately determine the stage of hernia development and avoid dangerous strangulation.

Choosing a surgeon for an inguinal hernia is crucial for the outcome of treatment. As a surgeon with over 39 years of experience, I can say that even the same operation can have different results – it all depends on who performs it.

For inguinal hernias, it is best to consult an abdominal surgeon experienced specifically in operations on abdominal wall organs. Even more precisely – a hernia specialist, a doctor who deals exclusively with hernias: inguinal, umbilical, postoperative. Such a surgeon knows anatomical features thoroughly, is skilled in modern mesh fixation techniques, has experience in minimally invasive (laparoscopic) procedures, and can choose the optimal approach for your specific case.

When choosing a clinic, pay attention not only to advertising but also to the reputation of the facility, patient reviews, and the quality of surgical equipment. It is a plus if the center can provide comprehensive diagnostics, consultations with related specialists, and comfortable postoperative care.

Do not hesitate to ask the doctor questions: how many similar surgeries they perform each year, which techniques they use, and how postoperative care is organized. The answers to these simple questions will help you understand whether you are dealing with a professional you can trust with your health.

Sometimes patients look for “alternative methods” – manual reduction, ointments, or support belts. However, it is important to know: none of these methods eliminate the actual defect in the abdominal wall. A hernia will not disappear on its own; it can only be temporarily “hidden.” Over time, it enlarges, and the risk of strangulation becomes significantly higher.

Before the procedure, it is important to undergo examinations: ultrasound, blood tests, and a consultation with a therapist or cardiologist – to ensure the body is ready for anesthesia and recovery. The doctor explains the procedure, possible anesthesia options, and expected hospital stay. The day before surgery, it is recommended to follow a light diet and avoid physical exertion. A well-prepared patient is already halfway to a successful outcome.

This method has been used for over two centuries and remains a reliable option. Through a small incision in the groin, the surgeon returns the organs to their proper place and reinforces the weak area with a special mesh to prevent recurrence. Modern materials do not cause rejection, integrate well with tissues, and the procedure itself lasts about 30–40 minutes. The advantage of this method is the ability to clearly see anatomical structures, which is especially important for large hernias.

This is a more modern, minimally invasive technique. Instead of one large incision, several tiny punctures are made through which instruments and a camera are inserted. The surgeon performs all maneuvers internally while monitoring the process on a screen. This approach results in minimal pain, no large scars, and a rapid return to normal life – often within a few days. Laparoscopy is particularly effective for bilateral hernias or recurrences after previous surgery.