What Is an Inguinal Hernia? Symptoms, Repair Options and Warning Signs

What is an inguinal hernia?

The most contested territory in the groin, subject of a three-part peace summit (Pax Inguinalis) and roughly a century of surgeons disagreeing politely at conferences.

The short answer

An inguinal hernia happens when tissue, usually fat or a loop of intestine, pushes through a weak spot in the lower abdominal wall into the inguinal canal in the groin. It shows up as a bulge that gets bigger when you stand, cough or strain, and politely retreats when you lie down. Your insides are trying to leave; the hernia is the door they found.

Who gets one

Men, mostly: their estimated lifetime risk is roughly one in four, far higher than women's. Age, family history, a chronic cough, constipation and previous hernias raise the odds. Many start as a small opening at birth that never quite got the memo to close.

How surgeons fix it (and argue about it)

Most repairs use synthetic mesh to reinforce the weak spot, a sort of trellis for your abdominal wall. In an open repair (the Lichtenstein technique is the classic) the surgeon works through an incision in the groin. In laparoscopic or robotic repair (TEP and TAPP are the common approaches) the mesh goes in from behind the abdominal wall through small incisions. Tissue repairs without mesh, such as the Shouldice repair, are still used for selected patients.

Which approach is best depends on the hernia, the patient and the surgeon's experience, which is roughly what Pax Inguinalis spends three episodes and several evening salons negotiating.

Does every hernia need surgery?

Not right away. For men with small hernias that cause few or no symptoms, “watchful waiting” is a reasonable option, though many eventually choose repair once the bulge starts making demands. Hernias in women are more often repaired because of a higher chance of a femoral hernia, which is more likely to get trapped.

When the joking stops: emergency signs

Get emergency care if the bulge becomes firm, painful or tender, turns red or purple, or won't push back in, especially with nausea, vomiting or not being able to pass gas. Those are signs of an incarcerated or strangulated hernia, which can cut off blood supply to the intestine. Go to an emergency department.

Frequently asked questions

What does an inguinal hernia feel like?

Often a bulge in the groin that's more noticeable when standing or straining, with aching, pressure or a dragging feeling. Some cause no symptoms at all and just sit there, bulging quietly.

Is laparoscopic or open hernia repair better?

Both work. Laparoscopic and robotic repairs may mean a quicker return to activity and are often preferred for hernias on both sides or repeat hernias; open repair can be done under local anesthesia. The right choice depends on you and your surgeon, not on who won the last conference debate.

When is a hernia an emergency?

When the bulge is suddenly painful, firm, discolored or can't be pushed back in, especially with nausea or vomiting. Go to an emergency department.

Not medical advice. This page is general information, written to explain terms our satire leans on; it isn't a substitute for advice from your own clinician. In an emergency, call 911.