Inguinal Hernia Anatomy

Inguinal Hernia Anatomy

An inguinal hernia occurs when soft tissue protrudes through the abdominal muscles. The soft tissue can be part of the intestine or part of the membrane that's around the abdominal cavity (omentum). The bulge can be quite painful, especially when you lift heavy objects, cough, or bend over. It gets worse when standing and feels better when lying down. When left untreated, this may lead to strangulation that refers to a situation in which the bulge blocks the blood supply to part of the bowel.

Inguinal Hernia Anatomy: Direct vs. Indirect
Inguinal hernia can be of two types, indirect or direct. Here is a bit more about both types.

Direct Inguinal Hernia
You have direct inguinal hernia when it enters in the fascia of the abdominal wall. Its sac is usually medial to the inferior epigastric vessels. It can affect both males and females, but men are ten times more susceptible to developing this type of hernia. A direct inguinal hernia will come out of an area in the transversalis fascia within the Hesselback's triangle, which is the anatomic region by the edge of the rectus abdominis muscle. The hernia cannot extend into the scrotum – it comes out via the superficial inguinal ring.

You are more likely to deal with direct hernias when your abdominal walls become weak with age. Some other risk factors include chronic cough, chronic Constipation, Obesity, family history of direct inguinal hernias, and prior episodes of hernias.

Indirect Inguinal Hernia
An indirect inguinal hernia occurs when the deep inguinal ring fails to close properly after the testicles have passed through it. Quite like other hernias, indirect hernias will also protrude via the shallow inguinal ring and lead to groin hernia. By learning more about inguinal hernia anatomy, you will understand the real cause of indirect inguinal hernias.

A baby boy will have a coat to the testicles as it passes through the inguinal ring, which will make a temporary connection called the processus vaginalis. The processus is obliterated after the testicles have completed descended. The inguinal canal has the deep inguinal ring at its beginning, which allows for enough space for the spermatic cord to pass. When the opening space is larger than what is required for the spermatic cord, this may lead to an indirect inguinal hernia.

How Can It Be Treated?
Your doctor will conduct a physical exam to confirm if you have inguinal hernia. They may also ask you about certain signs and symptoms along with looking for a bulge in your groin area. You may have to cough hard to make your hernia more prominent.

Your doctor will consider how large or small your hernia is. If it is small, your doctor will suggest following a "wait-and-watch" approach. You don't need any treatment for small hernia, but it is important to go for surgery to treat enlarged or painful hernia to prevent serious complications.

If you do need surgery, you will have two options – herniorrhaphy and laparoscopy.

Herniorrhaphy
Also called an open Hernia Repair, the procedure involves making an incision in your groin to send the protruding intestine or omentum back into its original place in your abdomen. Your doctor will then sew the torn muscle with the weak area being reinforced with a synthetic mesh. You should try to move as soon as you can without feeling any pain. It may take up to four weeks or even more to get back to your normal activities.

Laparoscopy
This is a minimally invasive procedure and involves operating through a very small incision in your abdomen. Your doctor will insert a small tube with an attached camera into the incision to repair the hernia. Since the procedure does not involve large incision, you are more likely to return to your normal activities early. You may consider laparoscopy if your hernias have recurred after traditional hernia surgery. This is important to prevent any car tissue from forming. Your doctor may recommend laparoscopy if you have bilateral inguinal hernias.

Considering the inguinal hernia anatomy, some experts believe that a laparoscopic repair has an increased risk of complications. It is, therefore, important to ask a professional and experienced surgeon to perform the procedure. Don't go for this procedure if you have very large hernia, you have had pelvic surgery in the past, and you cannot receive general anesthesia.

How to Prevent Inguinal Hernia
With knowledge about inguinal hernia anatomy, you can understand what you can do to prevent it from happening in the first place. What you should understand is that you cannot do much about the congenital defect that increases your risk for developing inguinal hernia. Here are some steps you can take to keep things under control.

• You should be active and exercise regularly to maintain a healthy weight. Be sure to talk to your doctor about the exercise you can or cannot do in your condition.


• You should work with a dietician or ask your doctor to help you make a diet plan. Be sure to eat plenty of vegetables, fruits, and whole grains that contain dietary fiber. It is important to prevent straining and constipation to avoid making your hernias worse.


• Avoid heavy lifting as much as possible. If you really need to do some lifting, bend from your knees. Never bend from your waist or you will end up making things worse.


• You need to avoid smoking because it will cause a chronic cough that can aggravate an inguinal hernia.

You need to bear in mind that when you have inguinal hernias, you cannot correct this situation with a supportive garment designed to keep hernias in place. You should wear it though if your doctor has asked you to wear it for a short time before your surgery.

Inguinal Hernia

Inguinal Hernia






Inguinal hernia is a condition in which the tissue pushes itself through weak spots of Groin Muscle. This in turn may cause bulging of groin area which may cause pain. The soft underlying tissue, mostly part of intestine comes out through weak spots of abdominal wall. Inguinal hernia may cause sharp pain when one coughs or lifts heavy object. This disorder has to be operated and does not go away without treatment. Inguinal hernia can be cured completely by surgical procedure.

Causes :

It is true that inguinal hernia occurs without any apparent cause. But some doctors believe that when a person exerts too much pressure on the abdomen or engages in straining activities like that of difficult bowel movements, he can get hernia.

Often, the opening of the muscle wall fails to close properly after birth causing inguinal hernia. There will be a weak area in the stomach muscle and when one exerts pressure, the tissue pushes itself through some opening to bulge out. Hernia can occur anytime and even for children.

Obesity can increase the chance of getting hernia. The person who is engaged in work involving lots of lifting and moving heavy objects is prone to get inguinal hernia easily. Very often men have this problem but some women may also have inguinal hernia during pregnancy since there would be tremendous pressure on her belly due to the development of baby.

If there is any weak point on the abdominal wall, it can cause hernia in due course.

Symptoms :

Bulging of groin or scrotum area is the only symptom of identifying hernia. It can be felt like a round structure or lump. It can cause bulging slowly as a process taking several weeks or even months. For some men, it can appear suddenly while lifting heavy objects or while coughing. Hernia can be painful but not always. There will be swelling of groin area and the affected person will feel heavy in the bottom. Pain and discomfort may not be present for all people having hernia. There can be tugging or burning sensation in that region. In rare cases, there can be nausea with vomiting when the tissues of the intestine get trapped inside hernia.

Children may also get inguinal hernia when they laugh or cries. You can observe for bulging of scrotum or groin area and the child may cry with pain.

Diagnoses :

Your doctor will look for the above symptoms and physically examine the body for diagnosing hernia.

Treatment :

Unlike popular belief, hernia will not go on its own and it needs surgery. For some people hernia may not give any pain or hurt but for others it may cause huge bulging and exert pressure and heaviness on the area. Small hernias without any pain or pressure need not be operated but large hernias have to be repaired as soon as it is detected.

Surgery is the only option of treatment available for inguinal hernia. During the process, the surgeon will make an incision and gently push the tissue well inside the intestine and close the opening of inguinal canal through sutures. It can be done by laparoscopic method in which small incision is made and a tube with camera is sent inside for completing the surgery.

If you delay the surgery it can cause strangulation when the intestinal tissue gets blocked in the hernia causing intense pain.

Who are at risk?

Men are more inclined to get inguinal hernia than women. Men inherit weakness during the formation of testicles inside the womb. In male babies, the testicles are formed well within the abdomen which later on is pushed down into the inguinal canal deep into the scrotum. After birth, the passage of inguinal canal may not close fully leaving some space for the spermatic cord to go inside. This gradually makes the area weak and hence men are more prone to get this problem than women.

In girl babies the inguinal cord will close completely after birth giving no room for the development of hernia. Putting extra pressure on the abdomen due to pregnancy can cause hernia in rare cases.

People with family history of hernia have more risk of getting it later in life than others. Having fibrosis can increase the risk of getting hernia for women. Chronic cough and Constipation problem and infants who are born before the full term of pregnancy also have more chance for getting inguinal hernia than others.

Prevention :

You can prevent getting hernia by maintaining healthy weight and eating fiber rich foods. While lifting heavy objects, do not strain very much and bend your knees well enough to lift the object. Quit smoking and do regular exercises.

Inguinal Hernia – Symptoms, Causes, Treatment, Surgery, Pictures

Inguinal Hernia – Symptoms, Causes, Treatment, Surgery, Pictures

What is an Inguinal Hernia?

An inguinal hernia happens when tissue that is soft – most of the time part of the intestines – bulges thru a tear or a place that is weak in the lower wall of abdomen. The bulge that results may be painful – particularly when the individual coughs, lifts an object that is heavy or when bending over.

Although this is not essentially dangerous alone, this type of hernia does not get better or go away by itself. An inguinal hernia may cause complications that can be life-threatening. It is because of this, that the individual’s primary care physician is probably going to advise repair of the hernia surgically, especially if painful or becomes too large. Inguinal Hernia Repair is a fairly common procedure surgically.

Inguinal Hernia Symptoms

Some of these types of hernias do not create any symptoms and an individual might not know they have one until the physician catches it during a routine exam. But more than likely, the individual is able to see and feel the bulge that is created by the intestine protruding. This bulge is normally more noticeable when the individual stands upright, particularly if they strain or cough.

Symptoms and signs of an inguinal hernia include:

• Budge in the area on either side of the pubic bone


• Burning, aching or gurgling sensation at the bulge


• Discomfort of pain in the groin, particularly when coughing, lifting or bending over


• Dragging or heavy sensation in the groin


• Pressure or weakness in the groin

Inguinal hernias in children or newborns are caused from a fault in the wall of the abdomen that is present at birth. At times this hernia may be seen only when the infant is coughing, crying or straining during a bowel movement. In a child who is older, a hernia is most likely to be apparent when the child strains during a bowel movement, coughs or stands for any lengthy time period.

Your primary care physician needs to be seen if there is a noticeable or painful bulge in the area on either side of the pubic bone. This bulge is most likely to be more noticeable when standing upright and can normally be felt when a hand is put directly over the area affected.

The hernia should be able to be gently and easily pushed back into the abdomen when the individual is lying down. If not, the swelling can be reduced enough by applying an ice pack to the area so that the hernia can slide in easily. Lying with the pelvis higher than the head can also help.

If it is still not possible to push the hernia in, this herniated intestine may have become confined in the wall of the abdomen – a condition that is serious and that might require immediate medical attention. This condition can also be accompanied by vomiting, nausea, rapid heart rate, fever, sudden pain which intensifies quickly, and a hernia bulge that turns dark, red or purple. If any of these symptoms or signs occurs call the family physician right away.

Inguinal Hernia Causes

Often these hernias have no cause that is apparent. But many happen as a result of:

• Extra pressure within the abdomen


• Pre-existing weaknesses in the abdominal wall


• Combination of pressure increase in the abdomen and a pre-existent weakness in the abdominal wall


• Heavy lifting


• Straining with bowel movements or urination


• Pregnancy


• Fluid in abdomen


• Chronic sneezing or coughing


• Excessive weight

In many individuals, the wall of the abdomen weakness that causes these hernias happens at birth when the peritoneum or abdominal lining does not close correctly. Other hernias developed late in life when deterioration or weakened muscles due to aging, strenuous physical action or coughing that usually come with smoking puts the last bit of pressure on the abdomen causing the hernia.

With males, the spot that is weak normally happens along the inguinal canal. In this area the spermatic cord that encloses the vas deferens – tube carrying sperm – goes in the scrotum.
With women, the inguinal canal has a ligament that keeps in place the uterus and hernias often occur where the connective tissue from the uterus fastens to tissue which surrounds the pubic bone.

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Men are most probable to have along the inguinal canal a weakness due to the way males grow in the womb. With males, testicles develop in the abdominal region and move thru the inguinal canal in the scrotum. Usually quickly after birth, this canal closes virtually completely, leaving only room enough for spermatic cord to go through, but it is not big enough to permit the testicles to transport back in the abdomen.

But, often the canal does not properly close, leaving an area of weakness. There is little chance that this inguinal canal will not close after delivery in baby girls. But females are more apt to have hernias develop in the femoral canal which is a hole near the inguinal canal that allows the femoral vein, artery and nerve to go thru.

Weaknesses may also develop in the wall of the abdomen late in life, particularly after any injury or some surgeries in the cavity of the abdomen.

But whether or not an individual has a weakness that is pre-existing, extreme pressure in the abdomen from heavy lifting, straining, excess weight or pregnancy can cause a hernia.

Inguinal Hernia Treatment

When hernias are small and not bothering the individual physicians usually take a “watch and wait” approach. But hernias that are painful or enlarging will normally need surgical repair to relieve discomfort as well as to prevent any serious complications.

Inguinal Hernia Surgery

There are generally two (2) types of operations for hernias:

Herniorrhaphy
This is a procedure that is also referred to as “open” repair, and the surgeon makes one incision in the groin and then pushes the intestine that is protruding back into the abdomen. Then the surgeon will repair the torn or weak muscle by suturing this area together. Often the area that is weak is also strengthened as well as reinforced with a synthetic mesh which is a procedure known as hernioplasty.

Laparoscopy
With laparoscopic surgery, the surgeon uses many very small incisions instead of only one. Then a fiber-optic tube containing a miniature camera is introduced into the abdomen thru one incision and surgical instruments that are also small are inserted thru the remaining incisions. The surgeon then does the surgery using the camera as the guide by following on a monitor. With surgery that is laparoscopic, synthetic mesh is always the technique used to patch-up the hernia – hernioplasty.

The pros of laparoscopic surgery include:

• Less discomfort


• Fast return to normal activities


• Less scarring

This technique is a great choice for individuals whose hernias recur following the traditional surgery for hernias due to the fact that laparoscopic approach allows the surgeon to work around any scar tissues from earlier surgery. It is also recommended for individuals who have a hernia on each side of the body – “bilateral inguinal hernias”.

But laparoscopic repair does have disadvantages such as:

• Increased risk of complications


• Increased recurrence following surgery

Inguinal Hernia Pictures