A hernia (sometimes called a rupture) occurs when an organ or part of it (the lining of that organ) pokes through the sheath of muscles that surround it, usually causing a visible bump or swelling, and sometimes pain.
Gradually, a hernia will increase in size over time. As it does so, the visible lump will get larger, and it may become more difficult to ‘reduce’ it i.e. push it back in, even when lying down. Some can become so large that they interfere with normal activities. However, enlarging hernias do not necessarily become more painful.
As a hernia enlarges, and more of the abdominal contents (bowel, fat, occasionally other organs) are pushed into it, the contents can become stuck and not retract back into the abdominal cavity; this is called an “irreducible” or “incarcerated” hernia. Although not dangerous in itself, an irreducible hernia is often uncomfortable and may lead to the next stage: a strangulated hernia, which is dangerous.
A hernia strangulates when the blood supply to the organs or parts of organs in the hernia become shut off, so that the organs in the hernia start to die and become gangrenous. This uncommon complication presents with worsening pain, tenderness over the hernia and worsening malaise. It requires rapid intervention and surgery to prevent the bowel dying and peritonitis setting in.
It is to avoid such complications that surgical repair is usually suggested when someone develops a hernia, even in its early stages.
Most hernias can be diagnosed by a suitably trained doctor using a combination of selective questioning combined with a physical examination.
Occasionally an ultrasound examination may be required (a painless hand held scanning examination – the same test that is used to examine pregnant women).
Not always. There are some groin hernias that are unlikely to enlarge or produce long term problems, and they can be safely observed over time. You need to discuss this with your surgeon who will advise you accordingly. Most groin hernias however will require treatment for the reasons discussed in What can happen to a hernia? and When is a hernia dangerous?
Most treatments are surgical. A truss or external support is occasionally fitted to prevent a hernia ‘slipping out’, but these are cumbersome devices, difficult to keep clean and they can occasionally trap the hernia leading to the development of strangulation. Their current use therefore is debatable, and they should only be prescribed under careful supervision.
Surgical treatment is targeted at two things. Firstly, reducing the hernia, i.e. pushing back the organs into their rightful place and secondly ensuring that the hernia cannot come back. These days this is usually done by inserting some kind of polypropylene or other soft plastic mesh, to buttress the muscles where they are most weak.
There are a wide variety of techniques for achieving this, and your surgeon should be able to discuss the benefits and drawbacks of each technique with you. Currently, most procedures should no longer require an overnight stay in hospital, but be performed safely as a day case. Most techniques will use minimally invasive or keyhole access, meaning that your recovery from surgery should be fairly rapid, compared to techniques requiring large skin and muscle incisions. Finally many modern techniques can be performed in suitable cases under local anaesthetic with sedation, rather than under general anaesthetic.
We are all different however and hernias also differ: a type of technique and anaesthetic suitable for you and your hernia can only be decided after discussion with your specialist hernia surgeon.
There are two known complications to avoid in repairing a groin hernia: recurrence (Recurrent Hernias) and the development of chronic pain.
Unfortunately, repairing a hernia can never return the body to the state it was in before the hernia developed. There will always be a risk of a hernia returning or recurring. With modern techniques, this risk is small, perhaps ranging from 2 – 5% over ten years post operatively. Some situations may increase these risks such as an increased abdominal pressure from obesity or chronic straining due to coughing or heavy lifting. Recurrent hernias can be repaired however (see Recurrent Hernias)
A second, and perhaps more worrying complication is the development of chronic pain following surgery. Over the last two decades, this disconcerting outcome has been recorded following 5 – 10% of hernia repairs. While no consensus exists as to its cause, some techniques seem more associated with it than others, and there is growing evidence that some of the newer “pre-peritoneal” procedures such as ONSTEP may avoid such chronic pain syndromes. (ONSTEP for Groin Hernias)
You should discuss possible complications with your surgeon before agreeing to any surgical intervention.