Inguinal hernias and their symptoms

• The main symptom of inguinal hernias is the bulge caused by the hernia sac, although in some cases there is a very annoying intermittent pain.
• Inguinal hernias are so called because they occur in the area called the inguinal region.
• The only definitive way to solve inguinal hernias is through surgery.

Inguinal hernias are protrusions of part of the structures of the abdominal cavity through a hole or weakness in the abdominal wall.

Inguinal hernias are formed by hernia sacs that can vary in size depending on the weakness of the abdominal wall or the hole generated in the abdominal wall. 

These hernia sacs are composed of various components: they may contain a small loop of small intestine or they may contain small accumulations of intra-abdominal fat or other structures.

The components of the hernia sac, which ultimately forms inguinal hernias, may have all of the components listed above or only one of them, the common characteristic of all of them is that the last layer of the hernia sac that forms inguinal hernias is formed by a thin tunic of tissue that we call peritoneum (tissue that envelops all the organs and structures that are housed inside the abdominal cavity).

Inguinal hernias occur, as the name suggests, in a location on the human body that we call the inguinal region. This inguinal region is located in the lower abdomen, between the beginning of the lower limbs and the pubic region (in both men and women).

From an anatomical point of view, the inguinal region is described as the triangle-shaped area that lies between these three vertices: one vertex at the highest point of the hip, another vertex at the pubis and the third vertex at an imaginary line that divides the abdomen into 2 equal halves and usually coincides with the most medial part of the rectus abdominis (abdominal) muscles.

The main symptoms of inguinal hernias are minor in 90% of cases. By minor we mean that in a very high percentage of patients suffering from inguinal hernias these may go unnoticed or simply a lump in the groyne area that appears or disappears under certain circumstances.

There are certain circumstances that may favour the presence or appearance of an inguinal hernia. 

Advanced age, lack of physical exercise, the presence of previous abdominal surgery, multiple pregnancies, obesity or chronic coughing illnesses such as asthma are antecedents that increase the risk of inguinal hernias.

Patients suffering from or showing symptoms of inguinal hernia are usually patients who discover by chance a bulge in the inguinal area that appears and disappears with certain postures or at certain times of the day. 

All circumstances that increase intra-abdominal pressure usually lead to the appearance, albeit momentary, of an inguinal hernia.

Factors such as an attack of coughing, physical exercise, defecation or the simple fact of standing for several hours can be circumstances that cause the hernia sac to come out through the hole or weakness of the muscle wall, causing the patient to notice the bulge in the inguinal area. 

As mentioned above, 90% of the population suffering or suffering from inguinal hernia will not notice anything beyond the presence of a momentary bulge, so the hernia will not interfere in the performance of daily activities of daily living.

Intermittent episodes of pain, usually mild in intensity, usually subside when the inguinal hernia is reintroduced into the abdominal cavity, in 10% of the population with inguinal hernia or symptoms of inguinal hernia.

Warning signs related to inguinal hernias that should be considered for urgent care include: severe pain in the region of the bulge or inguinal hernia that does not subside with mild analgesics, inability to reduce the hernia or bulge as normal, nausea and vomiting, fever or dysthymic sensation (sensation that accompanies fever and is characterised by sweating, paleness, slight shivering or shivering).

When a patient suffers or presents symptoms of inguinal hernia and suffers from the signs aforementioned, he/she should see a primary care physician or a specialist surgeon for a re-evaluation of the inguinal hernia, as it is important to differentiate between 2 of the most frequent complications of inguinal hernias: incarcerated inguinal hernia and strangulated inguinal hernia.

The symptoms of an incarcerated inguinal hernia and a strangulated inguinal hernia are diffuse and difficult to differentiate except by physical examination, in both cases, the primary care physician or specialist may palpate an enlarged lump, of harder consistency than usual, which may be painful to the touch and is usually very difficult to reduce. 

It is sometimes necessary to order an imaging test such as an abdominal ultrasound or a computerised tomography (CT) scan to get a glimpse of the lump or to reach an accurate diagnosis.

An incarcerated inguinal hernia is an inguinal hernia that cannot be reduced, i.e. an inguinal hernia that has protruded through the inguinal foramen or a weakness of the muscular wall and cannot be reintroduced into the abdominal cavity again, but shows no signs of vascular involvement.

The reason why the hernia sac protrudes through the hernial foramen and cannot be reintroduced is simple: sometimes the contents of the inguinal hernia can protrude through the inguinal foramen and remain there for some time; at that point, it is possible that due to the slight compression of the muscle around the hernia, the hernial sac starts to swell and increase in size, making it more difficult to reduce again.

Strangulated inguinal hernia is basically the same circumstance as incarcerated inguinal hernia with the big difference that in this case there is vascular compromise affecting the contents of the hernia sac.

By vascular compromise we mean the difficulty of the vascularisation of the hernia sac contents to circulate normally, which means that the tissues are not well nourished or well oxygenated and an episode of tissue ischaemia begins to develop. 

If the process continues over time, it is possible that the contents of the hernia sac that forms the inguinal hernias could become necrotic and rupture.