Causes | Symptoms | Treatment | Complications | Recovery | Follow Up | Next Steps
What is an inguinal hernia?
A hernia is defined as a weakness in the abdominal wall in which organs or fat may pop through.
An inguinal hernia is when this occurs in the groin. The groin and pelvis are complex structures in which many vessels and organs pass through, and each of these openings can expand over time and form a hernia.
Inguinal hernias make up 75% of all hernias, and the lifetime risk of these occurring is 27% in men and 3% in women.
Femoral hernias
Femoral hernias are also classified as groin hernias, however, they protrude through a different hernia defect. These are repaired basically the same way as inguinal hernias and have similar symptoms, although they more commonly occur in females.
What causes an inguinal hernia?
Most groin hernias result from ruptures of the weakened tissue you were born with or because of “wear and tear.” Often, we do not know exactly why a person develops a hernia.
Some of the common risk factors of getting a hernia are believed to include:
- Chronic cough
- Chronic constipation
- Careers or hobbies that require lifting heavy objects
Over time, given repeated stress in the area, the defects can open through the weakened tissues.
How do I know if I have a hernia?
You may notice a bulge in your groin that is soft and may be reducible. You may also have associated symptoms such as:
- Groin pain or soreness
- Groin bulging which may disappear when lying down
- Discomfort while straining or lifting
- Burning or gurgling sensation in the groin
When should I be concerned?
If you are having severe pain in your groin, redness, or signs of a bowel obstruction such as inability to have a bowel movement associated with nausea or vomiting, you may need surgical evaluation immediately, as the contents of the hernia may be stuck.
How is an inguinal hernia diagnosed?
The most common way inguinal hernias are diagnosed is on a physical exam during a visit with a physician. You may not even have any symptoms but may have an obvious bulge.
If you have symptoms which are classic of an inguinal hernia, you may need medical images to see it better such as a CT scan or ultrasound.
What are my options for repair?
Even though some smaller hernias without symptoms can be watched over time, most research shows that even small hernias progress over time, therefore repairing them early may be beneficial.
The 3 main reasons a hernia should be fixed electively are:
- To improve or cure discomfort in the groin due to a hernia
- To prevent progression of the hernia to a larger, more difficult to treat condition
- To avoid the need for an emergency intervention and prevent risks of the intestines being trapped or ”choked” within the hernia
The goal in fixing an inguinal hernia is to reduce the hernia “sac”, or the lining of the belly which goes through the hernia defect, and then cover the opening to prevent fat or organs from going through the defect again. This can be fixed through an old-fashioned surgical incision over your groin (known as an open approach) or using minimally-invasive options–either laparoscopically or robotically–to create several small incisions around your belly button.
How does an open umbilical hernia repair work?
An incision is made over your groin and then the hernia is located and found. The hernia sac, or the lining of your belly which goes through the hernia defect, is reduced and the defect is made smaller but not completely closed, as blood vessels and other important structures go through the area. If needed, a mesh is placed and secured, closing off the hernia, and the incision is closed.
Open groin repairs are used for patients who want to avoid general anesthesia and/or prefer a repair without mesh. Our method of choice for open non-mesh groin repairs is the Shouldice method.
Open repairs with mesh are reserved for patients in any of the following situations:
- Have very large hernias extending into scrotum
- Have extensive history of abdominal surgery
- On blood-thinning medications that cannot be interrupted
- Have failed previous laparoscopic repairs
How does a laparoscopic or robotic hernia repair work?
Three incisions are made at the upper part of your belly and your belly is filled with carbon dioxide gas. This allows your surgeons to work with a wide viewing area. A small flap is created from the lining of your belly and the hernia is found and reduced. Then the area is covered with a mesh and secured into place. The flap is closed and the gas is sucked out.
Laparoscopic or robotic surgery are typically the preferred means of repair. The use of minimally-invasive techniques provides the benefits of reduction in pain, faster functional recovery, better cosmetic results, and faster return to work and exercise. Moreover, the laparoscopic and robotic approaches allow surgeons to easily identify and treat hernias on the other side, likely avoiding another surgery in the future.
Mesh and inguinal hernia repair
All laparoscopic/robotic repairs involve the use of mesh reinforcement. In those techniques, mesh is used routinely since the hernia defect cannot be safely closed completely, as blood vessels and nerves travel through the area of the hernia.
When it comes to the use of mesh, your surgeon should pay particular attention to stay away from dissecting near the nerves in the area and to ensure the mesh type and size are uniquely tailored to the patient/hernia characteristics, the mesh is positioned flat and without folds or wrinkles, and mesh fixation occurs far away from any nerves.
Complications after surgery
Complications of inguinal hernia repair are rare, and include but are not limited to:
- Seromas (fluid build-up) where the hernia used to be
- These appear/feel like a walnut or lime; they may feel like an old “hernia”
- More common in large hernias
- Usually cause no symptoms and resolve without interventions
- May last up to 90 days
- Wound infection, wound dehiscence (falling apart), abscess
- These are practically unheard of after minimally-invasive repairs
- Bleeding
- It is normal to have some bruising around the belly button after surgery
- Internal bleeding however, is extremely rare
- Chronic pain (<1%)
- Hernia recurrence (1-3%)
When to call the office
Please call your doctor’s office if you are experiencing any of the following:
- Fever >100.4 which is sustained on 2 different readings. Temperatures less than this are normal after surgery, as the body heats up as it is healing
- Redness surrounding incisions, drainage from incisions
- Bleeding from your incisions that will not stop with pinpoint pressure (hold pinpoint pressure for 10 minutes first).
- Vomiting or persistent nausea which does not go away with time
- Inability to urinate more than 6-8 hours after surgery
- We typically recommend trying to stand in a hot shower for 15-20 minutes
- Severe abdominal pain unrelieved by prescription medications or increasing in intensity
- Large amount bruising or discoloration over incisions or flanks
- Some bruising around the cuts or in the genital area is not abnormal
- If you feel that you are getting worse each day instead of better
When to go to the ER
Please call 911 and go to the nearest ER for the following:
- Chest pain
- Fainting spells
- Shortness of breath or difficulty breathing
- Trouble speaking, weakness on one side of your body or both, changes in your vision
- Please let your surgeon know once this has happened in case there is a surgical problem
What is the typical recovery?
Most inguinal hernia surgery is ambulatory, meaning you will be able to go home the same day as your surgery. You should have someone drive you home from the hospital or surgery center as you will still be under the effects of anesthesia.
The typical experience is that you will have pain for about 1-2 days (it may feel like you did 500 crunches), soreness for 1 week, and little twinges of pain for about a month or nothing at all. Ice packs are key in minimizing inflammation and pain after surgery.
Pain management after umbilical hernia repair
Pain management may vary widely depending on your doctor. At Columbia, our typical pain control regimen includes Acetaminophen (Tylenol) and Ibuprofen (Motrin or Advil). We recommend that you take 650mg of Tylenol every 6 hours combined with 600mg of Ibuprofen 3 times daily after each meal (unless otherwise contraindicated). If you only have minimal pain, you do not need to take anything, however try not to fall behind your pain medicine if the pain persists. Also, please remember that the maximum amount of Tylenol within 24 hours is 4000mg (it might be less if you have liver problems) and 3200mg/24 hours of Ibuprofen (unless you have history of ulcers or kidney disease)
Post-surgery restrictions and recommendations
We encourage application of ice packs to the groin area for the first 24-48 hours. This should be done for 10-15 min at least 6 times daily.
For larger hernias in men, we strongly recommend scrotal support garments. In most cases, a tight pair of briefs works very well.
We recommend you move around at least once an hour while awake. Long walks are not discouraged but should not be done through pain. You can go for a light jog after 1 week.
If you are having groin discomfort, please stop whatever activity you are doing and rest.
Most patients can go back to work after 2-3 days. If your job involves strenuous activities, you might need 7-10 days to recover.
Other recommendations include:
- Typically, we do not place any significant restrictions after inguinal hernia repair. The rule of thumb is “if it hurts, do not do it.” We suggest you begin resuming activities after all of the surgical pain has subsided.
- Restart all preoperative activities gradually, starting with the least intense.
- Avoid strenuous exercise for at least 2 weeks. Avoid squats for 4-6 weeks.
- Avoid sports involving sudden movements (tennis, golf, soccer, etc) for at least 4 weeks.
- Avoid yoga and Pilates for 3-4 weeks
- No driving for 2 days after surgery or while taking narcotic pain medication. You should be able to get in and out of the car with no pain before driving.
- No flying until at least 1-2 weeks after surgery. If there is an extremely important event, discuss this with our team.
Follow up after surgery
Your doctor typically will want to see you back for a 2-3 week follow up appointment. If everything is normal there may not be a need to return for an in-person visit.
Your body will be healing from any surgery for about a year (you may not realize this). You should feel almost like yourself after the first 6-8 weeks. You will have some degree of healing for about 6 months.
If you overdo it with physical activity and get a recurrence of some mild pain, reduce the inflammation with ice, Ibuprofen (if possible) and rest. If pain persists, please contact your doctor. If you are worried, they are worried–give them a call.
Next Steps
If you’re dealing with an inguinal hernia, the Columbia Hernia Center is here for you.
- Our team is highly experienced in all the most advanced treatment options.
- Our precise attention to detail has allowed us to reduce the rates of chronic pain after surgery to less than 1%. We also pride ourselves in our ability to avoid post-operative narcotics.
- Our specialized pain management protocols have allowed us to avoid narcotics in over 95% of our minimally-invasive repairs.
- After your procedure, our surgeons and office staff will be with you every step of the way. If any complications come up, we’ll be there to get your recovery back on track.
To set up a consultation, please call us at (212) 305-5947 or use our online appointment request form. We look forward to answering your questions and meeting your hernia care needs.