What is an inguinal hernia?
A hernia is when something inside the body pushes through a wall or barrier that’s supposed to keep it in place. The abdominal wall normally keeps everything inside, but if there’s a weak spot, pressure from things like lifting, coughing or even standing can cause a bulge.
An inguinal hernia is when tissue (usually fat or part of the bowel) pushes through a weak spot in the groin area. This area is called the inguinal region.
Do inguinal hernias only affect men?
No, but about 1 in 4 men will be diagnosed with an inguinal hernia at some point in their lives. Only about 3% of women will develop one.
Why? Inguinal hernias are more common in men because before birth the testicles move down from inside the belly into the scrotum. That journey leaves a natural weak spot in the groin, which can make it easier for tissue to push through later in life.
Women also have a small passage in the groin (canal of Nuck), but nothing needs to pass through it. As they grow, it normally closes up. The passage is tiny, so the chance of a weak spot forming is much lower than in men.
What causes an inguinal hernia?
People develop inguinal hernias for several reasons.
Some people are born with one, which means they have it from birth, this is called congenital. In others, the small passageway that the testicles used to descend into the scrotum does not fully close, leaving a natural weak spot where a hernia can appear later in life.
Inguinal hernias frequently develop with age, as the tissues of the abdominal wall gradually lose strength and elasticity.
Weaker abdominal muscles or conditions that affect the connective tissue – the body’s scaffolding – further increase the likelihood of hernia forming.
Anything that raises pressure inside the abdomen – such as chronic coughing, obesity, pregnancy or fluid buildup from ascites -can also reveal a weakness that is already present. This increased pressure adds to the overall likelihood of developing a hernia later in life.
Smoking adds further risk because it weakens tissues and can cause chronic coughing, which leads to recurrent increases in abdominal pressure.
Heavy lifting is often blamed, but it rarely causes a hernia by itself – it usually just makes an existing weakness noticeable.
In fact, specific lifting episodes are responsible for an inguinal hernia in fewer than 10% of patients.
Professional weightlifters do not have higher rates of inguinal hernias!
Hernias also tend to run in families, showing a hereditary predisposition.
What are the symptoms?
The abdominal wall normally keeps everything inside, but if there’s a weak spot, pressure from things like lifting, coughing or even standing can cause a bulge.
An inguinal hernia often shows up as a soft lump in the groin. It may be more noticeable when standing, straining or lifting.
Some people have no symptoms, while others feel discomfort, a heavy or dragging sensation, swelling around the testicles or a burning feeling in the groin. Pain is usually mild, but can worsen with activity and tends to be worse by the end of the day. Lying down or gently pushing the hernia back in often helps.
In rare cases, the hernia can become trapped (incarcerated), causing sudden, severe pain, a hard tender lump and sometimes nausea or vomiting. This is an emergency and requires immediate medical attention!
How is it diagnosed?
An inguinal hernia is usually found during a doctor’s check-up. The doctor looks for a lump or bulge in the groin, which may show up more when you stand, cough or strain.
Your doctor may gently press on it to see if it can be pushed back in. Most of the time, this is enough to know it’s a hernia.
Sometimes, if the bulge is small or hard to see, the doctor may request a scan like an ultrasound, CT or MRI to make sure.
Will it go away on its own?
No, an inguinal hernia will not go away by itself. It usually stays the same or may get bigger over time.
What is the treatment?
It depends on the type of hernia you have and the severity of your symptoms.
In the past, doctors often recommended repairing all hernias soon after diagnosis to prevent future complications, but newer evidence shows that such complications are uncommon. However, over time, some patients still require an operation because they develop symptoms.
If your hernia isn’t causing pain or other symptoms, it is generally safe to just watch it over time. Recent studies estimate that the lifetime risk of the intestine or fat getting trapped (incarceration) or losing its blood supply if it remains trapped too long (strangulation) is less than 1 in 300.
Surgery is done if the hernia is painful, causing problems or to avoid the risk of complications.
The main goal of surgery is to improve your quality of life and help prevent complications.
What does the operation involve?
There are basically two ways to repair a hernia: the traditional open repair and the laparoscopic (keyhole) technique.
Open repair
This is the traditional method. The surgeon makes a cut in the groin, pushes the bulge back through the weak spot in the muscle and places a soft mesh patch over the area where the hernia came through.
The mesh acts like reinforcement, similar to patching a hole in fabric. It avoids pulling the tissues together under tension. The mesh is gently secured to the surrounding tissues, so it stays in place and it also works as a scaffold for your body to grow stronger tissue over it.
This operation is considered low-risk and can be done with local numbing medicine, spinal anaesthetic or general anaesthetic, depending on the situation.
Laparoscopic repair
As with any keyhole (laparoscopic) surgery, the surgeon makes a few small cuts in your abdomen and uses a camera and long instruments to repair the hernia. This approach generally leads to less pain and a quicker recovery than open surgery.
To create space to work safely, the surgeon uses carbon dioxide (CO₂). In a TEP (Totally Extra-Peritoneal) repair a balloon is usually inserted to create space and then the gas is insufflated between the abdominal muscles and the lining of the abdomen.
In a TAPP (Trans-Abdominal Pre-Peritoneal) repair, the gas is placed directly inside the abdominal cavity.
During the operation, similar to open surgery but from a deeper route, the tissue that has bulged through the groin (fat or bowel) is gently pushed back into your abdomen. The weak area is then covered with a mesh to strengthen the spot and help prevent the hernia from coming back.
Your surgeon will determine the most suitable surgical approach based on your symptoms, hernia type and individual circumstances.
What to expect after surgery?
After your operation, you might go home the same day or spend one night in the hospital.
It’s normal to feel some pain, swelling or bruising around the surgical area (groin, testicles and wounds). You may also notice a pulling or tight sensation in the groin.
Most people can return to light daily activities within a few days, but should avoid heavy lifting or strenuous exercise for a few weeks. Ask your surgeon about what’s right for you.
Being completely inactive is not recommended.
Gentle activity such as short walks should start almost immediately, as recent research shows that early movement can help speed recovery.
After surgery, the most common side effect is some numbness in the groin, which often improves over time as the nerves settle down – this is particularly common after an open repair.
You may also notice some swelling or a small collection of fluid under the skin, called a seroma, or occasionally a small bruise or haematoma. These usually improve on their own over a few weeks.
How to prepare for surgery?
Before surgery, there are several things you can do to reduce complications and lower the chance of the hernia coming back:
- Stop smoking
- Achieve a healthy weight
- If you have diabetes – make sure it is well controlled
Physical activity can help strengthen your core muscles, which supports both recovery and the hernia repair.
Recent research has shown good results with hypopressive abdominal exercises. These exercises focus on engaging and strengthening the deeper abdominal muscles (transversus abdominus) without increasing pressure in the abdomen, which can be particularly helpful if you experience pain with standard abdominal workouts. Start with 20-minute sessions, 3 to 5 times per week. The intensity should be adapted to your fitness level, so guidance from a specialist is recommended.
Always check with your surgeon before starting any exercise program.
When surgery can’t wait
An inguinal hernia becomes incarcerated when a bulge that you could normally push back in suddenly won’t go back anymore. If this happens, it’s worth first lying down, relaxing and gently trying to push it back the same way you’ve done before. If it still won’t budge, you should seek urgent medical assessment.
When a hernia stays trapped for a long time – usually a few hours – the tissues inside (fat or bowel) can become so tightly squeezed that their blood vessels are compressed. Without enough blood flow, the tissue loses oxygen, a process called ischaemia. This progression is called strangulation, which is dangerous and requires immediate surgical care.
If a doctor can successfully push the hernia back in, surgery can usually be planned rather than done as an emergency – but it’s still best not to wait too long.
If the hernia can’t be pushed back in or if there are signs of poor blood flow emergency surgery is needed. In these cases, any damaged bowel or fat may need to be removed, which increases the risk of infection. When this happens, a mesh repair isn’t always possible and the operation may be a bit different from a standard scheduled procedure.
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