Inguinal Hernia

A hernia occurs when tissue from one body cavity bulges through an opening in your muscle wall into another. Inguinal hernias are the most common type of hernia. They happen when abdominal tissue, such as belly fat or a loop of intestines, bulges through an opening in your lower abdominal wall . This is the wall that separates your abdomen from your groin.

Inguinal hernias occur in the inguinal canal, which is a passageway that runs down either side of your pelvis into your sex organs. They’re also called groin hernias. (“Inguinal” means “in the groin.”) They’re the most common type of groin hernia, though not the only type. (Less common are femoral hernias, which happen in the smaller femoral canal that runs underneath the inguinal canal.)

What’s the difference between a direct inguinal hernia and an indirect inguinal hernia?

• Direct inguinal hernia: A direct inguinal hernia penetrates directly through the wall of your inguinal canal. This type of hernia occurs in adults over time, from a combination of weakening abdominal muscles and chronic pressure on the muscle wall.
• Indirect inguinal hernia: An indirect inguinal hernia enters your inguinal canal through the top. This usually occurs because of a birth defect. In some fetuses, the opening to their canal doesn’t close all the way during development in the uterus.

Who does inguinal hernia affect?

For reasons of anatomy, inguinal hernias usually affect people assigned male at birth (AMAB), by a ratio of 10:1. Your testicle begins above your lower abdominal wall and descends through your inguinal canal into your scrotum. The place where your testicle passes through is more susceptible to a hernia because it’s a preexisting opening, which is more easily reopened. And, sometimes, it doesn’t close all the way during development in the first place.

In people assigned female at birth (AFAB), the inguinal canal is narrower and begins under their abdominal wall. It carries the round ligament that supports their uterus, and this tough ligament helps to reinforce their muscle wall. However, women with connective tissue diseases may be more susceptible to hernias where connective tissue attaches their uterus to their inguinal canal. Congenital indirect inguinal hernias may also affect babies who are AFAB.

How common are inguinal hernias?

Up to 75% of all hernias are inguinal hernias. Around 25% of people AMAB will have an inguinal hernia during their lifetime, compared to 2% of people AFAB. Direct (acquired) inguinal hernias are more common in middle-aged and older men. Indirect inguinal hernias affect up to 4.5% of children, including 2% of babies AMAB and 1% of babies AFAB. Premature babies are up to 30% more likely to get one.

How serious is an inguinal hernia?

Hernias aren’t always serious, but serious complications can develop. Hernias do tend to worsen over time. As the opening becomes weaker and wider, more tissue can push through it. The more tissue pushes through, the more likely it is to become trapped. This can be painful, and in extreme cases, can be dangerous. Once trapped, a piece of your intestine could become pinched and blocked, or the tissue could become cut off from your blood supply.

If your hernia already causes you discomfort, your healthcare provider will probably recommend fixing it in surgery before it becomes worse. If you don’t have symptoms yet, they may just wait and watch it for a while, but most inguinal hernias will become symptomatic with time. Pediatricians generally recommend treating children with inguinal hernias immediately, as their risk of complications is greater. This is also true for people AFAB.