Groin hernia are common, occurring in up to 10% of all men. 90% of groin hernia occur in men. The groin area is known anatomically as the inguinal region. It is the hinge area where the leg meets the body. Two common hernia occur in this area, inguinal and femoral. They are named because they occur at different sites, and although they are not far apart they behave differently. The anatomy is complicated because of the many muscle attachments and the constant movement.
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There are several different types of hernia based on where they occur. It can get a bit confusing. The simplest thing is to find out what sort you have or have been told you have and start by reading about that type. All hernia have things in common but each has it's own presentation and risks. Treatment is usually specific for each type.
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Inguinal Hernia
Inguinal hernia occur in up to 10% of men but only rarely occur in women. They are divided into 2 types based on anatomy. The Indirect type occurs mostly in younger males and the Direct type in older men. The anatomy of these is a little different and complex but interesting if you are a surgeon.
There is almost certainly an inherited genetic predisposition of weaker groin tissue that contributes to both. Inguinal hernia can occur in women due to a remnant structure that descends along the same path. Although rare it shows that men and women share some things in common.
Femoral Hernia
These are small hernia that occur near the inguinal canal close to the top of the inner thigh. They are more common in women. The defect is often only 10 - 15 mm in diameter. They are barely noticeable and only cause trouble if bowel gets caught. Because they are small they are frequently missed and commonly need urgent surgical treatment.
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Bilateral Inguinal Hernia
Inguinal hernia are often bilateral - occurring on both sides. This is because the weakness in the muscle or tissue is symetrical. One side may occur first so it is the other side should always be checked.
These are rare hernia that occur at the lateral edge of the '6 pack' rectus muscles. They have a small opening and can get bowel stuck in them. They do not bulge out into the subcutaneous fat and are difficult to diagnose. An USD is the best test. They are easily repaired by open or laparoscopic surgery.
The term 'ventral' refers to the front of the abdomen. So any hernia in this site can be called ventral. It includes epigastric hernia, umbilical and paraumbilical and Spigelian hernia. However it commonly refers to incisional hernia that follow other surgery.
Incisional or Post Operative Hernia
An incisional hernia occurs at the site of a previous abdominal operation. They can occur after any surgery, no matter how large or small. They are also called ventral hernias as they usually occur on the ventral or front part of the abdomen. Any abdominal incision can be followed by a ventral hernia. They may appear within a few days of the operation or years later. These are often symptomatic and can be complicated and need a lot of thought about how to repair them.
We can discuss these 2 together. The belly button is a weak spot as the umbilical cord passed through it. It does not always close over and any thing that increases abdominal pressure can cause it to reopen. This commonly is intra abdominal fat, fluid accumulating in the tummy or pregnancy. They are easy to spot as the belly button pokes out.
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Equally as common is a para-umbilical hernia which pokes out just beside the belly button (Para). These are congenital and are commonly mistaken for an umbilical hernia. They are generally pretty small and do not always need surgical repair. However if they are symptomatic surgery should be considered.
A relatively common hernia that occurs in the midline of the abdomen above the belly button. Sometimes painful but can often be ignored. These are frequently multiple.
Midline or Epigastric hernia
Stomal Hernia
This is a partictular hernia that occurs around a stoma that has been made in the abdominal wall during previous surgery. They are at risk of bowel getting caught in them and should be repaired if possible. However the surgery is rather difficult and needs planning.
Recurrent hernia are exactly what it says. This is a new hernia that reappears in the same place. This may be days after the original surgery or many years. It is immediately more complex as the previous operation will have altered the anatomy and will make the next repair more difficult. There are extra risks associated with another repair including a further recuurence.
This refers to hernias occuring inside the abdomen. They are not due to a hole in the abdominal wall so there is no bulge to see. This makes them dangerous as they are often missed. They are due to bowel being caught under a band or adhesion. Or in a 'pocket' within the abdomen.
Bands and adhesions are common after abdominal surgery. Most often the bowel is blocked and the patient presents with a bowel obstruction. However there is a high risk of the bowel being strangled, lose its blood supply and become gangrenous. Early detection is important and early surgery essential.
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A bowel obstruction in a patient with previous surgery should immediately raise the question; is this a closed loop. Early surgery is essentail.
Sports Hernia or Athlete Groin Strain
Demanding sports place stress on the muscles and tendons in the groin. Tears and inflammation are common and can cause pain similar to that of a hernia. They do not need hernia surgery. More on the Symptoms page.
Something that looks like a hernia but isn't !
The central midline of the abdomen is tendon that separates the two rectus or '6 pack' muscles. These are important muscles that stabilise the spine and allow the abdomen to help with breathing amongst other things. With time these 2 muscles can separate stretching the tendon between them. This produces a longish bulge in the midline particularly noticeable on raising your head while trying to sit up. It is common and can appear after pregnancy. There is an inherited tendancy to develop. This is called a Divarication or Diastasis.
It is not a true hernia and does not cause symptoms. Most patients notice the swelling. It does not need fixing unless it is large.
'Divarication' of the Rectus
Hydrocoele of the scrotum
A hydrocoele is a collection of watery fluid around the testes inside the scrotum. They are common and can occur in newborn baby boys due to abdominal fluid travelling down the residual connection with the abdomen.
They occur in adult men, often with out an underlying cause. They can occur with a hernia and can be confused with a hernia. Medical students are taught how to tell the difference using a pen light in a darkened room.
Fitmomintraining.com
A Richcter's hernia occurs when only part of the side of the bowel wall gets caught in a defect. It is named after August Gottlieb Richter who described this type of hernia in 1785.
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They can occur in any hernia but the risk is greater when the hole is small, typically a femoral or inguinal hernia.
Uncommon Hernia
There are rare hernia that are a real challenge to diagnose. They mostly occur in the pelvis and are largely not visible.
A 'Pre - Vascular Hernia' occurs in front of the major blood vessels deep to the inguinal groin crease. This usually happens after previous surgery. These can be repaired with mesh but require planning to prevent further trouble.
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A Lumbar Hernia occurs in the loin after open kidney surgery can also be difficult to repair due to local muscle weakness.
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An Obturator Hernia is a hernia occurring in the pelvis. They are rare and difficult to diagnose as they are not visible. The patient usually has the leg flexed as it is more comfortable and may have pain in the front of the thigh.
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Occasional rare Pelvic Hernia can occur through other sites in the pelvis. These are nearly always in the 5th & 6th decades or older. These hernia have a small defect and a high risk of incarceration. For example a hernia through the sciatic notch may present with a sciatica due to pressure on the sciatic nerve.
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