The groin is that area of the body where the legs join the trunk. This area is probably the most frequent site of hernia formation not associated with prior surgery. A hernia is a protrusion of body parts from their normal location. It occurs due to a congenital developmental problem or is acquired over time due to tears or weakening of the muscles and /or fibrous tissues in the area.

There are three main types of groin hernias that occur. These are indirect and direct inguinal hernias and femoral hernias. Inguinal hernias are much more common than femoral hernias in both males and females. However, femoral hernias are more common in females than males. A person can have more than one type simultaneously.

Indirect hernias occur in association with a failure of normal developmental anatomy but can be seen with a weakening of local musculature over time. Almost all groin hernias in young patients are indirect hernias but this type of hernia can be seen in the elderly as well. Femoral hernias can be associated with a congenital developmental problem but are usually acquired hernias due to tears or weakening of local fibrous tissues. Virtually all direct inguinal hernias are acquired hernias due to stress and strain on local tissues acutely or gradually over time.

All groin hernias have increased intraabdominal pressure (IAP) as a precursor to their development. This can come from routine activities but is often due to extra pressure from heavy lifting, obesity, pregnancy, excessive coughing from lung disease, straining to urinate because of prostate problems, or straining to evacuate the bowels because of constipation or bowel obstruction from tumors. Once the hernia has developed, it will not go away. However, reducing or eliminating those factors, which cause increased IAP, will help with symptoms and may slow the progression of the hernia.

Hernias eventually result in a bulge in the area where they have developed once they become large enough. This may be noticeable after doing some sudden straining or may be noticeable towards the end of the day after being up on your feet. Hernias can cause pain that can be quite sharp and severe. On the other hand the pain can just be a dull ache.

Once a suspected groin hernia is confirmed by physical examination, surgical repair is almost always indicated. As stated previously, the hernia will not go away once it has formed. Most will enlarge over time. As the hernia defect enlarges, there comes a point where it is large enough to entrap vital structures such as a loop of intestines. This can cause intestinal obstruction but can also lead to strangulation and gangrene of the bowel.

There are numerous surgical procedures that have been developed to correct groin hernias. For many years, these were all done as open procedures requiring an incision in the groin. Now there are closed, or laparoscopic, techniques for dealing with the problem as well. Prosthetic devices such as mesh are often used with open procedures and, invariably, with the closed procedures. Problems such as bowel obstruction or prostatic obstruction causing IAP should generally be dealt with prior to the hernia repair. Almost all groin hernia repairs are now done as outpatient surgery. The recovery time can vary from several days to several weeks depending on the type of hernia, the type of repair, the age and condition of the patient, and the level of activity the patient expects to return to. No one technique is appropriate for all hernias and patients. It is important for the patient’s doctor to be experienced in several different techniques so that the procedure chosen is tailored to the needs of the patient. Sometimes, the intraoperative findings will necessitate a change to a different technique from that originally discussed, but this is always with the patient’s welfare in mind. 

During the surgical recovery period, it is important for the patient to avoid those activities that will increase IAP and put undue stress on the repair before tissues have achieved maximal healing. The surgeon will generally specify the time frame for this as it can vary from one case to the next. After the recovery period, most properly performed repairs have a better than 90% chance of holding up over time. Controlling those factors, which can cause increased IAP, will help your hernia repair be a one-time event.