Inguinal hernia

An inguinal hernia is a bulge in the groin, and it does not go away.

A portion of intestine or fatty tissue pushes through a weak spot in the inguinal canal of the lower abdominal wall. It is more common in men than in women, it can be present at birth or appear later in life, and it does not heal on its own. A small hernia causing no real symptoms may simply be monitored. One that is painful, growing, or cannot be pushed back in needs a surgical opinion. An inguinal hernia specialist is a general surgeon, and Dr Sulaiman repairs them by keyhole where the case allows.

FRCSEd (General Surgery)Five clinics in Singapore

Cross-section through the layered abdominal wall, rendered in translucent blues. A loop of bowel, lit warm orange, has pushed through a split in one of the muscle layers and hangs below it, still wrapped in a thin translucent sac. — The wall has a weak point, and the bowel finds it. It is the loop coming through, not the wall itself, that causes the symptoms.

Groin

Where it shows

Intestine or fatty tissue pushes through a weak spot in the inguinal canal of the lower abdominal wall.

Men

Most affected

More common in men than in women. It can be present at birth or acquired later in life.

Chance it heals

It does not heal on its own. A small, symptom-free hernia may be monitored rather than operated on.

A&E

If it traps

Incarceration and strangulation are emergencies. See section 01.

His story

Dr Sulaiman Bin Yusof

Senior Consultant Colorectal and General Surgeon, seeing patients at five clinics in Singapore.

MBChB (Sheffield), M.Med (Surgery), FRCSEd (General Surgery)
Consults in English and Malay
MOH Fellowship, Peter MacCallum Cancer Centre, Melbourne
Singapore Health Quality Service Star Award 2023
Dean's Honour Roll for Teaching

More about Dr Sulaiman

When it cannot wait

Some symptoms mean today, not next week.

If left untreated, an inguinal hernia can become incarcerated, where it becomes trapped, or strangulated, where the blood supply to the herniated tissue is cut off. Both require emergency medical attention. Where the trapped tissue is a loop of intestine, it can also block the bowel entirely, which is a small bowel obstruction.

Go to an emergency department if you have sudden severe pain in the groin or abdomen, nausea or vomiting alongside a painful lump, or a firm tender lump that cannot be pushed back in.

What it feels like

A bulge that shows itself when you stand, cough or strain.

Visible bulge

A visible bulge in the groin is a clear sign. It becomes more noticeable when standing, coughing or straining, because the increased abdominal pressure pushes the herniated tissue further out.

Pain or discomfort

Common in the groin, especially when bending over, lifting heavy objects or coughing.

Weakness or pressure

Many people feel weakness, pressure or heaviness in the groin, from the strain the herniated tissue puts on the abdominal wall.

Burning or aching

A burning or aching sensation at the site of the bulge, constant or intermittent, often worse with physical exertion. It comes from irritation and inflammation of the tissues around the hernia.

Swelling around the testicles

In men, the hernia can cause swelling around the testicles if the protruding intestine descends into the scrotum.

Two types

Two types, and the difference is when the weakness started.

Inguinal hernias are classified into two main types based on their cause and anatomical location.

Indirect

The most common type, often occurring in infants and children because of a congenital weakness in the abdominal wall. The hernia follows the pathway the testicles take during foetal development, and in males it can extend into the scrotum.

Direct

Typically occurs in adults as the abdominal muscles weaken over time. It is caused by a defect or weakness in the posterior wall of the inguinal canal, which lets intestine or fatty tissue protrude directly through the abdominal wall.

Why it happened

Six things that make it more likely.

A weakness you were born with

Some people are born with an innate weakness in the abdominal wall, particularly in the inguinal canal. The muscles are not as strong, which lets tissue push through.

Pressure inside the abdomen

Activities and conditions that raise intra-abdominal pressure can weaken the abdominal muscles over time.

Pregnancy and weight

Increased weight and pressure, especially across multiple pregnancies, can weaken the abdominal muscles as they stretch.

Age, and being male

Muscles naturally lose strength and elasticity with age, which makes the abdominal wall more susceptible. Men are more likely to develop inguinal hernias than women because the inguinal canal is larger in men, being the route the testes descend through before birth.

Family history

A family history can raise the risk, through genetic factors that contribute to weak spots in the abdominal muscles.

Low birth weight or prematurity

Infants born prematurely or with a low birth weight are at higher risk, because their abdominal muscles may not be fully developed.

Cutaway illustration of the abdominal wall with a loop of intestine pushing through a gap in the muscle layer, forming a bulge under the skin. — How a hernia forms: tissue pushes through a weakness in the muscle wall and bulges under the skin.

How it is confirmed

Usually an examination, sometimes a scan.

Diagnosis typically starts with a physical examination, where the doctor inspects the groin for a visible bulge. He will palpate the hernia, feeling for any protrusion, and may ask you to strain to make it more noticeable. He will also assess pain or discomfort in the groin during physical activity, to gauge the severity and location of your symptoms.

If the hernia is not easy to see or feel, imaging can give a clearer picture.

Ultrasound

Uses sound waves to create images from inside the body and can pick up hernias that are harder to spot.

CT scan

Gives detailed pictures of the abdomen, showing whether there is a hernia and how big it is.

MRI

Uses magnetic fields and radio waves for even more detail, another way to confirm a hernia and see how it affects the surrounding tissues.

What can be done

Managing the symptoms, and repairing the wall.

Non-surgical treatment can help manage symptoms and reduce discomfort. It does not repair the hernia.

Pain relief

Over-the-counter pain relievers such as paracetamol or ibuprofen can help manage the pain and improve day-to-day functioning.

A truss or supportive garment

Provides external support, helping to hold the hernia in place and reduce discomfort, particularly during physical activity. A properly fitted truss should be used under a doctor's guidance, to make sure it works and to prevent further complications.

Surgery is required when non-surgical measures stop managing the symptoms, or when complications develop.

Open repair

Also called herniorrhaphy. An incision is made in the groin to reach the hernia. The protruding tissue is pushed back into the abdomen and the weakened area repaired with sutures, often reinforced with synthetic mesh, which is called hernioplasty. Suitable for both small and large hernias, and can be performed under local, regional or general anaesthesia.

Keyhole repair

A minimally invasive procedure through several small incisions in the abdomen. A laparoscope, a thin tube with a camera, and other instruments repair the hernia from within using synthetic mesh. Preferred for hernias that recur or occur on both sides, because it typically means less pain and a faster recovery.

Cutaway illustration through the layers of the abdominal wall: skin, a yellow fatty layer, then a sheet of red muscle with an oval gap in it. A flat white woven mesh lies across the gap and overlaps onto the intact muscle on every side, with loops of bowel visible beneath. — The mesh is laid flat over the gap and well past its edges, so the abdominal wall grows into it rather than being pulled closed under tension. Illustration, not a photograph, and not yet certified by Dr Sulaiman.

What happens on the day, and what recovery looks like week by week, is on the keyhole hernia repair page.

Lowering the risk

What actually helps.

Keeping your abdominal muscles strong and avoiding activities that put too much pressure on your abdomen are the two things that matter.

Simple exercises like planks and leg raises help support the muscles, and lifting objects correctly reduces strain on the abdomen. A diet high in fibre prevents constipation, which avoids straining during bowel movements, a common cause of raised abdominal pressure. Maintaining a healthy weight matters too, as extra weight adds pressure to the abdominal area.

Common questions

Three questions people ask first.

Will it heal on its own?

An inguinal hernia does not heal on its own and typically requires surgery to repair the weakened area of the abdominal wall. Where the hernia is small and not causing significant symptoms, a doctor may recommend regular monitoring to detect changes.

How long is recovery?

Recovery varies depending on the procedure. Generally there is some pain and swelling for a few days afterwards. Most people resume light activity within a week and normal activity within a few weeks, but heavy lifting should be avoided for several weeks to allow proper healing.

Do I need a specialist for an inguinal hernia?

In Singapore the specialist for an inguinal hernia is a general surgeon with experience in hernia repair. Dr Sulaiman is a senior consultant general and colorectal surgeon who repairs inguinal hernias by keyhole where the case allows, and self-referrals to a specialist are welcome.

Book a consultation

A groin hernia does not close on its own. Have it examined.

If you have a bulge in the groin, or an ache that comes on when you stand, cough or lift, it is worth having it examined by a specialist rather than waiting to see whether it settles. Self-referrals are welcome and appointments are typically available within one working day. If the pain came on suddenly, or the lump is firm, tender and will not push back in, go to A&E instead of waiting for an appointment.