Inguinal Hernia

What is an Inguinal Hernia?

An inguinal hernia occurs when a portion of tissue, often part of the intestine, pushes through a weak spot in the abdominal muscles, resulting in a noticeable bulge in the groin area. This condition typically develops in the inguinal canal, a passage located in the lower abdominal wall.

The canal is present in both men and women but has unique anatomical roles; in men, it allows the spermatic cord to pass to the scrotum, while in women, it supports the round ligament of the uterus.

Inguinal hernias are classified into two main types:

Indirect inguinal hernia — this is the more common type and occurs when the hernia follows the pathway of the inguinal canal. It is often congenital, resulting from a failure of the abdominal lining to close properly during foetal development.
Direct inguinal hernia — this type develops over time due to a weakening in the abdominal wall’s muscles, often as a result of strain or ageing.

The condition can affect people of all ages but is more prevalent in men, particularly those with a family history of hernias or certain risk factors, such as chronic coughing, frequent heavy lifting, or prolonged constipation.

What causes Inguinal Hernia?

An inguinal hernia occurs when tissue from inside the abdomen, often a section of the intestine, pushes through a weak area or defect in the lower abdominal wall, particularly in the inguinal canal. This protrusion results from an imbalance between the pressure exerted within the abdomen and the strength of the surrounding muscular and connective tissues. The abdominal cavity is designed to contain organs and tissues securely within a supportive framework of muscles and fascia.

Under normal circumstances, the muscles and fascia of the abdominal wall resist intra-abdominal pressure generated by activities such as lifting, straining, or coughing. However, when the pressure exceeds the capacity of the tissues to withstand it, or if the wall has a pre-existing defect, the tissues may give way. This breach allows the herniation of internal structures, typically through the inguinal canal, which is naturally weaker due to its anatomical role in accommodating structures like the spermatic cord in men or the round ligament in women.

The condition often progresses as repetitive pressure episodes enlarge the hernia opening over time. This gradual weakening allows more abdominal contents to protrude, further compromising the abdominal wall and increasing the size of the hernia.

What are the symptoms of an Inguinal Hernia?

Recognising the symptoms of an inguinal hernia is essential for timely diagnosis and treatment. While the condition often starts with mild or intermittent discomfort, it can progress to more noticeable and potentially serious signs. Here are the common symptoms:

Visible bulge — a noticeable lump in the groin or lower abdomen, which may become more apparent when standing, coughing, or straining. The bulge may reduce or disappear when lying down.
Discomfort or pain — a sensation of pain, aching, or burning in the groin area, especially during physical activity or movement such as bending, lifting, or coughing.
Dragging or heavy sensation — a feeling of pressure, heaviness, or weakness in the groin, which may worsen over time.
Swelling around the testicles — in men, the hernia may extend into the scrotum, causing swelling or discomfort in the area.
Changes in symptoms during activity — symptoms often worsen during strenuous activity or prolonged standing and improve with rest.

While mild symptoms may not always require immediate intervention, it is crucial to seek medical attention if the hernia becomes painful, hard, or discoloured, as these could indicate a complication such as strangulation.

Who is at risk of an Inguinal Hernia in Singapore?

Inguinal hernias can affect individuals of all ages, but certain factors make some people more susceptible than others. Here are a group of people who are more at risk of developing inguinal hernia:

If you recognise any of these risk factors in yourself or your loved ones, it is advisable to consult a specialist for evaluation. At Allen Sim Urology, we provide comprehensive care to assess and manage inguinal hernias so we can help you maintain your health and well-being.

Gender

Men are significantly more likely than women to develop inguinal hernias due to the natural anatomy of the male inguinal canal, which is wider and less supported.

Age

The risk increases with age as the abdominal wall muscles naturally weaken over time.

Family history

Individuals with a family history of inguinal hernias are at a higher risk, as genetic factors may contribute to weaker abdominal tissues.

Chronic coughing

Conditions that cause persistent coughing, such as chronic obstructive pulmonary disease (COPD) or smoking-related cough, can increase abdominal pressure and the likelihood of herniation.

Heavy lifting

Frequent lifting of heavy objects, especially without proper technique, can strain the abdominal muscles and lead to hernias.

Straining during bowel movements or urination

Chronic constipation or urinary problems, such as an enlarged prostate, can create excessive abdominal pressure, heightening the risk.

Pregnancy

The added weight and pressure on the abdominal muscles during pregnancy can make women more prone to developing an inguinal hernia.

Obesity

Eexcess weight places additional strain on the abdominal wall, increasing the risk of hernias.

Premature birth and low birth weight

Babies born prematurely or with low birth weight may have underdeveloped abdominal muscles, which makes them more susceptible to hernias.

How is an Inguinal Hernia diagnosed?

01. Comprehensive medical history

Our healthcare experts start by discussing your symptoms and medical background, including any activities or health conditions that might have contributed to the hernia.

02. Physical examination

Our team performs a detailed examination to check for a bulge in the groin area. You may be asked to stand and cough, as this helps to make the hernia more apparent.

03. Imaging studies

When additional clarity is needed, we use imaging techniques like ultrasound or CT scans to confirm the diagnosis and assess the size and location of the hernia.

04. Individualised evaluations

For cases that are more complex, we may carry out further assessments to understand the condition of your abdominal muscles and identify any other factors influencing the hernia.

What are the treatment options for Inguinal Hernia in Singapore?

Our goal is to relieve discomfort, prevent complications, and help you return to your daily activities as quickly as possible. Depending on the severity of your hernia, we may recommend one of the following approaches:

Regular monitoring

For small or asymptomatic hernias, we may suggest regular monitoring to ensure there are no signs of worsening. We provide guidance on lifestyle adjustments to minimise strain on the abdominal muscles, which can help reduce the risk of hernia progression.

Open hernia repair

This traditional surgical method involves making an incision in the groin to access and repair the hernia. The protruding tissue is gently repositioned, and the weakened area of the abdominal wall is reinforced with sutures or a synthetic mesh.

Laparoscopic hernia repair

This minimally invasive technique uses small incisions and specialised instruments to repair the hernia. A tiny camera provides a clear view inside the abdomen, which allows us to reposition the tissue and secure the weakened area with mesh. This approach often results in quicker recovery times and less postoperative discomfort.

Robotic-assisted hernia repair

For suitable cases, we may use robotic techniques for enhanced precision and visualisation, which can be particularly beneficial for complex or recurrent hernias.

If you are experiencing symptoms of an inguinal hernia or have concerns about your condition, schedule a consultation with Allen Sim Urology for expert advice and personalised treatment options.

Frequently Asked Questions (FAQs)

01. Can an inguinal hernia heal on its own?

No, inguinal hernias do not heal by themselves. Without treatment, they may enlarge or lead to complications. Surgical intervention is typically required to repair the hernia.

02. What happens if an inguinal hernia is left untreated?

If left untreated, an inguinal hernia can lead to complications such as incarceration or strangulation, where the blood supply to the herniated tissue is compromised, which may require emergency medical attention.

03. Is inguinal hernia surgery considered safe?

Yes, inguinal hernia repair is a common and generally safe procedure. However, as with any surgery, there are risks involved, which should be discussed with your healthcare provider.

04. How long is the recovery period after inguinal hernia surgery?

Recovery time varies depending on the individual and the type of surgery performed. Generally, patients can return to light activities within a week and resume normal activities within a few weeks, following their surgeon's advice.

05. Can lifestyle changes help prevent inguinal hernias?

While not all inguinal hernias can be prevented, maintaining a healthy weight, avoiding heavy lifting, and practicing proper lifting techniques can reduce the risk. Strengthening abdominal muscles and treating conditions that cause chronic coughing or constipation are also beneficial.