What is a hernia?
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A hernia happens when an organ or fatty tissue pushes through a weak spot or tear in the surrounding muscle or connective tissue in the abdomen. The most common type is the inguinal hernia. It appears as a bulge in the groin or scrotum when part of the abdominal contents push into the inguinal canal through a weakened abdominal wall.
What is a groin hernia?
Groin hernias, which include inguinal and femoral hernias, are more common in men, especially older men. A femoral hernia also occurs in the groin but is found in a slightly different area. It sits to the side of the femoral vein and artery, in what is known as the femoral canal.
Why should I repair the hernia if there is no pain?
Dr Maré Du Plessis recommends that patients undergo an operation to repair a hernia.
He says: “The problem with hernias is that people are not well informed, and it’s not something people really talk about. An inguinal or femoral hernia should always be repaired. Even if it doesn’t cause any symptoms, it still needs to be fixed. A patient might say, “It’s not bothering me” or “I don’t feel any discomfort,” but we still recommend surgery. This is because research shows that hernias which don’t cause symptoms at first, usually become problematic later on. It’s best to repair them while the patient is still healthy enough for anesthesia. Waiting until they are in their seventies or eighties makes the surgery more risky.”
When hernias become symptomatic, there is a higher risk of complications and the hernia can become incarcerated or strangulated.
What is an incarcerated or strangulated hernia?
An incarcerated or strangulated hernia happens when the contents of the hernia gets stuck in the hernial orifice and it doesn’t reduce spontaneously. The patient gets severe pain in the groin and they end up in the emergency room needing an emergency hernia repair. Strangulation is when the contents of the hernia dies, and if it’s either small intestine or colon it becomes a dire complication and the patient can develop sepsis, which has a potential risk of death, especially in an older patient.
But why do we actually get hernias in the first place?
These two types of groin hernias have an embryological origin, meaning they begin to form before birth. The inguinal canal acts as a passageway for the testicles to move through. In the developing baby, the testicles form inside the abdominal cavity. Just before birth, they travel through the inguinal canal and the groin, down into the scrotum. Once the testicles have reached the scrotum, the canals are supposed to close and seal off.
In some babies, the canal doesn’t close properly, and they are born with a large inguinal hernia. Bowel contents can push through the canal into the scrotum, and in rare cases, the baby may need hernia surgery shortly after birth. More commonly, the canal closes but not completely. This leaves a weak spot that can get bigger over time and lead to a hernia later in life.
Another cause of hernias is increased pressure in the pelvis, often due to chronic constipation.
In older men, an enlarged prostate (known as prostatism) can also lead to constant straining when trying to empty the bladder. This is why we always ask about constipation and any problems with urination. These symptoms may suggest the need for a colonoscopy or a prostate check to rule out other conditions. We may also do a blood test to measure prostate levels in the bloodstream.
When to seek help
If you can feel a bulge in the groin area, or are feeling pain in that area, ask your GP to examine you, and refer you to a specialist, or call us and book a consultation. You can read more about the surgery to repair an inguinal hernia, here.