Groin hernias are one of the most common types of hernia, affecting both men and women. They occur when a part of the bowel or internal fat pushes through a weak spot in the lower abdominal wall, creating a lump or bulge in the groin area.
While not always painful, groin hernias can cause discomfort and can lead to serious complications if left untreated. This article explains what groin hernias are, what symptoms to look out for, and when to seek medical advice.
What Types of Groin Hernias Are There?
There are two main types of groin hernias:
- Inguinal hernia: This is the most common type of hernias accounting for 3 out of 4 hernia cases. About 1 in 4 men and 3 out of 100 women will develop inguinal hernias at some point in their lives. It occurs when tissue pushes through a weak point in the inguinal canal. Inguinal hernias can be:
- Indirect: Occur when abdominal contents protrude through the deep inguinal ring due to a congenital defect. These are the most common type and often appear in younger patients.
- Direct: Occur through a weakness in the posterior wall of the inguinal canal and are typically acquired with age. They are more common in older men.
- Femoral hernia: This occurs lower down in the groin, where the femoral canal passes through the abdominal wall. Femoral hernias are less common but more likely to cause complications. They are more frequent in women.
What Causes Groin Hernias?
Several factors can contribute to the development of a groin hernia:
- Congenital weakness in the abdominal wall
- Repeated heavy lifting
- Chronic coughing or sneezing (e.g. from smoking or asthma)
- Constipation and straining during bowel movements
- Obesity or significant weight gain
- Pregnancy
- Age-related muscle weakening
- Family history of hernias
Sometimes hernias develop with no obvious cause.
Common Symptoms of Groin Hernias
- A bulge or lump in the groin area
- Discomfort or aching, especially when standing or lifting
- A heavy or dragging sensation in the groin
- Pain that improves when lying down
- In men, the bulge may extend into the scrotum
The lump may come and go, and is often more noticeable after activity or at the end of the day.
What Can Go Wrong If a Hernia Is Left Untreated?
If untreated, groin hernias can become more serious. Possible complications include:
- Incarceration: The hernia becomes trapped and cannot be pushed back in
- Strangulation: The blood supply to the trapped bowel is cut off, leading to tissue death. This is a medical emergency.
Femoral hernias, though less common, are more likely to become strangulated and often require earlier treatment.
How Are Groin Hernias Diagnosed?
Most groin hernias can be diagnosed with a physical examination. Your GP or surgeon will usually be able to feel the hernia when you cough or strain. During the examination, the opposite groin is also carefully checked to look for a hernia on the other side, as hernias can sometimes occur on both sides.
Ultrasound is sometimes used, particularly when the diagnosis is unclear, but it tends to overdiagnose hernias or suggest a hernia where there isn't one. In cases of diagnostic uncertainty, a CT scan may be needed to confirm the diagnosis and rule out other causes of groin lumps.
It's important to distinguish hernias from other conditions such as swollen lymph nodes, varicoceles, hydroceles, or groin strains.
Managing a Groin Hernia Without Surgery
Groin hernias do not heal on their own. While some inguinal hernias that are not causing any symptoms can be safely observed, they tend to grow larger with time. The larger the hernia, the more difficult the repair, and the greater the chance of complications or recurrence.
All femoral hernias should be repaired, even if they are small, because they have a higher risk of becoming strangulated and causing serious complications.
For patients who are unfit for surgery, support garments or trusses may provide temporary symptom relief. However, these do not treat or reverse the hernia, and their use should be supervised by a medical professional.
Emergency surgery to repair a painful or entrapped hernia is more complex. It often involves bowel resection, a longer hospital stay, higher risk of complications, and increased likelihood that the hernia will come back.
