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Allen KamravaMD · MBA · FACS · FASCRS

Colon and Rectum

Inguinal Hernia

An inguinal hernia is a bulge of abdominal contents, such as intestine or fat, through a weak spot in the lower abdominal wall into the groin area.

Reviewed by Allen Kamrava, MD, MBA, FACS, FASCRS · Last reviewed 2025-10-12

Overview

What is an inguinal hernia?

An inguinal hernia is a protrusion of abdominal contents, most commonly a loop of intestine or abdominal fat, through a weak area in the lower abdominal muscles. This bulge occurs in the groin area, specifically in the inguinal canal. Inguinal hernias are very common, affecting men far more often than women. They can be present at birth (congenital) or develop over time (acquired).

There are two main types:

  • Indirect Inguinal Hernia: This is the most common type and is usually congenital. It occurs when the inguinal canal fails to close properly after the testicle descends into the scrotum during fetal development. This leaves a path for abdominal contents to slide into the canal.
  • Direct Inguinal Hernia: This type is acquired and results from a weakening of the muscles of the abdominal wall over time, often due to aging or chronic straining. It is more common in older men.

Symptoms

What are the symptoms of an inguinal hernia?

The most common sign of an inguinal hernia is a visible bulge in the groin or scrotum. The bulge may become more noticeable when you stand, cough, or strain, and it may disappear when you lie down. Other symptoms include:

  • A feeling of heaviness, aching, or burning in the groin.
  • Pain or discomfort in the groin, especially when bending over, coughing, or lifting.
  • In men, pain and swelling in the scrotum if the protruding intestine descends into it.

Causes & risk factors

What causes an inguinal hernia?

An inguinal hernia is caused by a combination of muscle weakness and strain. The weakness can be a congenital defect or can develop later in life. Any condition that increases pressure on the abdominal muscles can contribute to the formation or worsening of a hernia. Common causes and risk factors include:

  • Increased intra-abdominal pressure: From chronic coughing, chronic straining during bowel movements or urination, obesity, or heavy lifting.
  • A pre-existing weak spot: Such as a patent processus vaginalis (in indirect hernias) or weakened connective tissue.
  • Family history: Having a close relative with a hernia increases your risk.
  • Smoking: Can weaken connective tissues.
  • Previous abdominal surgery.

When to see a doctor

When should I see a doctor?

You should see a doctor if you have a painful or noticeable bulge in your groin. While many hernias are not immediately dangerous, they do not go away on their own and tend to get larger over time. A doctor can confirm the diagnosis and discuss whether you need surgery. Early elective repair is often recommended to prevent the hernia from becoming incarcerated.

Urgent — get care now

When is it an emergency?

An inguinal hernia becomes an emergency if it is incarcerated (trapped) or strangulated. This occurs when the contents of the hernia sac become stuck and cannot be pushed back into the abdomen. Strangulation means the blood supply to the trapped tissue is cut off, which can lead to tissue death (gangrene).

You should seek immediate medical attention if you have a hernia and develop any of the following symptoms:

  • Sudden, severe pain in the hernia.
  • Nausea, vomiting, and inability to have a bowel movement or pass gas.
  • The bulge becomes firm, tender, and cannot be pushed back in.
  • The bulge turns red, purple, or dark.

Diagnosis & tests

How is an inguinal hernia diagnosed?

The diagnosis of an inguinal hernia is usually made with a physical examination. The doctor will examine your groin for a bulge. You may be asked to stand and cough or strain to make the hernia more prominent. The doctor may gently try to push the hernia back into your abdomen (reduce it). In most cases, no further testing is needed. If the diagnosis is unclear, an ultrasound or CT scan may be used to look for a hernia.

Treatment

How is an inguinal hernia treated?

The definitive treatment for an inguinal hernia is surgical repair. For small, asymptomatic hernias in men, a strategy of watchful waiting may be an option, but most hernias will eventually require surgery.

There are two general types of hernia surgery:

  • Open Hernia Repair: The surgeon makes an incision in the groin and pushes the protruding tissue back into the abdomen. The weakened area of the abdominal wall is then reinforced, most commonly with a piece of synthetic mesh. This is known as a tension-free repair and has a very low recurrence rate. The repair can be done under local, spinal, or general anesthesia and is often an outpatient procedure.
  • Laparoscopic Hernia Repair: This is a minimally invasive approach. The surgeon makes several small incisions in the abdomen and uses a laparoscope (a thin tube with a tiny video camera) and specialized instruments to repair the hernia. A piece of mesh is placed on the inside of the abdominal wall to cover the defect. Laparoscopic repair is always done under general anesthesia. It may result in less postoperative pain and a quicker return to normal activities compared to open surgery.

Self-care

Recovery After Hernia Surgery

Recovery time varies depending on the type of surgery. Most people can return to light activities within a few days and normal activities within a few weeks. It is important to avoid heavy lifting and strenuous activity for 4-6 weeks after surgery to allow the repair to heal properly. Maintaining a healthy weight and avoiding constipation can help prevent the hernia from recurring.

Frequently asked questions

Can an inguinal hernia go away on its own?
No. An inguinal hernia is an anatomical defect and will not heal on its own. It will likely get larger and more symptomatic over time.

Do all inguinal hernias need surgery?
Most inguinal hernias are recommended to be surgically repaired to avoid the risk of incarceration and strangulation. However, for older, sedentary men with small, minimally symptomatic hernias, watchful waiting can be a safe option.

What is a sports hernia?
A 'sports hernia' is not a true hernia but a strain or tear of any soft tissue (muscle, tendon, ligament) in the lower abdomen or groin area. The medical term is athletic pubalgia. The pain is similar to an inguinal hernia, but there is no bulge.

References

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