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Groin Hernia

What that bulge in your lower abdomen means and how to treat it.

What is a groin hernia?

Your abdomen is essentially a collection of organs, intestines, and tissue. All of these are held together within the abdominal wall—the thick, fibrous, and muscular sac that keeps your insides in and the outside out.

A hernia is a hole in your abdominal wall that occurs any time an organ or body tissue pushes out through it. In a groin (or inguinal) hernia, part of the intestines, fat, or pelvic organs from your belly can protrude through the abdominal wall in the groin—the area between your stomach and thigh. They can also slide in and out, depending on whether or not you are straining your abdominal muscles, or if you are standing up versus laying down.

This can lead to an unsightly bulge in the groin, discomfort, and pain. Surgery can be performed to repair the hernia. But it doesn’t always require surgery if it is not causing problems. A compression belt called a truss can be used to help with any discomfort in the area.

How serious is a hernia in the groin?

Pro Tip

Ask the surgeon which type of hernia repair they plan on doing. There is more than one way to approach a hernia repair. An “open” approach through an incision over the groin, with cameras through the abdomen, or even a robotic repair through multiple small incisions in the abdomen. —Dr. Conor Coogan

There are many people who have groin hernias without knowing it, or they may have mild discomfort when they become larger. But they can become “stuck,” causing them to swell and cut off the blood supply. This can cause severe pain over the groin area, constipation, fever, vomiting, and the area may look discolored.

If this happens, you might need emergency surgery. While rare that the hernia becomes stuck, it is a reason to consider repairing a hernia. Groin hernia surgery is one of the most common surgeries in the U.S., with over 700,000 repairs each year.

Most common symptoms

Most people discover a bulge in their groin. This bulge may be noticeable all the time or just stick out sometimes. Activities that increase pressure on the abdomen—coughing, standing, heavy lifting, straining—make the bulge stick out more.

Not everyone will feel pain from a groin hernia. But many people complain of a dull discomfort in the area of the lump. Usually, it is worse after a long day on your feet or straining.

If the contents of the hernia get stuck outside the abdomen, they can swell and cut off the blood supply. You may have more intense pain, along with a fever, chills, nausea, vomiting, or constipation. If this happens, go to the hospital immediately.

Some conditions may mimic a hernia with symptoms of pain, discomfort, or a new lump in the groin. For example, there are many lymph nodes in the groin area that can get enlarged and tender if you have a cold or stomach bug. These usually feel like small marbles under the skin. And they will go away when you get over your sickness—unlike a hernia, which does not go away until it's repaired.

Main symptoms

The symptoms of a groin hernia are often mild. They include:

  • A mass or bulge visible in the groin area
    • This mass generally gets bigger the more pressure you put on your abdomen. Like when straining, coughing, heavy lifting, or standing up all day at work.
    • Over time, most groin hernias will grow in size.
  • Pain or discomfort, which is worse when you are straining, coughing, or standing for a long time.

Other symptoms you may have

  • Pain on the inner thigh
  • Difficulty urinating
  • Generalized abdominal pain
  • Constipation

Next steps

If you find a new mass or bulge in your groin but only feel symptoms of mild pain or discomfort, you should make an appointment with your doctor.

If you find a new bulge in your groin and have severe pain—especially when you touch it—and fever, chills, fast heart rate, inability to eat, nausea, vomiting, or significant bloating of your abdomen, go to the emergency room or urgent care.

Groin hernia treatment

Dr. Rx

Nearly all repairs are performed with medical grade mesh. The mesh is safe, sterile, and greatly helps to reduce the chance of the hernia coming back. Think of the mesh as similar to a patch—like if you were patching a pair of jeans. —Dr. Coogan

Since a hernia is a hole in your abdominal wall, it will not get better on its own. The hole may eventually enlarge. If you have minimal or no symptoms, surgery may not be needed. You can take a wait and see approach.

While most hernias get worse over time, it does not always happen. Delaying surgery is generally safe, with less than 2% of people needing emergency surgery. Wearing a hernia truss can help with discomfort in the area.

If a hernia is causing discomfort or pain, you may choose to have the hernia repaired with surgery.  Surgery can help with symptoms and keep them from becoming worse. Talk to your surgeon about the risks and benefits of hernia repair.

Surgery

Groin hernia repair is one of the most common surgical procedures in the world. It is generally very straightforward. And works well for cases with mild symptoms.

  • Hernia repair is either done through open surgery—where a cut (incision) is made over the groin—or laparoscopic surgery, where multiple smaller incisions are made over the abdomen. The risk for complications are similar. For small, simple hernia repairs, either approach works. Typically, you’ll go home the same day or the next morning.
  • People who have painful hernias may have something called an incarcerated hernia or strangulated hernia. This is when the blood supply has been cut off. It requires emergency surgery.
  • A less common type of groin hernia, called a femoral hernia, also requires surgical repair right away. It has a higher risk of complications—getting it repaired is always advised regardless of symptoms.
  • Large, complex groin hernias or patients who need an emergency repair may have a longer hospital stay. They will be monitored for pain and sometimes will be given IV antibiotics if part of the bowel was removed.

No matter the approach, most repairs use mesh, a sterile patch, to improve the strength of the repair. Mesh reduces the rate of the hernia coming back after surgery by about half.

Causes of a groin hernia

In younger adults (especially males), groin hernias are usually from a defect in the abdominal wall. Right at the level of the groin. This lets the abdominal contents poke through.

In older adults, hernias generally happen because the tissue of the abdominal wall has become weak with age. This allows bowel or other abdominal contents to stick through.

There are many things that cause a hernia to form. Including genetics. But also factors like smoking, aging, or chronic steroid use can weaken the abdominal wall.

Additionally, more pressure on your abdomen (i.e., due to coughing, straining, heavy lifting, or pregnancy) stretches your abdominal wall. This increases the risk of having a hernia.

Groin hernias in children

Occasionally, babies and children get groin hernias—especially premature male infants. Groin hernias in children often look like a mass in the groin. They are often found by a pediatrician during a well visit.

Just like in adults, hernias do not get better over time—and can get larger. The chance of a hernia becoming stuck is higher in children, so it is recommended that all hernias in children are repaired. Repairs in children are very common procedures performed by a pediatric surgeon on an outpatient basis. They take under an hour and do not use mesh.

Follow up

Pro Tip

Let your surgeon know what your typical work entails. You may have to be on light duty—no heavy lifting—for 1 to 2 months. —Dr. Coogan

After surgery, follow your surgeon’s instructions. Typically, they will ask that you do not lift anything heavy (greater than 10 lbs or a gallon of milk) or do strenuous exercise for 6 to 8 weeks.

This allows the tissue to heal and helps prevent the hernia from recurring. Keep the site of the incisions clean and dry. Watch for redness, discharge, or other signs of infection.

Preventative tips

It is hard to keep a groin hernia from forming. But you can lower your risk by not smoking, eating healthfully, and exercising regularly. If you have already had a surgery to repair a groin hernia, talk to your surgeon about what else you can do to lower your risk of having another one.

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