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JAMA Patient Page
June 27, 2017

Groin Hernia

JAMA. 2017;317(24):2560. doi:10.1001/jama.2017.1556

A groin hernia is a weakness in the muscles and tissues of the groin.

Both men and women have natural weaknesses in the tissues of the inguinal canal, a passage from the inside of the abdomen to the scrotum in men and labia in women. This passage normally seals off during development. An indirect inguinal hernia occurs when the inguinal canal does not close completely. Over time, this opening enlarges and organs in the abdomen push into the canal. A direct inguinal hernia occurs when the weakness is in the floor of the inguinal canal rather than through its opening. Direct and indirect hernias cause similar symptoms and look nearly the same on physical examination. Lower in the groin, another area that can form a hernia is the femoral canal, which contains blood vessels that travel from the abdomen to the legs.

Factors associated with development of groin hernias include smoking, long-term coughing, obesity, and straining during urination or bowel movements. Groin hernias are more common in men—25% develop a hernia over the course of their lifetime. Indirect hernias are the most common groin hernia in men and women. Femoral hernias most often occur in women and most frequently require surgery.

What Should You Do If You Have a Groin Hernia?

You should limit any activities that cause groin pain or discomfort, such as heavy lifting or straining. You should be seen by a doctor to determine if surgery is needed. An incarcerated hernia is an uncommon yet major concern when the intestines become stuck in the hernia. This can cut off the blood supply to the intestines (strangulated hernia) and cause subsequent damage to them. Emergency surgery is required to free the intestines and repair the hernia. Symptoms include persistent groin pain, tenderness over the bulge, a bulge that could previously be pushed back in but is now stuck out, and skin color changes over the bulge. If you are concerned about either an incarcerated or a strangulated hernia, contact a physician immediately.

Should All Groin Hernias Be Repaired?

A groin hernia will not get better on its own, but not all groin hernias need to be repaired. The decision to repair the hernia depends on the type of hernia and amount of pain and discomfort you experience and its interference with activity. A surgeon may repair a hernia with a single incision (open surgery) or with multiple smaller incisions (laparoscopic surgery). The hernia is closed by either bringing the groin tissue back together or placing a prosthetic (manmade) mesh over the hernia. However, if the hernia is not painful or does not limit daily activities and there is a low risk of a strangulated hernia, you and your doctor may choose to monitor your hernia without surgery. The risks associated with hernia surgery include prolonged pain, bleeding, infection, nerve damage, damage to surrounding blood vessels, and damage to nearby organs including the intestines and, in men, the testicles.

A hernia truss is a supportive undergarment designed to keep the protruding tissue in place. Although some individuals with symptomatic hernias report more comfort and support while wearing a truss, some patients have continued pain and discomfort. Your surgeon can help you decide if a truss is a good option for you.

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Article Information

Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Sources: Fitzgibbons RJ et al. Watchful waiting vs repair of inguinal hernia in minimally symptomatic men. JAMA. 2006;295(3):285-292.

Fitzgibbons RJ et al. Long-term results of a randomized controlled trial of a nonoperative strategy (watchful waiting) for men with minimally symptomatic inguinal hernias. Ann Surg. 2013;258(3):508-515.

Additional Contributions: Thank you to Ellen Weiss, MS, for her work on concept development and initial drafts of the illustration.

Topic: Hernia