Inguinal hernia: symptoms, causes, treatment and when it is an emergency

The NHS says common symptoms of a hernia include a bulge or lump where the hernia is, such as in the groin, which may get bigger when you cough, sneeze or cry and get smaller when you lie down. The skin over the lump may seem tight and stretched, and an inguinal hernia can cause a heavy, dragging feeling in the leg.

North Cumbria Integrated Care says your hernia may feel uncomfortable or tender, especially when you bend, stretch or lift, and these symptoms may not be there all the time. In men the hernia can slip down into the scrotum, making it sore and swollen. Some people notice a burning or sharp pinching sensation in the groin.

The NHS notes that although a large hernia may look uncomfortable, it may not be painful because the weak area of muscle has stretched. Not everyone with a hernia has symptoms such as pain.

The NHS says to get help from NHS 111 if you have a hernia and any of the following:

• Pain in or around the hernia.

• A bloated tummy.

• Feeling sick or being sick, including vomiting blood or vomit like coffee grounds.

• Constipation.

• A high temperature, or feeling hot, cold or shivery.

• Sudden confusion.

North Cumbria Integrated Care explains that in a strangulated hernia the blood supply to the piece of bowel trapped in the hernia is cut off. The hernia is likely to become irreducible (cannot be pushed back) and the skin over it may change colour. The bowel can also become obstructed, with pain, nausea or vomiting.

It says strangulated hernias are uncommon, it is difficult to predict whose hernia may become strangulated, and that it needs emergency surgery straight away. It says about five people in every one hundred need emergency surgery for a first hernia.

If you cannot reach NHS 111 quickly and you are very unwell, go to A&E and do not drive yourself.

North Cumbria Integrated Care describes two types. An indirect hernia is where you are born with a weakness in the muscles of the abdomen, through the gap called the inguinal canal that does not fully close. A direct hernia usually happens when you strain your abdomen and the tissue pushes directly through a weak point.

It says causes that raise the pressure in your abdomen affect hernias, such as coughing, straining on the toilet, obesity, heavy lifting or certain sports, although it notes there is no good evidence that occasional lifting or regular sporting activities are risk factors.

MyHealth Devon lists a chronic or persistent cough, being overweight or pregnant, lifting, carrying or pushing heavy loads, straining on the toilet and previous abdominal surgery as conditions that raise pressure in the tummy.

North Cumbria Integrated Care says a hernia is usually diagnosed by a healthcare professional taking a medical history and carrying out an examination. You may need other investigations such as an ultrasound, CT or MRI scan.

The NHS says to see a GP if you think you have a hernia, and they may refer you for tests or treatment.

The NHS says an inguinal hernia may not need treatment if it is not causing symptoms. You might have a repair if the hernia is causing symptoms such as pain, to prevent a blocked bowel (bowel obstruction), or to prevent strangulation.

North Cumbria Integrated Care says current guidelines suggest that if your hernia causes no or minimal symptoms it can be monitored, although your surgeon may still offer repair because the weakness will not go away. If it is reducible and not causing significant problems, you and your surgeon may choose to "watch and wait". If it is irreducible, you are more likely to need an operation sooner.

MyHealth Devon says the use of a truss for groin hernias is best avoided, as they are rarely effective and may lead to complications if incorrectly fitted. It also notes that local commissioning policies apply, so certain treatments may not be available to you on the NHS in every area.

The NHS says there are two main ways: laparoscopic (keyhole) surgery with a few small cuts in the tummy, or open surgery with one larger cut in the groin. You will have a general anaesthetic or a local anaesthetic, depending on where and how big the hernia is and your general health.

The hernia is pushed back into place and a thin sheet of mesh is usually put over it and fixed with small stitches. Sometimes only stitches are used. The surgery usually takes between 30 and 90 minutes and you can usually go home the same day.

The NHS says it usually takes up to 4 to 6 weeks to recover, but it can take longer. Stay off work for usually at least 1 to 2 weeks, or up to 6 weeks if your job involves heavy lifting. Do not do heavy lifting or strenuous activity for at least 4 to 6 weeks, and do not drive until your healthcare team says it is safe.

Normal after-effects include bleeding from the wound for a couple of days, pain for a few days, and bruising or swelling around the wound or genitals for a couple of weeks. Complications are uncommon and include wound infection, a lump or swelling that lasts weeks or months, pain or numbness in the groin that may last longer than 3 months, the hernia coming back, damage to the bowel, blood vessels or bladder, and blood clots.

After surgery, the NHS says to get help from NHS 111 for pus from the wound, a high temperature, lots of bleeding, being sick for more than 24 hours, a throbbing or cramping leg pain or breathlessness. Call 999 for severe breathing difficulty, chest or upper back pain or a racing heart, which could be a blood clot in the lungs.

North Cumbria Integrated Care says females also have an inguinal canal, usually narrower than in males, and can have an indirect hernia. Anyone can get a hernia, whether male or female, young or old.

MyHealth Devon lists pregnancy among conditions that raise pressure in the tummy. If you are pregnant and notice a groin lump, mention it to your midwife or GP.

On the NHS the route is GP, then a general surgeon if repair is appropriate. MyHealth Devon notes local commissioning policies can affect who is offered surgery for minimally symptomatic hernias.

Private repair is also available. Whichever route you use, ask about open versus keyhole repair, mesh, expected recovery and what happens if the hernia comes back.