The Inguinal hernia is known as bulging of fat or part of the small intestine (contents of the abdomen) through a weak region in the lower abdominal wall.The two main types of the inguinal hernia in literature are indirect inguinal hernias and direct inguinal hernias. An impairment in the abdominal wall at birth can result in an indirect inguinal hernia, while weakness in the muscles of the abdominal wall may cause a direct inguinal hernia.

Some inguinal hernias have no obvious cause. Other inguinal hernias might occur because of straining during bowel movements or urination, a pressure increasing within the abdomen, or because of a pre-existing weak spot in the abdominal wall. In addition, there are risk factors that contribute to developing an inguinal hernia include male gender, older age, and chronic constipation. The indirect inguinal hernia is identified to be a congenital lesion. The direct hernia is different from the indirect hernia because it is often identified to be an acquired lesion.

Some of the signs and symptoms associated with inguinal hernia include the feeling of pain or discomfort in the groin region and a protrusion in the area on the right or on the left side of the pubic bone. A physician could use several diagnostic procedures to diagnose inguinal hernia properly such as reviewing the medical and family history, performing a physical examination, imaging tests such as abdominal X-ray, computerized tomography (CT) scan, and abdominal ultrasound. A hernia can be fixed permanently only by conducting surgery. There are two major types of hernias surgery, those are an open hernia repair and laparoscopy.

In case the inguinal hernias not properly treated, they can lead to various complications such as recurrence of a hernia, infarcted testis or ovary with atrophy, wound infection, incarceration, and strangulation of hernia. Some practices that could help prevent a hernia include using healthy lifting weights techniques. , losing weight, drinking lots of fluid, and eating plenty of fiber.

The treatment result for most hernias is usually good. A hernia is rare to come back. The abundance of epidemiological data regarding the prevalence of the inguinal hernia is limited despite high disease prevalence, even in the United States and Western Europe (11). In males, the incidence increases from 11 per 10,000 person-years, aged 16-24 years, to 200 per 10,000 person-years, aged 75 years or above.

Usually, the inguinal hernia occurs when fat or part of the small intestine (contents of the abdomen) bulge through a weak or fragile region in the lower abdominal wall. The most common form of hernia is the inguinal hernia. It can emerge as a swelling or lump in the groin, or as an enlarged scrotum. An inguinal hernia is not necessarily dangerous. It does not improve on its own and life-threatening complications can occur if inguinal hernia is not improved.

Mainly, two types of inguinal hernias can be noticed in the literature :

• Indirect inguinal hernias: This type emerges at birth and results from a congenital defect in the abdominal wall. This is the more common form of inguinal hernias and it is responsible for most cases of inguinal hernias, particularly in children.
• Direct inguinal hernias: This type resulted from weakness in the muscles of the abdominal wall that develops over time and it is found mainly in male adults.

Usually, the type of inguinal hernia determine the cause of inguinal hernia. An impairment in the abdominal wall at birth can result in an indirect inguinal hernia. Weakening the abdominal muscles around the inguinal canal by aging, previous surgery, and stress or strain is the main cause of direct inguinal hernia, which found mostly in male adults.

Some inguinal hernias have no obvious cause. Other inguinal hernias might occur because of:

• Straining that may generates during bowel movements or urination.
• Pressure increasing within the abdomen possibly because of pregnancy.
• A pre-existing weak spot in the abdominal wall.
• A combination of increased pressure and a pre-existing weak spot in the abdominal wall.
• Exhausting activity.
• Chronic coughing or sneezing.

Factors that contribute to developing an inguinal hernia include:

• Male gender: The ratio of inguinal hernia prevalence for males and females is 8:1.
• Older age: Because of the gradual muscles weakening as age advancing.
• Caucasian ethnicity: Many studies reported noticeable prevalence of inguinal hernia among white- skinned population.
• Family history: Having parent or sibling, who has inguinal hernia can increase the risk.
• Chronic cough: It is sometimes related to smoking.
• Chronic constipation: Because of the possible straining and stress during bowel movements.
• Premature birth and low birth weight.
• Pregnancy: Because pregnancy increases pressure inside the abdomen and can weaken the abdominal muscles.
• Antecedent inguinal hernia or previous hernia repair.

Actually, the indirect inguinal hernia is identified to be a congenital lesion.  The “indirect” aspect of this type is derived out of the fact that there is no direct herniation for the bowel and peritoneum through a weakness in the abdominal wall.  However, the bowel and peritoneum take the course through the internal ring, patent processus vaginalis, and into the scrotum. In addition, they seemingly bulging lateral to the inferior epigastric vessels.

The direct hernia is different from the indirect hernia because it is often identified to be an acquired lesion. The developing of weak spot in the lower abdominal musculature resulted from normal and/or abnormal stresses reinforced by living and aging is the main cause behind appearing of this type.  In adults, stresses and strains such as constipation, heavy lifting, frequent coughing, and pregnancy (in female) can trigger hernia.

Some of the signs and symptoms associated with inguinal hernia are:

• Groin pain or discomfort, particularly when the patient asked to bend over, cough or lifting weight.
• A protrusion in the area on the right or on the left side of the pubic bone, which becomes more obvious when coughing in position of standing upright
• The feeling of burning and aching at the bulging site
• Weakness or pressure in the groin
• A heavy or dragging sensation in the groin
• In case the protruding intestine descends into the scrotum, occasional pain and swelling around the testicles could manifested.

The trapping of the contents of the hernia in the abdominal wall is named incarceration. The strangulation of an incarcerated hernia is when discontinuation of blood flow occur to the tissue that is trapped. A strangulated hernia can be considered as a life-threatening condition if not well cured.

When strangulation of hernia occur, some of signs and symptoms can be manifested in form of:

• Fever
• Sudden pain with rapid intensifying
• The bulging hernia color turns red, purple or dark
• Inability to move the bowels
• Inability to pass gas
• Nausea, vomiting or both

A physician could use one of the followings to correctly diagnose an inguinal hernia:

• Reviewing the medical and family history: Considering the medical and family history for the patient may contribute in providing proper diagnosis for inguinal hernia.
• Performing physical examination: The physician examines the body of patient by asking him/her to stand and start coughing to help the physician locate the protrusion caused by the hernia as it moves into the groin or scrotum and he may perform gentle massaging to help hernia back into its original location in the abdomen.
• Imaging tests: Usually, a physician does not recommend imaging tests unless he want to check for strangulation or incarceration, or in case he is unable to feel the hernia during the physical examination, or if he is not sure if the hernia is the responsible for the swelling observed in groin. The imaging tests include:

1. Abdominal X ray which used to provide a recorded picture on film by using radiation.
2. Computerized tomography (CT) scan: It creates images by combining x rays and computer technology.
3. Abdominal ultrasound: It uses painless sound waves to create an image of the organ’s structures.

Hernia can be fixed permanently only by conducting surgery. This surgery is called herniorrhaphy. There is two major types of hernias surgery:

• Open hernia repair: Local anesthesia or general anesthesia could be used in this surgery. By making an incision in the groin, the surgeon bring back the bulging tissue into the abdomen.
• Laparoscopy: This procedure conducted with general anesthesia and it is minimally invasive in which the surgeon makes several small incisions in the abdomen and uses gas to inflate the abdomen to make the internal organs easier to see in order to give the surgeon a close-up view of the hernia and surrounding tissue. The surgeon, then, repairs the hernia using synthetic mesh while watching the monitor.

Some of the complications related to inguinal hernias are:

• Recurrence: The recurrence of hernias increases in case of: Elderly patients, girls with sliding hernias, growth failure cases, chronic respiratory problems, after incarcerations, cases with increased intra-abdominal pressure, prematurity, and children aged younger than 1 year.
• Infarcted testis or ovary with atrophy.
• Wound infection.
• Incarceration (trapping of hernia in the abdominal wall)
• Strangulation (obstruction of blood supply to small intestine)
• Bladder injury.
• Intestinal injury.

Some practices that could help preventing a hernia include:

• Using healthy lifting weights techniques.
• Losing weight if the person is obese or overweight.
• Drinking lots of fluid, eating plenty of fiber, going to the bathroom as soon as the urge come, and exercising regularly to relieve or avoid constipation.
• Men who strain with urination should see their physicians. This might regarded as an enlarged prostate’s symptom in some cases.
• Quitting smoking

There is no studies indicating that eating, diet, and nutrition can cause inguinal hernias. Preventing symptom of inguinal hernias can be done by eating high-fiber foods. Also, preventing constipation and straining (which can lead to hernia) by consuming fresh fruits, vegetables, and whole grains can be suggested.

The treatment result of most hernias is usually good. A hernia is rare to come back. If the intestine was damaged, the chance for reoccurrence of the hernia may be increased. Mainly, the prognosis (outlook) of hernias is very good and it is depends on comorbidity (presence of another disorders).

• Abundance epidemiological data regarding prevalence of inguinal hernia is limited despite high disease prevalence, even in the United States and Western Europe.
• According to a study published in the American journal of case reports , hernias made up around 7% of all surgical outpatient visits.
• According to a study published in the British medical journal, the incidence of inguinal hernia in male increases from 11 per 10,000 person-years, aged 16-24 years, to 200 per 10,000 person-years, aged 75 years or above.
• According to a study published in the journal of laparoendoscopic and advanced surgical techniques, incarcerated or strangulated hernias incidence in children is 12-16%. Half of incarcerated or strangulated hernias cases incidence can be found in infants aged younger than 6 months .