DEAR READER: An inguinal hernia occurs when a portion of the small intestine or internal fat protrudes through a weakened area in the lower abdominal muscles. This occurs on either side of the groin area between the abdomen and thigh, resulting in a bulge. Inguinal hernias are five times more common in males than in females and account for 75 percent of all hernias, of which there are several kinds. An inguinal hernia can occur at any time from infancy to adulthood.

There are two types of inguinal hernia — direct and indirect. A direct hernia is caused by degeneration of connective tissue of the abdominal muscles, common in older people. This type develops gradually because of continuous stress on the muscles involved. Factors include weight gain, lifting heavy objects, muscle strain, chronic cough and straining from constipation. Indirect hernias are congenital and much more common in males because of the way a male develops in the womb. Indirect inguinal hernias can occur in females as well; however, the condition is the result of a weakened area in the abdominal wall, not because of a weakened area of the inguinal canal.

Symptoms of either type include a bulge, pain, burning or discomfort — especially when lifting or otherwise straining — and weakness or pressure in the groin. Incarcerated hernias are so named because the bulge that protrudes is swollen and cannot be massaged back into the abdomen. When this occurs, the blood supply to that area may become compromised. Symptoms can include fever, increasing pain, tenderness, redness and an elevation in the patient’s heart rate. This situation requires immediate attention.

Diagnosis of an inguinal hernia is made through examination by a physician and the medical history provided by a patient.

Treatment for adults is surgery accomplished either through laparoscopy or open repair. The laparoscopic approach uses general anesthesia. Incisions are made in the lower abdomen. A thin tube with a video camera is then attached. The camera allows the area to be viewed on a monitor, and repairs are made using synthetic mesh. This procedure affords shorter recovery time but cannot be used on large hernias or on patients who may have had prior pelvic surgery. Open repair requires anesthesia into the abdomen or spine to numb the area. An incision is made in the groin, the hernia is repositioned into the abdomen, and the abdominal wall is reinforced with sutures. The area is then strengthened with synthetic mesh or screen in a procedure known as herniorrhaphy.

Post-surgical conditions can include wound infection, bleeding, pain at the site of the scar and injury to internal organs. Recurrence can occur. Generally speaking, however, hernia repair using either method is safe and most often uncomplicated.

To provide related information, I am sending you a copy of my Health Report “An Informed Approach to Surgery.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.