Inguinal hernia — groin lump explained
An inguinal hernia occurs when abdominal contents — usually fat or part of the bowel — protrude through a weakness in the groin area, creating a lump under the skin. It is the most common hernia type — especially in men.
Unlike hiatus hernia (stomach through diaphragm), inguinal hernias appear in the groin — sometimes extending into the scrotum.
Symptoms
Typical:
- lump in groin — one or both sides
- more obvious when standing, coughing, straining
- may disappear lying down (reducible)
- dragging ache or discomfort — worse after activity
- no symptoms — found incidentally
Not always painful — but not harmless without assessment.
Who gets them
- men — 25% lifetime risk
- ageing — tissue weakens
- chronic cough — COPD, smoking
- constipation — straining
- heavy lifting over time
- previous groin surgery
- family history
- connective tissue disorders
Indirect inguinal hernias — congenital canal persistence — common in infants and young men.
Complications
Incarceration
Hernia stuck out — cannot push back — needs urgent surgical assessment.
Strangulation — emergency
Blood supply cut off to trapped bowel:
- sudden severe pain at hernia site
- hard, tender irreducible lump
- vomiting, abdominal distension
- constipation — no flatus
- fever, tachycardia
Call 999 / A&E immediately — surgery within hours saves bowel.
Diagnosis
GP examination:
- inspect and palpate groin/scrotum
- cough impulse — lump expands on cough
- differentiate from enlarged lymph node, hydrocele, varicocele, testicular mass
Ultrasound if uncertain — especially women (femoral hernia).
Referral to surgeon for elective repair discussion.
Treatment
Watchful waiting
Selected minimal asymptomatic hernias in high-risk surgical patients — close monitoring — strangulation risk remains (~1 to 3% per year for symptomatic unrepaired).
Surgical repair — standard
Mesh reinforcement — open (Lichtenstein) or laparoscopic (TEP/TAPP):
| Approach | Notes |
|---|---|
| Open | Local or general anaesthetic; common |
| Keyhole | Faster recovery for bilateral; specialist |
NHS waiting lists apply — urgent if strangulation.
Non-surgical
Trusses — historical — not recommended routinely — skin complications.
Living before surgery
- avoid heavy lifting where possible
- treat cough and constipation
- know red flags for strangulation
- manual reduction if GP taught safe technique for reducible hernia
Inguinal vs femoral hernia
Femoral hernia — below inguinal ligament — more common in women, higher strangulation risk — lower groin lump needs prompt surgical referral.
Any groin lump deserves GP assessment — not assume benign.
Children
Infant inguinal hernias — more urgent repair — higher strangulation rate in babies — paediatric surgery.
Inguinal hernias are common and fixable — elective surgery prevents emergency; sudden pain and vomiting with groin lump means A&E, not wait.
Common questions about inguinal hernia
- What does an inguinal hernia feel like?
- Soft lump in groin or scrotum — often more visible when standing, coughing, or straining; may disappear lying down. Aching or dragging discomfort — not always painful. Bulge may gurgle. Reducible hernia can be pushed back gently — irreducible lump needs urgent review.
- Do all hernias need surgery?
- Symptomatic or enlarging inguinal hernias are usually offered elective repair on NHS — open or keyhole (laparoscopic). Very small asymptomatic hernias in older frail patients may be watched — individual decision. Surgical repair prevents strangulation risk.
- What is a strangulated hernia?
- Bowel trapped in the hernia loses blood supply — sudden severe pain, tenderness, vomiting, constipation, fever. Irreducible hard lump. Surgical emergency within hours — call 999 or go to A&E.
- What is the difference between direct and indirect inguinal hernia?
- Indirect — through inguinal canal, often into scrotum, common in younger men, congenital weakness. Direct — through abdominal wall weakness, more common over age 40. Surgical repair similar — surgeon distinguishes at operation.
- Can a woman get an inguinal hernia?
- Yes — less common than in men; femoral hernias more common in women and have higher strangulation risk. Any groin lump in women needs GP assessment.
- How long is recovery from hernia surgery?
- Keyhole repair — often return to desk work 1 to 2 weeks, heavy lifting avoided 4 to 6 weeks. Open repair — similar restrictions, slightly longer discomfort. Follow surgeon advice — recurrence possible but uncommon with mesh repair.
Sources
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