page_title: Inguinal hernia
section_title: Diagnosis
hierarchical_section_title: Inguinal hernia / Diagnosis
caption_attribution_description: English: Proposed revision of file Inguinalhernia2.png
context_page_description: An inguinal hernia is a protrusion of abdominal-cavity contents through the inguinal canal. Symptoms are present in about 66% of affected people. This may include pain or discomfort especially with coughing, exercise, or bowel movements. Often it gets worse throughout the day and improves when lying down. A bulging area may occur that becomes larger when bearing down. Inguinal hernias occur more often on the right than left side. The main concern is strangulation, where the blood supply to part of the intestine is blocked. This usually produces severe pain and tenderness of the area.
  Risk factors for the development of a hernia include: smoking, chronic obstructive pulmonary disease, obesity, pregnancy, peritoneal dialysis, collagen vascular disease, and previous open appendectomy, among others. Predisposition to hernias is genetic and occur more often in certain families. Deleterious mutations causing predisposition to hernias seem to have dominant inheritance. It is unclear if inguinal hernias are associated with heavy lifting. Hernias can often be diagnosed based on signs and symptoms.
context_section_description: There are two types of inguinal hernia, direct and indirect, which are defined by their relationship to the inferior epigastric vessels. Direct inguinal hernias occur medial to the inferior epigastric vessels when abdominal contents herniate through a weak spot in the fascia of the posterior wall of the inguinal canal, which is formed by the transversalis fascia. Indirect inguinal hernias occur when abdominal contents protrude through the deep inguinal ring, lateral to the inferior epigastric vessels; this may be caused by failure of embryonic closure of the processus vaginalis.
  In the case of the female, the opening of the superficial inguinal ring is smaller than that of the male. As a result, the possibility for hernias through the inguinal canal in males is much greater because they have a larger opening and therefore a much weaker wall through which the intestines may protrude.
  Inguinal hernias, in turn, belong to groin hernias, which also includes femoral hernias. A femoral hernia is not via the inguinal canal, but via the femoral canal, which normally allows passage of the common femoral artery and vein from the pelvis to the leg.
  In Amyand's hernia, the content of the hernial sac is the vermiform appendix.
  In Littre's hernia, the content of the hernial sac contains a Meckel's diverticulum.
  Clinical classification of hernia is also important according to which hernia is classified into
  Reducible hernia: is one which can be pushed back into the abdomen by putting manual pressure to it.
  Irreducible/Incarcerated hernia: is one which cannot be pushed back into the abdomen by applying manual pressure.
  Irreducible hernias are further classified into
  Obstructed hernia: is one in which the lumen of the herniated part of intestine is obstructed.
  Strangulated hernia: is one in which the blood supply of the hernia contents is cut off, thus, leading to ischemia. The lumen of the intestine may be patent or not.
caption: A frontal view of an incarcerated inguinal hernia (on the patient's left side) with dilated loops of bowel above.
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