Groin or abdominal pain associated with a bulge. Is it a hernia?

A hernia is the protrusion of an organ through its containing wall, and groin hernias are the most common types of hernias.

Groin hernias (also known as inguinal hernias) occur more often on the right side than the left, and in situations where there is raised abdominal pressure, such as builders doing heavy lifting, or smokers who are prone to bouts of coughing. While they are more common in men, they also occur in women. People with congenital tissue (collagen) disorders such as Ehlers Danlos syndromes are also more prone to getting hernia’s when compared to the general population.

Many people will discover a groin/inguinal hernia when a lump or bulge appears. Symptoms include groin tenderness, discomfort, or pain, particularly when straining, bending over, or lifting anything heavy.

Some people will notice their hernia lump getting progressively bigger during the daytime, particularly if straining and upright, and then smaller, or ‘reducing’, once they lie down. For men, the testes may swell up occasionally if the bowel descends into the scrotum.

“Sometimes, the bowel can get trapped in the hernia, causing a bowel obstruction which requires emergency surgery. If you have a hernia, it is best to repair it before it gets to that stage.” — Dr Reuben Ndegwa (Specialist General Surgeon- Brisbane Private Hospital)

Many people are asymptomatic (without symptoms), and only discover a hernia by chance through scans for to an unrelated medical investigation. These hernias have often been present since birth, and sometimes doctors choose not to operate depending upon size of the hernia and other factors.

Treatment options

There are two options for surgical repair of a hernia: open or keyhole (laparoscopic). Both options are widely used and depend on your circumstances. Both involve the use of a prosthetic mesh to reinforce the abdominal wall.

“Recovery is more rapid following keyhole surgery, particularly if we repair both sides at once. However, the approach needs to be individualised to the hernia and patient characteristics,”.

“For example, if there is any indication that the patient may have prostate issues, then it may be more appropriate to avoid a keyhole approach which may interfere with future prostate surgery.

“If you are young and fit you will often have same day surgery. Some patients opt to stay in overnight, particularly in the case of open surgery, mostly for the rest post-operatively.”

The recovery afterwards can be slightly uncomfortable, and doctors recommend a recover period of a few days off work after surgery. Activities such as walking and cycling are perfect post-operatively, but it is best to avoid gym workouts for a month.

“We advise patients not to swim for two weeks, and to shower rather than take a bath over that time as well”.

“We also advise refraining from heavy lifting. I tell my patients that a limit of 10 kilograms is all they should lift for a month, particularly after open surgery.”

Dr Ndegwa recommends seeing your GP if you discover a lump or a dragging sensation in the groin.