What are the main causes of an inguinal hernia?

An inguinal hernia is the protrusion of part of the intestine or fatty tissue through a weak area in the lower abdominal wall, specifically in the inguinal canal. This weakness occurs due to a combination of factors that may be present from birth or develop later in life [3].

Congenital and Acquired Abdominal Wall Weakness

Weakness of the abdominal wall is the primary factor in the formation of an inguinal hernia. This weakness can be congenital, meaning it is present from birth, or acquired, developing with age. In the case of an indirect inguinal hernia, the cause is related to a defect in the lower abdominal wall present since birth. During fetal development, the inguinal canals contain openings inside the abdomen that usually close before birth. If one or both openings remain open, abdominal contents can protrude through them, causing a hernia. Although this defect is present at birth, an indirect inguinal hernia may not manifest until many years later [3].

A direct inguinal hernia is related to a weak area in the wall of the inguinal canal that develops later in life. Part of the abdominal contents protrudes through this weak area. This type of hernia primarily affects men, and rarely affects women or children [3].

Factors Increasing Intra-abdominal Pressure

In addition to abdominal wall weakness, factors that increase intra-abdominal pressure play a significant role in the appearance or aggravation of an inguinal hernia. These factors include [1]:

• Heavy lifting: Activities requiring significant physical effort and lifting heavy weights increase pressure on the abdominal wall.
• Chronic coughing: Conditions such as asthma or chronic bronchitis can cause frequent coughing, which increases intra-abdominal pressure.
• Chronic constipation: Straining during bowel movements increases pressure on the pelvic and abdominal region.
• Standing or walking for long hours: Certain professions that require standing or walking for long periods daily may contribute to increased pressure.
• Pregnancy: Intra-abdominal pressure increases in pregnant women.
• Obesity: Excess weight places additional pressure on the abdominal wall.

Other Risk Factors

Several other factors increase the likelihood of developing an inguinal hernia [3]:

• Gender: Men are 8 to 10 times more likely to develop an inguinal hernia compared to women [3].
• Age: The chance of developing an inguinal hernia increases with age, and it is more common among people aged 75 to 80 years. Among children, inguinal hernias are more common between the ages of 0 and 5 years, and in premature infants [3].
• Family history: Having a family history of inguinal hernia increases the risk of developing one.
• Previous surgery: Men who have undergone a prostatectomy may be at higher risk.
• Connective tissue disorders: Certain conditions that affect the strength of connective tissues can increase weakness in the abdominal wall.

When to See a Doctor?

If you notice any bulge in the groin area (between the lower abdomen and the thighs) or in the scrotum in males, or feel pain, discomfort, heaviness, or burning in this area, it is important to consult a doctor [3]. Symptoms may worsen with straining, lifting, coughing, or standing for a long time, and improve with rest or lying down [3].

Signs Requiring Emergency Care: Medical help must be sought immediately if symptoms of a strangulated or incarcerated hernia appear, as this is a life-threatening condition. These symptoms include [3]:

• The hernia bulge suddenly becomes larger.
• A hernia bulge that previously returned inward no longer does so.
• Fever.
• Redness in the hernia area.
• Sudden or severe pain, or tenderness to the touch in the hernia area.
• Symptoms of bowel obstruction, such as abdominal pain, bloating, nausea, and vomiting.

For more information on the types of hernias, their symptoms, and when surgery is required, you can visit Hernia: Types, Symptoms, and When Is Surgery Required? (Arabic)

Medical references

• Inguinal Hernia
• Hernia