What is a hernia?

John is 58 years old, has worked for decades as a porter and, a few months ago, began to notice a small lump in his right groin. At first, he barely noticed it, and the swelling would disappear when he lay down. Over time, the sensation of heaviness and discomfort increased, especially at the end of a long working day. Embarrassed, he kept postponing his appointment, thinking that "it was nothing serious". When he finally sought care, the doctor confirmed: it was an inguinal hernia. John was relieved to learn that there was a solution. But he was also left with a reasonable question: why did it take him so long to seek help?

John's story is far more common than it seems. And that's exactly what I want to talk about with you today.

What is a hernia?

Imagine the abdominal wall as a sturdy mesh that keeps all internal organs in the right place. When this mesh has a weaker point, whether due to genetic inheritance, repetitive strain or other factors, part of the abdominal contents can "escape" through this opening. That is a hernia.

In the case of inguinal and femoral hernias, this escape happens in the groin area, which is the fold between the belly and the thigh.

Inguinal hernia

The inguinal hernia is the most common of all hernias. It occurs when part of the intestine or abdominal fat passes through a canal in the groin wall called the inguinal canal. This canal exists naturally in our body, but when the surrounding muscles lose strength, it becomes an unwanted exit.

Femoral hernia

The femoral hernia is less common and appears a little lower, passing through a space called the femoral canal, close to the blood vessels in the leg. It is more frequent in women, especially after pregnancies, and tends to be smaller, which does not mean it is less concerning. On the contrary: the risk of complications is greater, because the space through which it passes is narrower.

What are the symptoms?

The most classic sign is a bulge or visible lump in the groin area. This lump can appear and disappear depending on body position: it tends to appear when standing, coughing, sneezing, straining or carrying weight, and can disappear when the person lies down.

In addition, the person may feel:

  • Sensation of heaviness or pressure in the groin
  • Discomfort or pain when getting up, squatting, straining or at the end of the day
  • Sensation of "pulling" in the region
  • In men, discomfort that radiates to the testicle on the affected side

In some cases, especially at the beginning, the hernia does not hurt at all. That is why many people delay seeking help, thinking that if it doesn't hurt, it doesn't need attention. This is a mistake that can be costly.

Who has the greatest risk of developing one?

Hernias don't pick and choose, but there are factors that significantly increase the chances of developing them:

Male sex
The inguinal canal in men is anatomically wider, which makes them far more susceptible to inguinal hernia. It is estimated that men are 10 times more likely to develop this type of hernia than women.

Advanced age
With ageing, muscle fibres and supporting tissues naturally lose elasticity and strength.

Family history
If a close relative had a hernia, your chances are greater. There is an important genetic component in the quality of the connective tissue that forms the abdominal wall.

Intense and repetitive physical effort
Those who carry weight frequently, strain a lot or work in a position that increases abdominal pressure are more exposed. It is not that the effort causes the hernia from scratch, but it accelerates the process in those who already have a predisposition.

Chronic constipation
Frequent straining to evacuate increases the pressure inside the abdomen repeatedly over the years.

Chronic cough
Lung diseases such as COPD or intense smoking, which cause persistent cough, also increase this pressure continuously.

Obesity
Excess weight constantly overloads the abdominal wall.

Multiple pregnancies
Pregnancy, especially when it occurs more than once, stretches and weakens the abdominal and pelvic muscles, which explains why women have a higher risk of femoral hernia.

Previous surgeries in the region
Any procedure that has already passed through the abdominal wall can create points of weakness.

Is a hernia always something pathological?

Yes. Unlike conditions that can be natural and require no treatment, a hernia is always a structural change, a real point of weakness in the abdominal wall. It will not resolve on its own, it will not disappear with medication, and it will not improve with specific exercise.

This does not mean that every hernia represents an immediate emergency. There are cases where the hernia is small, does not cause relevant symptoms and can be monitored clinically for some time, with the doctor assessing whether the patient's surgical risk at that time is greater than the risk of waiting.

But the fact is that hernias have a natural tendency to grow over time. And the larger it is, the more difficult the surgery and the greater the risk of complications.

Is surgery always necessary?

This is one of the questions I hear most often in the consulting room, and the honest answer is: in most cases, yes, surgery is the only definitive treatment for a hernia.

There is no medication that closes a hernia. There is no exercise that repairs the torn tissue. Belts and abdominal bands help contain discomfort in the short term, but they do not treat the problem.

The decision to operate or monitor depends on a series of factors that the doctor will evaluate individually:

  • Size of the hernia
  • Symptoms present
  • Patient's clinical conditions
  • Surgical risk
  • Presence or absence of complications

Incarceration and strangulation

And speaking of complications, there is a situation that turns the hernia into an immediate emergency: incarceration and strangulation.

Incarceration occurs when the contents that have escaped through the hernia become trapped and can no longer return inside the abdomen. Strangulation is the next step: the trapped intestine has its blood supply compromised, which can lead to necrosis (tissue death) within hours. This is a surgical emergency.

When to seek emergency care?

There are signs that do not allow for waiting. Seek emergency care immediately if you notice:

  • The hernia lump has become hard, does not go back inside and does not disappear when you lie down
  • Sudden intense pain in the region
  • Nausea, vomiting or fever associated with discomfort in the groin
  • Redness or warmth in the skin over the lump
  • Absence of bowel movements and gas

These signs may indicate incarceration or strangulation, and every hour counts.

Why does early care make a difference?

Treating a small hernia, electively, with the patient in good clinical condition, is a much simpler and safer surgery than operating on a large, symptomatic hernia or, worse, a strangulated one.

Elective surgery, done at the right time, has a high success rate, low risk of complications and relatively short recovery time. Laparoscopy, a minimally invasive technique, is widely used and allows faster return to activities.

Postponing treatment out of fear or thinking that you are "doing fine" is a risk not worth taking.

What you can do now?

If you have noticed something similar to what has been described here, or if you have any of the risk factors mentioned, the first step is to see a doctor for clinical evaluation. The diagnosis is usually made by history and physical examination, and in some cases can be supplemented with ultrasound.

Do not wait for pain to appear to take action. Hernias that do not hurt also need attention.

Important information

This content is for informational and educational purposes. It does not replace individualised medical evaluation, clinical diagnosis or monitoring by a healthcare professional. Each case is unique. If you have questions about your health, see a doctor.

Dr. Rebeca Soares Andrade. CRM-GO 39335