Anatomy
The various muscles of the abdominal wall are transected by the inguinal canal, which contains nerves (N ilioinguinalis and the genital branch of N genitofemoralis) and in men the spermatic cord (funiculus spermaticus). In women, the inguinal canal contains a small fibrous ligament instead.
Cause
Where the inguinal canal breaks through the abdominal wall, weak spots (anulus inguinalis superficialis and anulus inguinalis profundus) occur. If the abdominal wall becomes too weak, the intestines can be pushed out through the weak points in the abdominal wall, causing a true inguinal hernia. In rare cases, intestines are pushed down between the large blood vessels in the groin (femoral hernia).
Symptoms
Pain in the groin with worsening when coughing. Occasionally a bulge can be seen in the groin. Usually, the swelling (containing bowel) can be pushed back into place. If the swelling is painful and cannot be pushed back into place, the hernia may be trapped (which requires emergency medical attention). There will often be a lot of pain, vomiting and possibly fever.
Examination
In obvious cases with visible swelling in the groin, the diagnosis is usually made by general medical examination. If there is doubt about the diagnosis, CT, MRI or dynamic ultrasound scans can be performed to detect weaknesses in the abdominal wall while increasing the pressure in the abdominal cavity by applying pressure. None of these tests diagnose all types of inguinal hernia, so a normal examination does not rule out the diagnosis.
Treatment
For mild discomfort, you can primarily try strength training of the abdominal muscles. If discomfort persists, surgery is advised ( Patel VH, Wright AS. 2021). If there is increasing pain and suspicion of an incarcerated hernia, you should seek urgent medical attention to assess the indication for emergency surgery, as there is a risk of permanent injury to the bowel. For uncomplicated surgery, an approximately 2-month recovery period should be expected before maximum sports activity can be resumed, depending on the sport in question.
Complications
If the progress is not smooth (even after surgery), you should consider whether the diagnosis is correct:
In particular, the following should be considered:
- Sportsman’s hernia
- Inflammation of the adductor of the thigh
- Inflammation of the pubic joint
- Bursitis on the front on the hip joint
- Fluid accumulation in the joint
- Osteoarthritis of the hip joint
- Tendonitis of the superficial hip flexor attachment
- Tendonitis of the deep hip flexor
- Inner snapping hip
- Stress facture in the femoral neck
- Nerve entrapment
