General and Gastrointestinal Surgery

About Inguinal Hernias

A hernia is a protrusion of an organ or tissue through a hole. The hole is usually an abnormal opening that should not be there. This is the case in the groin, where an inguinal hernia occurs, and through an incision, where an incisional or ventral hernia occurs. Another example is the umbilical (or belly button) hernia in which tissues, and possibly intestine, pass through an opening in the navel that did not close after birth. If the site of the umbilical cord does not fuse solidly with the rest of the abdominal wall, a small hole is left. In time, this hole can enlarge and allow the passage of tissue, resulting in an umbilical hernia.

Occasionally, a hernia occurs at the site of an opening that, under normal circumstances, does not allow tissue or organs to protrude through it. Such is the case for a hiatal hernia, in which the stomach protrudes through the opening that normally allows the esophagus to pass from the chest into the abdomen. A hernia through a normal opening occurs when the opening enlarges or when barriers to protrusion disappear.

Inguinal hernias can develop at the site of a potential opening or by creating a new opening. Two types of inguinal hernias are:

  • Indirect inguinal hernias form at the site of a congenital defect in the abdominal wall. During development, the testicles in males and ovaries in females are formed in the abdomen. Although the ovaries remain in the abdomen in females, the testicles move outside the abdomen in males into the scrotum. The site through which they pass from the abdomen into the scrotum becomes the site for a hernia if it does not completely heal. 
  • Direct inguinal hernias develop through the anterior abdominal wall where no potential hole exists--thus, the name "direct." They can occur because there are not as many layers of muscle and ligaments in the lower abdomen in the inguinal (groin) region. The layers used in other parts of the abdominal wall to provide strength are used in the inguinal region to help form the spermatic cord. In addition, the spermatic cord and round ligament must pass through a tunnel in the tissue to get to the scrotum and pubic bone, respectively. This tunnel is known as the inguinal canal. Because it is not composed of all the tissue layers located elsewhere in the abdominal wall, it is weaker, making it more susceptible to a direct hernia.

Can women get indirect inguinal hernias?

Sure. Even though the ovaries remain in the abdomen, the development of gonads in males and females is the same. In men, the spermatic cord, which caries sperm from the testicles to the penis passes through the abdominal wall and remains there as a tubular structure. It is along this cord that the indirect hernia actually occurs. Although women do not have spermatic cords, the same structure develops into the round ligament, a cord of fibrous and elastic tissue that passes from the uterus through the abdominal wall and attaches to the pubic bone. The round ligament is one of the supporting ligaments of the uterus and the place it passes through the abdominal wall can be the site at which an indirect hernia forms.