Causes and symptoms of inguinal hernia

An inguinal hernia is the appearance of a protrusion of layers of the abdominal wall in the inferolateral part of the abdomen, into which internal organs can prolapse. With an advanced inguinal hernia in male patients, the protrusion can penetrate into the scrotum, and in women - into the tissue of the labia majora. For a number of reasons, inguinal hernia quite often develops in children, even infants, however, adults are not immune from its occurrence. At the same time, it is unacceptable to hope that the child will “outgrow” the hernia, and especially that it will disappear on its own in an adult. A frivolous attitude towards this pathology can lead to dangerous consequences, among which, by far, the most dangerous is strangulation of the contents of the hernial sac - it can lead to peritonitis, inflammation of the peritoneum, and this, in turn, is a life-threatening condition. Understanding the causes of inguinal hernias can significantly prevent this condition. In addition, this is important for determining competent treatment tactics.

What you need to know about the anatomy of the inguinal canal

An inguinal hernia is a protrusion of the abdominal wall, one way or another associated with a specific anatomical formation - the inguinal canal. The inguinal canal is a slit-like fold in the groin area between the muscles and fascia (connective tissue). The inguinal canal begins in the abdominal cavity, then follows towards the surface of the abdominal wall, towards the pubis. The inguinal canal is not just a fold; it contains certain anatomical formations: in men it is the spermatic cord, which consists of a vascular arteriovenous bundle, nerves and the vas deferens itself. In the fair sex, the inguinal canal contains the round ligament of the uterus.

The inguinal canal has two “rings” formed by muscles and ligaments. The internal corresponds to the entrance to the inguinal canal in the abdominal cavity, the external is the exit from it. The entrance and exit are the “weak” places of the inguinal canal. It is in these places that hernial protrusions most often form.

To further consider the causes of an inguinal hernia, it is necessary to find out what a congenital hernia is - and, on the contrary, what kind of hernia formation is called acquired.

Treatment of hydrocele (hydrocele) and lymphocele without surgery. Duration of observation.

Hydrocele in children under 1 year of age requires observation by a pediatric urologist-andrologist. If fluid accumulates and tension appears in the membranes of the testicle, punctures are performed to remove hydrocele. Sometimes repeated punctures are required.

Communicating hydrops with a narrow peritoneal process is usually observed up to 2 years.

Observation is also required for traumatic dropsy, which occurs as a result of a bruise without compromising the integrity of the testicle. As a rule, 3 months are enough to assess the dynamics of the process and, if there is no improvement, prescribe surgical treatment. The same applies to hydrocele formed after inflammation.

The most difficult is the management of patients with lymphocele that forms after surgical treatment of an inguinal hernia and varicocele. In this case, prematurely performed surgery has little chance of success. For 6-12 months, it is necessary to monitor the condition of the testicle according to ultrasound and duplex examination of the scrotal organs in order to assess the dynamics of the process and the effectiveness of the therapy.

Congenital hernias of the inguinal region

The development of a congenital inguinal hernia in a boy is associated with a specific anatomical anomaly that occurs in the prenatal period, during the formation of the testicles. The testicles in the human embryo initially develop inside the abdominal cavity. The abdominal cavity itself is lined from the inside with peritoneum - a thin and fairly simple serous tissue. Future testicles are also formed inside the peritoneum, where they remain until the third to fifth month of pregnancy. During the fifth month of intrauterine development, the testicles gradually begin to descend: they enter the inguinal canal and pass along it, carrying with them the sheets of peritoneum that envelop them. Movement along the inguinal canal continues until the seventh month of intrauterine development of the fetus. By the time of birth, the testicles descend into the scrotum, forming the so-called vaginal process of the peritoneum - a pocket of serous tissue that communicates with the abdominal cavity. However, then this canal first collapses, and then completely overgrows, and communication with the abdominal cavity stops.

For one reason or another (which can be very different - from hereditary characteristics of the formation and descent of the testicles to the impact of unfavorable external factors on the body of the expectant mother or an already born baby), the process of fusion of the vaginal process of the peritoneum may be disrupted. If there are open cavities along its length, cysts of the spermatic cord may subsequently form. If the peritoneal pocket remains unclosed along its entire length, all the prerequisites are created for the subsequent formation of an inguinal hernia. With the slightest increase in intra-abdominal pressure - and in a newborn baby it increases even when crying - loops of intestine or strands of omentum may fall into the pocket. As a rule, the first manifestations of a congenital hernia, given its origin, occur precisely in childhood. It is extremely rare that the manifestation of a congenital hernia occurs in adults, however, such a development of events is also possible and should be remembered.

The vast majority of congenital hernias occur in boys. However, there is a possibility of their formation in girls. The process as a whole is similar to that in the developing male body, but instead of the testicles, the “conductor” of the peritoneal process is the uterus, fallopian tubes and ovaries. The fact is that initially the rudiment of the uterus in the body of a female fetus is laid inside the abdominal cavity, and much higher than its subsequent location. During intrauterine development, the uterus gradually moves into the pelvic cavity - the place where it will be located in the future. In this case, the uterus also carries along a layer of peritoneum, forming a pocket, which can subsequently also cause the development of a congenital inguinal hernia.

Postoperative period

Surgeries for dropsy are usually well tolerated by children and do not significantly interfere with their movements. However, with sudden movements or constipation as a result of increased intra-abdominal pressure or direct impacts, the formation of hematomas in the scrotum and groin area is possible. Therefore, children should limit their activity until the postoperative wound heals and follow a diet.

On the first day after surgery, non-narcotic painkillers (analgin, paracetamol, ibuprofen, Panadol and others) are usually prescribed. Laxatives are used for 4-5 days after surgery.

For 2 weeks after surgery, do not wear underwear that compresses the scrotum to avoid pushing the testicle up toward the inguinal canal, due to possible fixation of the testicle above the scrotum.

School-age children are exempt from physical education for 1 month.

Acquired hernias - causes and predisposing factors

The main reason for the appearance of any acquired hernia of the abdominal wall (and inguinal hernias are no exception) is a violation of the balance between the level of pressure inside the abdominal cavity and the ability of the abdominal wall to resist this pressure. In the abdominal wall of each person, due to its anatomical features, there are several “weak” places that are more vulnerable to the formation of hernial protrusions. In the groin area, such places are the outer and inner rings of the inguinal canal. However, thanks to the compensatory capabilities of the body (the tone of the muscle tissue of the diaphragm and the press), even with a temporary increase in pressure inside the abdominal cavity (for example, during straining, lifting a load, or during childbirth), a hernia does not normally form. The appearance of protrusion indicates that at some point the exhaustion of compensatory means occurred.

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In clinical surgery, it is customary to divide the factors for the formation of acquired inguinal hernias into two large groups:

predisposing factors;
producing factors.

The predisposition may not manifest itself for a long time until suddenly the moment of depletion of compensatory capabilities to maintain intra-abdominal pressure occurs. Predisposing factors include:

hereditary predisposition to the development of inguinal hernia;
structural features of the abdominal wall, general body constitution;
gender factor;
age;
pregnancy;
unfavorable social and living conditions;
features of professional activity, some hobbies, excessive physical work or physical inactivity;
some somatic pathologies, including obesity or, conversely, severe exhaustion.

Producing factors are a number of conditions, the implementation of which results in sharp fluctuations in pressure inside the abdominal cavity. The main producing factors are as follows:

childbirth;
lifting weights;
coughing;
constipation;
urinary disorders (for example, with adenomatous changes in the prostate).

Let us consider the main factors in the formation of inguinal hernias in more detail.

When is surgery performed for hydrocele?

Operations for communicating hydrocele of the testicle are most often performed in children aged 2 years.
From 1 to 2 years, operations for communicating hydrops are performed if:
when the volume of the scrotum clearly changes with changes in body position
dropsy increases, causing discomfort
infection joins
Surgeries for post-traumatic dropsy – 3-6 months after injury.
Lymphocele that occurs after surgery for an inguinal hernia or varicocele is operated on 6 to 18 months after the appearance of fluid in the membranes of the testicle.

Main predisposing factors for groin hernias

Hereditary predisposition is one of the most important reasons for the formation of an inguinal hernia. Of course, a hernia itself cannot be inherited - features of the anatomical structure of the abdominal wall, features of the tissue structure of muscles and aponeuroses (tendons) are inherited, which in one way or another can contribute to the formation of a hernial protrusion. Therefore, inguinal hernia often runs in families. On the other hand, one should not consider the hereditary factor as a kind of death sentence: the correct approach to the physical development of a child, a reasonable choice of profession, dosed physical work in adulthood play a big role and serve as an effective prevention of the development of a hernia in the inguinal region. Therefore, the fact of the presence of a hereditary predisposition should be considered as a warning and a reason for a more responsible attitude towards one’s own body.

Constitutional features . Doctors have long noticed the relationship between body type (hyper-, normal-, asthenic) and the likelihood of developing certain diseases. This pattern also applies to inguinal hernias. In particular, people of the hypersthenic type (with a wide chest, wide abdomen, relatively short limbs and developed muscles) more often develop direct inguinal hernias. On the contrary, asthenics (people with a narrow chest and long limbs) are more likely to develop indirect inguinal hernias. This circumstance is explained by the fact that different types of body structure and the abdominal wall in particular correspond to various specific nuances of the structure of the abdominal wall, its muscles, ligaments and aponeuroses. It is worth considering that a particular body type in itself is not a determining factor in the development of a certain type of hernia - it only indicates an increased likelihood of this.

On the other hand, there are a number of genetic pathologies that are associated both with a certain body type and with connective tissue weakness, which results in the development of hernias. For example, Marfan syndrome. However, in this case, we are not talking about a connection with the constitution of the body, but about the result of congenital underdevelopment of connective tissue formations. Often in such pathologies, hernias are accompanied by articular dysplasia, scoliosis, flat feet, malocclusion and other manifestations of connective tissue deficiency.

Connection with gender - numerous statistical observations indicate that in the vast majority of cases, representatives of the stronger half of humanity experience inguinal hernias. This circumstance is explained, as mentioned above, by the specific structure of the male inguinal canal, as well as by the peculiarities of the intrauterine formation of the male body.

Pregnancy is a condition in which there is a significant increase in intra-abdominal pressure. It is absolutely physiological and by nature a certain margin of safety is built into the body of the expectant mother, which allows her to go through the period of bearing a baby without serious harm to her health. However, with multiple pregnancies, polyhydramnios, and frequent births, compensatory mechanisms may not be enough and there is a possibility of developing a hernia. In addition, it should be taken into account that the state of pregnancy affects connective tissue at the biochemical level. This is necessary for subsequent childbirth: muscles, ligaments, and joints soften, become more mobile and elastic, which also contributes to the formation of abdominal wall hernias. However, pregnancy more often causes hernias of the white line of the abdomen; inguinal hernia develops relatively rarely.

Obesity is a common cause of hernias. A thick layer of subcutaneous fat in the abdominal wall, which is almost always observed with excess body weight, provokes sagging and atrophy of the underlying muscle tissue. In addition, in obesity, adipose tissue is usually located in the lower abdomen. A thick layer of skin and fat creates additional stress on the muscles and aponeuroses of the lower third of the anterior abdominal wall, which leads to their degeneration, weakening and also creates a significant predisposition to the formation of inguinal hernias.

Exhaustion is the opposite of obesity, which can also serve as a prerequisite for the occurrence of an inguinal hernia. A sharp decrease in body weight, on the one hand, may indicate diseases that themselves can contribute to the formation of a groin hernia. On the other hand, the lower part of the anterior abdominal wall, even in fairly slender people, contains a fairly noticeable layer of fat. The disappearance of such a layer inevitably weakens the abdominal muscles and can provoke inguinal hernias.

Diseases and circumstances that are often accompanied by the occurrence of hydrocele

Cryptorchidism (undescended testicle)
Hypospadias
False hermaphroditism
Epispadias and exstrophy
Ventriculo-peritoneal shunt
Prematurity
Low birth weight
Liver diseases with ascites
Defects of the anterior abdominal wall
Peritoneal dialysis
Burdened heredity
Cystic fibrosis
Inflammatory diseases of the scrotum leading to the development of reactive hydrocele
Testicular torsion
Injury
Infection
Previous operations affecting the lymphatic system of the testicle

Diagnosis of cryptorchidism

Cryptorchidism is easily diagnosed. Upon examination, you may notice the absence of one or both gonads in the scrotum and swelling in the groin when the testicle is retained in this area. It is not possible to manually lower the testicle into the scrotum. With both bilateral and unilateral cryptorchidism, the scrotum is underdeveloped to a greater or lesser extent.

Patients with proximal forms of hypospadias, micropenia, or a non-palpable testicle often require a differentiated approach to treatment. Such children need consultation with an endocrinologist, geneticist, and additional examination methods to determine the karyotype in order to exclude pathology of sex formation.