By Adam P. Lipkin, MD, Fellow American College of Surgeons
The lump you are feeling may be your intestines protruding through a hole in the abdominal wall. Sounds scary, and a little hard to believe, but read on.
While everyone has heard of a hernia, most people do not understand what a hernia is. The abdominal cavity is encased by a strong layer of muscle called fascia and a hernia simply means there is a defect in the fascia that allows abdominal content (such as your small intestine or the colon) to poke out. Three percent of men will develop one in their lifetime. Some risk factors that predispose to getting a hernia include: being overweight, smoking, chronic cough, and chronic straining (constipation, prostate difficulty, heavy lifting).
Of course not every lump in the groin is from a hernia. A hernia is recognized as a lump or knot that becomes evident with standing, coughing, or straining. It is a few inches to the left or right of the pubic bone. It normally gets smaller or even undetectable when laying down. A hernia is typically uncomfortable but not necessarily very painful. Often times, a person will notice a squish sensation when the hernia pops out or goes back in. One of the good things about a hernia of the groin is that they are usually straightforward for a doctor to diagnose. No special tests or x-rays are necessary.
So what else could cause a lump in the groin? If it is a lump that doesn’t go away, it could be an enlarged lymph node, a tumor (long list of possibilities), or it may be a cyst. In any case, I advise evaluation by a physician.
Sometimes a hernia continues to protrude and doesn’t recede when laying down. This is called an incarcerated hernia, because the protruding tissue is trapped and cannot go back into the abdominal cavity where it belongs. This is typically very painful, especially if intestine is becoming strangulated (pinched so that blood supply is cut off). This leads to death of the intestine….and its owner without prompt care.
Incarceration certainly doesn’t happen to everyone with a hernia, but when it does happen it is a true emergency. That is one reason why anyone with a hernia should discuss it with a doctor, specifically a board certified general surgeon (a surgeon who specializes in hernias and other conditions of the abdomen).
Besides the risk of incarceration, some reasons to consider hernia repair are: 1) they never get any better on their own, 2) they tend to become larger and more uncomfortable over time, 3) they tend to cause progressive limitation of activity, 4) they may become more difficult to fix, and 5) there is no other treatment option. No medication or rehab will close the hole.
Fortunately, modern surgical techniques have made inguinal hernia repair a much easier experience. They are repaired safely without a hospital stay. The great majority can be repaired laparoscopically, using a camera, skinny instruments, and very small incisions (also known as minimally invasive surgery). Bleeding and infection are almost unheard of. Pain pills are not used. Patients return to full activity in less than a week without risking damage to the repair. So get that lump checked out!
Hernias also occur in the abdominal wall (between the rib cage and the groin). These are called ventral hernias and will be discussed in a future article.
Dr. Adam P. Lipkin has been practicing General Surgery in Southwest Florida since 2001. Dr. Lipkin specializes in minimally invasive surgery and has the advantage of modern, up to date training coupled with 2 decades of Operating Room and Endoscopy experience. Dr. Lipkin is Board Certified in General Surgery, and is a member of the American College of Surgeons.
779 Medical Dr., Suite 1
Englewood, FL 34223