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[Conditions](https://durgical.com/en/conditions/) · [Abdomen](https://durgical.com/en/anatomy/region/abdomen/)

# Inguinal hernia

An inguinal hernia is a bulge in the groin where fat or bowel pushes through a weak spot in the lower abdominal wall, above the [inguinal ligament](https://durgical.com/en/anatomy/inguinal-ligament/).

Updated 2026-10-29

## Structures involved

Tap one to see what it is and open it in 3D.

- [Inguinal canal](https://durgical.com/en/anatomy/inguinal-canal/)
- [Inguinal ligament](https://durgical.com/en/anatomy/inguinal-ligament/)
- [Transversalis fascia](https://durgical.com/en/anatomy/transversalis-fascia/)
- [Spermatic cord](https://durgical.com/en/anatomy/spermatic-cord/)
- [Epigastric vessels](https://durgical.com/en/anatomy/inferior-epigastric-artery/)
- [External oblique](https://durgical.com/en/anatomy/external-abdominal-oblique-muscle/)
- [Internal oblique](https://durgical.com/en/anatomy/internal-abdominal-oblique-muscle/)
- [Transversus abdominis](https://durgical.com/en/anatomy/transversus-abdominis-muscle/)
- [Iliohypogastric and ilioinguinal nerves](https://durgical.com/en/anatomy/iliohypogastric-nerve/)
- [Genitofemoral nerve](https://durgical.com/en/anatomy/genitofemoral-nerve/)

## In embryology

- [Gonads and the descent of the testis](https://durgical.com/en/embryology/gonads-and-the-descent-of-the-testis/)
- [Cryptorchidism](https://durgical.com/en/embryology/cryptorchidism/)
- [Processus vaginalis: hydrocele and indirect inguinal hernia](https://durgical.com/en/embryology/processus-vaginalis-hydrocele-and-indirect-inguinal-hernia/)

## In the clinical exam

- [Examination of the groin and abdominal wall for hernias](https://durgical.com/en/clinical-exam/examination-of-the-groin-and-abdominal-wall-for-hernias/)
- [Male genital exam: transillumination, cremasteric reflex, Prehn sign](https://durgical.com/en/clinical-exam/male-genital-exam-transillumination-cremasteric-reflex-prehn-sign/)
- [Bowel obstruction syndrome](https://durgical.com/en/clinical-exam/bowel-obstruction-syndrome/)

## What it is

Protrusion of abdominal contents, such as fat or bowel, through the [inguinal canal](https://durgical.com/en/anatomy/inguinal-canal/) or its posterior wall above the inguinal ligament, felt as a groin bulge.

## Who gets it

The most common abdominal wall hernia. It occurs in both sexes but is much more common in men; indirect hernias are the commonest type in men, women and children. Groin hernia repair is among the most frequent general surgery operations worldwide.

## Causes

- Indirect: a patent processus vaginalis lets contents pass through the deep inguinal ring, along the canal
- Direct: acquired weakness of the [transversalis fascia](https://durgical.com/en/anatomy/transversalis-fascia/) in the posterior wall (Hesselbach triangle)
- Raised intra-abdominal pressure acting on a weak area

## Risk factors

- Male sex and older age
- Family history
- Prematurity and low birth weight (indirect hernia in infants)
- Chronic cough, constipation, straining to pass urine (prostatic enlargement)
- Heavy lifting, previous hernia on the other side
- Connective tissue disorders, smoking, previous lower abdominal surgery

## Pathophysiology

An indirect hernia enters the deep ring, a gap in the transversalis fascia lateral to the inferior [epigastric vessels](https://durgical.com/en/anatomy/inferior-epigastric-artery/), and follows the [spermatic cord](https://durgical.com/en/anatomy/spermatic-cord/) (or round ligament), sometimes into the [scrotum](https://durgical.com/en/anatomy/scrotum/) or labium. A direct hernia bulges through the Hesselbach triangle, medial to the vessels. A narrow neck can trap contents (incarceration) and cut off their blood supply (strangulation).

## Classification

- Indirect (lateral to the inferior epigastric vessels, through the deep ring)
- Direct (medial to the vessels, through Hesselbach triangle)
- Pantaloon (combined direct and indirect)
- Reducible, incarcerated (irreducible) or strangulated
- Femoral hernia is a separate groin hernia, below the inguinal ligament
- Formal systems exist (e.g., European Hernia Society, Nyhus)

## Symptoms and signs

- Groin bulge that grows when standing, coughing or straining and goes back when lying down
- Dragging discomfort or aching in the groin, worse at the end of the day
- Swelling extending into the scrotum (indirect hernia in men)
- May be painless and found on examination

## Red flags

- Hernia that becomes tender, tense and no longer reduces
- Overlying redness or [skin](https://durgical.com/en/anatomy/skin/) discoloration
- Vomiting, distension or no passage of stool or flatus (bowel obstruction)
- Fever, tachycardia or signs of sepsis

## Diagnosis

**Clinical**
Examination standing and lying, with a cough impulse; position relative to the pubic tubercle (inguinal: above and medial; femoral: below and lateral). Distinguishing direct from indirect by examination is unreliable and is usually confirmed at surgery.

**Tests**
Not needed for an uncomplicated hernia. In suspected strangulation: blood count, lactate, electrolytes and [kidney](https://durgical.com/en/anatomy/kidney/) function.

**Imaging**
Usually none. Ultrasound for an unclear or occult hernia; MRI or CT if still in doubt. CT in suspected obstruction or strangulation.

## Differential diagnosis

- Femoral hernia
- Hydrocele, spermatocele or varicocele
- Inguinal lymphadenopathy
- Lipoma of the cord or groin
- Undescended or retractile [testis](https://durgical.com/en/anatomy/testis/)
- [Femoral artery](https://durgical.com/en/anatomy/femoral-artery/) aneurysm, saphena varix or psoas abscess

## Goal of treatment

Relieve symptoms and prevent incarceration and strangulation with a durable, low-recurrence repair, while limiting chronic postoperative pain.

## Treatment

**Follow-up**
Watchful waiting is a reasonable option for men with minimal or no symptoms, with advice about warning signs; many later need surgery.

**Surgical**
Open mesh repair (e.g., Lichtenstein tension-free technique) reinforces the posterior wall; it can be done under local, regional or general anaesthesia.

**Surgical**
Laparoscopic preperitoneal mesh repair (TAPP or TEP), useful for bilateral or recurrent hernias and in women, because it also covers the femoral canal.

**Acute**
An incarcerated, painful hernia needs emergency assessment; gentle reduction may be tried only when strangulation is not suspected, followed by early repair.

**Surgical**
Emergency surgery for strangulation, with bowel resection if non-viable. In children, herniotomy (ligation of the sac) without mesh.

## Complications

- Incarceration and strangulation with bowel obstruction or necrosis
- Chronic postoperative groin pain from the ilioinguinal, iliohypogastric or genital branch of the [genitofemoral nerve](https://durgical.com/en/anatomy/genitofemoral-nerve/)
- Recurrence
- Seroma, haematoma, wound or mesh infection
- Ischaemic orchitis or testicular atrophy, vas deferens injury
- Urinary retention after surgery

## Prognosis

Elective repair has good results and a low recurrence rate. Emergency repair of a strangulated hernia carries clearly higher morbidity and mortality, especially in older patients.

## Prevention

- Treating chronic cough, constipation and urinary obstruction
- Timely repair of symptomatic hernias and of femoral hernias

## Test yourself

Think of the answer, then tap the question to see it.

## Which landmark separates an indirect from a direct inguinal hernia?

The inferior epigastric vessels: indirect hernias are lateral (through the deep ring), direct hernias are medial (through Hesselbach triangle).

## What are the boundaries of the Hesselbach triangle?

Inferior epigastric vessels laterally, the lateral border of the rectus abdominis medially and the inguinal ligament inferiorly.

## Which is the most common type of groin hernia in women?

The indirect inguinal hernia; femoral hernias are more common in women than in men but are still less frequent than inguinal hernias.

## Why is a femoral hernia repaired promptly?

Its narrow, rigid neck gives it a high risk of incarceration and strangulation.

## Which nerves are at risk of injury causing chronic pain after inguinal hernia repair?

The ilioinguinal, iliohypogastric and the genital branch of the genitofemoral nerve.

[Add to my cards (5)](https://durgical.app/estudiar/?add=/en/conditions/inguinal-hernia/)

## Related conditions

- [Small bowel obstruction](https://durgical.com/en/conditions/small-bowel-obstruction/)
- [Femoral hernia](https://durgical.com/en/conditions/femoral-hernia/)
- [Hydrocele](https://durgical.com/en/conditions/hydrocele/)
- [Umbilical hernia](https://durgical.com/en/conditions/umbilical-hernia/)
- [Intussusception (children)](https://durgical.com/en/conditions/intussusception/)
- [Varicocele](https://durgical.com/en/conditions/varicocele/)
- [Cryptorchidism (undescended testis)](https://durgical.com/en/conditions/cryptorchidism/)
- [Hypospadias](https://durgical.com/en/conditions/hypospadias/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Open Inguinal Hernia Repair](https://www.ncbi.nlm.nih.gov/books/NBK459309/) (StatPearls (NCBI Bookshelf), 2026).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/conditions/inguinal-hernia/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/inguinal-hernia/