How is an inguinal hernia diagnosed in men?
Inguinal hernias in men typically present themselves as a bulge in or near the groin area. Some men notice swelling next to the pubic bone, while others notice swelling in the scrotum, near the testicles. The hernia may or may not be painful, though if painful, daily activities such as bending, lifting, coughing, and laughing may exacerbate the pain. Symptoms generally present slowly over time, starting with mild discomfort or even a painless bulge. Over weeks, months or even years, most men develop increased sensation of pressure, discomfort or pain in the groin. While many men with hernias are able to participate in daily physical activity, once the hernia becomes more uncomfortable, most stop or limit the activities that exacerbate the pain. While most hernias appear slowly over time, some hernias may appear suddenly requiring urgent evaluation, and sometimes emergency hernia surgery. A physical examination is typically all that is needed to diagnose a hernia in men. In women, the evaluation and treatment is very similar, yet there are a few differences you can read about in our FAQ about treating hernias in women.
When patients are examined in the office, they are to see if a bulge is visible, or where the pain occurs. If a bulge is visible, we typically push on it, from bottom up, to see if it is reducible (the contents of the hernia can be pushed back into the abdomen where they belong). If the hernia cannot be pushed back in easily, we try to do it with the patient lying down flat. If the hernia is still not reducible, we often try to schedule surgery within a couple of weeks in order to prevent complications from an incarcerated hernia. If a bulge is not easily seen, patients are asked to strain or cough in order to in order to increase their abdominal pressure and allow the hernia contents to push out of the abdomen. If a hernia is not felt with the patient standing, then we typically assess them for a groin strain or musculoskeletal strain. For this, patients are evaluated flat on the examination table, and are asked to flex different muscle groups in order to determine the source of their pain.
Physical examination by an experienced hernia surgeon can accurately diagnose almost every hernia. This entails examining the groin area for a bulge while the patient is standing, which if present, makes the diagnosis fairly obvious. It is important for us to know if the hernia is reducible, meaning the contents of the hernia can be pushed back into the abdomen where they belong. If the hernia is not reducible with standing, we have patients lie flat on the exam table. This allows for the abdominal muscles to relax and uses gravity to help reduce the hernia. If the hernia is still not reducible when laying flat, we often recommend surgery in the next couple of weeks to prevent complications from an incarcerated hernia.
If there is no bulge noted on initial exam of the groin, we palpate the area and ask the patient to cough or strain, which increases the abdominal pressure and forces the hernia contents out of the abdomen.
If there is no hernia felt on exam, then we will assess for a musculoskeletal strain, which is another common cause of groin pain in men. We evaluate for patients for groin strains and abdominal muscle strains by testing various muscle groups to determine the source of the pain.
X-Ray, Ultrasound, CT scan and MRI are rarely ever needed, and should not replace evaluation by an experienced hernia surgeon.
Why are inguinal hernias more common in men than in women?
When males are developing in utero, their testicles develop up in their abdomen and then descend down into the scrotum through the inguinal canal. This canal, initially very narrow, allows for blood vessels and nerves to travel to the testicle. As men age, the inguinal canal loses its structural integrity, changing from a long narrow cylinder to a shorter and wider cone. When this change occurs in the male inguinal canal, the enlarged internal opening (internal ring) and lack of angulation of the cone allows abdominal cavity contents to protrude into the inguinal canal. This is called an indirect inguinal hernia. A direct inguinal hernia occurs when the strength layer of the abdominal wall (the transversalis fascia) stretches and allows abdominal contents to push into the inguinal canal. Women do not have the same inguinal anatomy as men, and therefore are much less likely to develop inguinal hernias. In fact, men make up 90% of patients who require inguinal hernia surgery.
About Dr. Reinhorn & Dr. Fullington
Dr. Michael Reinhorn is a specialist in inguinal hernia and umbilical hernia. Dr. Reinhorn started his practice as a full service general surgeon in 2001. In 2012 Dr. Reinhorn started to focus on the care of hernia and pilonidal patients. In 2020, Dr. Nora Fullington was recruited from her work as a general surgeon performing hundreds of laparoscopic hernia repairs to Boston Hernia. Together with their physician assistant team, they provide a focused practice designed to provide a superior clinical experience. The team performs approximately 700 hernia surgeries every year and offers a tailored approach for each patient from anesthesia type to consideration of mesh and no mesh repairs, laparoscopic and open surgery. We have published outcomes and continue to participate in hernia and surgery societies. Our research led to a reduction in opioid prescribing after hernia surgery. Currently, Dr. Reinhorn serves as the chair of the Opioid Reduction Task Force of the Americas Hernia Society Quality Collaborative.
What our patients are saying:
– Dr. Michael Reinhorn, Is an amazing Doctor & Surgeon. His staff and team are world class. I’m a Chef by trade. This was my second hernia op and he had me up and back at work in 2 days. Read more