Inguinal Hernia Symptoms: Understanding and Managing Discomfort

Published: April 2025

Some people can go weeks or months with inguinal hernia symptoms before discovering they have one. The symptoms can range quite a bit, from hardly noticeable to nearly debilitating. Understanding the symptoms, especially before they have a chance to get worse, is crucial for timely diagnosis and treatment. In this page we’ll dive into the following:

Bulging or Swelling in the Groin

The most common initial symptom is a bulge or swelling in the groin, often noticed while showering. This bulge may be easily pushed back. It will often disappear when lying down flat and reappear when upright with the help of gravity.

Discomfort

You may notice pressure, aching, pulling, or twinges. Many patients report minimal discomfort at first, which can escalate with physical activity or prolonged sitting and standing. For some people, there is no physical pain, but knowing there is a bulge is bothersome!

Taking Action

If the bulge is increasing in size over time or discomfort becomes significant and affects daily activities, it’s essential to see a hernia specialist for evaluation and treatment options^1-7. Don’t put it off!

Understanding Swelling or Bulging in the Groin

A bulge or swelling in the groin is often a key indicator of an inguinal hernia. In fact, it is usually the first symptom patients notice.

Soft bulge or lump in the groin: A hernia is a hole in the strength layer of the abdominal wall. This allows bulging through this space that creates a lump in the groin. Patients often describe their hernia as soft, and easily able to be pushed back in. This is a reassuring sign indicating that the contents of the hernia are not trapped (“incarcerated”). However, evaluation by a hernia specialist is still important, and this is a good time to seek one.

Swelling or bulge that does not reduce: Sometimes patients are unable to push the bulge back in without pain, or it is so large that it interferes with wearing belts or tight pants. A bulge with these characteristics makes a prompt medical evaluation even more important. When hernia contents get stuck (also known as “incarcerated”), there is a risk of reduced blood supply to those contents — this is called “strangulation.” Although strangulation is rare, it can be a surgical emergency in the case where the bulging contents include intestine. The risk of this occurring in patients with hernias is VERY low — less than 1% — but patients with hernias need to be aware of the warning signs that would warrant emergent medical attention⁸. These signs include a very tender bulge at the hernia site that cannot be pushed back in, as well as signs of bowel blockage such as nausea, inability to eat or drink without vomiting, and not passing gas from below.

Monitoring a Hernia

Keeping track of any changes in size or tenderness can help your healthcare provider better understand your hernia. Make note of when you first noticed the bulge and perform periodic self-examinations. The bulge may remain unchanged for a very long time, progress steadily, or suddenly enlarge with an injury or heavier physical activity.

Pain and Discomfort

While many patients start with minimal pain, it is important to understand how discomfort may evolve over time.

Activity-Related Pain

Many patients experience increased discomfort with walking, exercise, or other physical activity. For example, if you normally walk 3 miles per day, you may find it difficult to walk mile 3 due to discomfort. That said, it is safe and encouraged to continue to be active even with a hernia. If there are certain activities that increase your discomfort, you may choose to avoid them but otherwise, we encourage continued exercise. The risk of getting into an emergency situation involving strangulation remains VERY low even with continued activity.

Other Triggers

Coughing or having a large meal can place pressure on the hernia, leading to temporary increases in bulging and discomfort.

Management

With inguinal hernias, you can use gravity to your advantage. Lying down flat on your back and gently pushing the bulge in, if possible, can help alleviate discomfort. You may find that a hernia truss or “belt” is useful in keeping the bulge in and preventing discomfort when you’re on your feet. Pain that is severe or doesn’t go away with these simple measures warrants prompt medical attention.

Consultation and Treatment

Timely consultation with a hernia specialist is vital for managing inguinal hernias effectively.

Timing

Specialists will provide a comprehensive evaluation to determine whether surgery or watchful waiting is the best approach. It is always better to have any symptoms evaluated sooner than later^1-7.

Surgical Considerations

For many patients, surgical intervention may be necessary to prevent future complications and restore their quality of life.

Post-Surgery Recovery

Different surgical approaches come with different recoveries^9-12. Be sure to discuss the best option for you with your surgeon. After surgery, it’s crucial that you follow all pertinent instructions and restrictions. If your surgeon recommends physical therapy after healing, it’s important to follow through for the best long-term quality of life.

References

1) Van den Dop, L. Matthijsvan den Dop, Matthijs et al. “Twelve-year outcomes of watchful waiting versus surgery of mildly symptomatic or asymptomatic inguinal hernia in men aged 50 years and older: a randomised controlled trial.” eClinicalMedicine, Volume 64, 102207.

2) Reistrup H, Fonnes S, Rosenberg J. “Watchful waiting vs repair for asymptomatic or minimally symptomatic inguinal hernia in men: a systematic review.” Hernia. 2021 Oct;25(5):1121-1128. doi: 10.1007/s10029-020-02295-3. Epub 2020 Sep 10. PMID: 32910297.

3) Collaboration IT Operation compared with watchful waiting in elderly male inguinal hernia patients: a review and data analysis. J Am Coll Surg. 2011;212:251–259.e1-4.

4) de Goede B., Wijsmuller A.R., van Ramshorst G.H., et al. “Watchful waiting versus surgery of mildly symptomatic or asymptomatic inguinal hernia in men aged 50 Years and older: a randomized controlled trial.” Ann Surg. 2018;267:42–49.

5) O’Dwyer P.J., Chung L. “Watchful waiting was as safe as surgical repair for minimally symptomatic inguinal hernias.” Evid Based Med. 2006;11:73.

6) Fitzgibbons R.J., Jr., Giobbie-Hurder A., Gibbs J.O., et al. “Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial.” JAMA. 2006;295:285–292.

7) Schroeder AD, Tubre DJ, Fitzgibbons RJ. “Watchful waiting for inguinal hernia.” Adv Surg. 2019;53:293–303.

8) Fitzgibbons RJ, Ramanan B, Arya S et al. “Long-term results of a randomized controlled trial of a nonoperative strategy (watchful waiting) for men with minimally symptomatic inguinal hernias.” Ann Surg 258(3):508–515. https://doi.org/10.1097/SLA.0b013e3182a19725

9) Belyansky, I., Tsirline, V. B., Klima, D. A., et al. (2011). “Prospective, comparative study of postoperative quality of life in laparoscopic, open, and robotic hernia repair.” Surgical Endoscopy, 25(8), 2461–2464.

10) Reinhorn M, Fullington N, Agarwal D, Olson MA, Ott L, Canavan A, Pate B, Hubertus M, Urquiza A, Poulose B, Warren J. “Posterior mesh inguinal hernia repairs: a propensity score matched analysis of laparoscopic and robotic versus open approaches.” Hernia. 2023 Feb;27(1):93-104.

11) Agarwal D, Bharani T, Fullington N, Ott L, Olson M, Poulose B, Warren J, Reinhorn M. “Improved patient-reported outcomes after open preperitoneal inguinal hernia repair compared to anterior Lichtenstein repair: 10-year ACHQC analysis.” Hernia. 2023 Oct;27(5):1139-1154.

12) Bharani T, Agarwal D, Fullington N, Ott L, Olson M, McClain D, Lima L, Poulose B, Warren J, Reinhorn M. “Open preperitoneal inguinal hernia repair has superior 1-year patient-reported outcomes compared to Shouldice non-mesh repair.” Hernia. 2024 Apr;28(2):475-484.