Some people are actually born with a hernia, called a congenital hernia. Others develop a hernia over time. Hernias commonly occur in the belly button (umbilical hernia) or in the groin (inguinal hernia). Both umbilical and inguinal hernias develop as abdominal tissues stretch enough to allow internal abdominal organs or fat to pop through the abdominal wall. This occurs in areas of inherent weakness in the abdominal wall. In men, there is a weakness in the groin which allows abdominal contents to leave the abdominal cavity through a defect in the groin. Typically, all of our tissues stretch as we get older and the abdominal wall is no different. Being overweight, frequent heavy lifting, and prior surgery can all increase the risk of developing a hernia. Events that increase the abdominal pressure quickly, can contribute to the formation of a hernia, or cause a hernia to appear sooner than it would have done naturally. Car accidents, falls, or work related injuries may increase abdominal pressure enough to contribute to a hernia. There are some people that have a genetic predisposition to get hernias, as the genetic makeup of their tissues allows for more stretching, and therefore an increased risk of hernia.
In the diagram we have drawn here, the normal inguinal canal is depicted in the top image in blue. As men age, the inguinal canal stretches as shown in the lower diagram in blue. The change in the geometry of the inguinal canal, creates a situation where intestine can herniate into the inguinal canal or scrotum, which leads to an indirect inguinal hernia – the most common type of inguinal hernia. A direct inguinal hernia can also occur, and results from stretching of tranversalis fascia in the groin.
Once fat or intestine herniate into the inguinal canal or scrotum, symptoms can develop and the hernia should be repaired. Since 2001, Dr. Reinhorn has been repairing inguinal hernias for people from New England. Using an innovative technique, Dr. Reinhorn is able to repair an inguinal hernia with mesh, under all the layers of the abdominal wall, while avoiding general anesthesia. He also has experience with the Shouldice technique, a non-mesh repair for inguinal hernia.