Types, signs and treatment of inguinal hernia in women

An inguinal hernia is a pathology in which, due to weakening of the abdominal wall, part of the peritoneum and internal organs fall out into the groin area; in women, the disease usually develops after 40 years. This condition causes a lot of inconvenience to a person and can lead to serious consequences.

Hernias most often occur in men, but women are also susceptible to developing the disease, especially those who have given birth frequently.

ICD 10 code

In the classification of diseases of the 10th revision, inguinal hernia is listed under the code K40.

[ 1 ], [ 2 ]

Causes of inguinal hernia in women

As already mentioned, inguinal hernia is less common in women compared to men.

The main reason for this condition is the physiological characteristics of women, even during intrauterine development, an opening develops in the abdominal cavity (in boys, the testicles descend into the scrotum through such an opening). Usually, such an opening in women is much smaller, but in some cases it is the one that causes the peritoneum to prolapse.

A hernia can also be provoked by lifting heavy objects and other factors that increase pressure in the abdominal cavity (obesity, heavy athletics, severe cough, frequent constipation, etc.).

A hernia can also be a consequence of surgery on the groin or abdominal cavity.

[ 3 ], [ 4 ]

Pathogenesis

The inguinal canal is located in the lower part of the inguinal region and has four walls formed by the oblique and transverse abdominal muscles. The canal is covered by connective tissue from the inside and by the inguinal ligament from the bottom. When the ligaments or muscles are injured or weakened, an opening is formed through which part of the peritoneum protrudes.

Symptoms of inguinal hernia in women

An inguinal hernia can be asymptomatic, causing no discomfort; the pathology is usually detected during a routine medical examination.

In most cases, the development of a hernia is accompanied by a feeling of discomfort in the groin area (pressure, burning, dull pain on one or both sides, etc.). Often, discomfort appears only after prolonged sitting, lifting weights, etc.

A bulge, which usually appears some time after the onset of discomfort (weeks or months), may indicate the formation of a hernia.

The bulge may disappear after the woman lies down, as lying down helps reduce the pressure inside the abdominal cavity.

With reducible hernias in the groin area, after pressing on the bulge, the internal organs return to their place for a while, but if the hernia is pinched, it is impossible to return it to its place in this way, severe pain in the groin appears, problems with stool, fever, vomiting, weakness, the skin over the hernia becomes red.

Oblique inguinal hernia in women

An oblique hernia in the inguinal region falls through the internal inguinal ring. Congenital pathologies of the inguinal canal can sometimes lead to the development of a hernia, but most often this type of hernia is acquired.

The course of an oblique hernia occurs in several stages, at the initial stage there is a slight prolapse into the inguinal canal, the hernia is almost impossible to see, the pathology is revealed during examination of the inguinal canal.

Over time, a small swelling appears within the inguinal canal, which becomes noticeable when tense and disappears after relaxation.

In women, a complete hernia results in the protrusion of internal organs into the labia majora.

In case of hernias of impressive size, most of the internal organs fall out, in which case it is no longer possible to put the hernia back in place by pressing (in some cases they can go down to the knee).

If the hernia has reached a large size, then the opening through which the internal organs fall out also stretches, the inguinal canal changes its shape and the natural oblique direction takes the form of a ring.

Direct inguinal hernia in women

A direct hernia can only be acquired; such a hernia develops and falls out from the internal inguinal fossa, closer to the middle (the intestinal loop gradually begins to fall out of the abdominal cavity).

This type of hernia most often develops in mature women; the pathology is provoked by physical overexertion, and in rare cases, surgery in the groin area.

[ 5 ], [ 6 ], [ 7 ]

Inguinal hernia strangulation in women

Incarceration is the compression of a hernia, which leads to circulatory problems and tissue death.

In most cases, strangulation is caused by increased pressure inside the abdominal cavity and the prolapse of a larger than normal volume of internal organs, resulting in the prolapsed organs becoming trapped and remaining outside.

Incarceration is the most dangerous and most common complication of an inguinal hernia, in which case it is important to know the symptoms and consult a doctor promptly.

One of the main problems of strangulation is the variety of symptoms that depend on the stage of the disease, the general condition of the patient, gender and external factors. Suspicion should be aroused by pain in the lower abdomen (in the groin area), vomiting, nausea, painful sensations when pressing on the bulge, the swelling does not disappear in the lying position, and becomes larger with tension.

In addition, the symptoms depend on the pinched organ, for example, when the intestine is pinched, frequent vomiting occurs, when the omentum is pinched, only a slight pain is felt, and there will be no vomiting or nausea. In addition, the temperature may rise, a fever may appear.

If a person knows about the presence of a hernia, then any changes will be immediately noticeable.

First signs

An inguinal hernia develops gradually and has its own signs, which are quite difficult to miss.

The first sign of pathology is pain in the groin area; in addition, when lying down, discomfort and pain in the lower abdomen appear.

Over time, a tumor begins to appear, which disappears when lying on the back. These are the first signs of the disease and if you contact a doctor in a timely manner, it is quite easy to cure the pathology.

Also, one of the symptoms of the development of a hernia is constipation, especially during pregnancy.

Problems with urination, pain in the groin area and abdomen are the main signs of a hernia.

In addition to pain, a woman may experience an unpleasant sensation while walking; even at a slow pace, weakness, burning, and pain appear.

It is possible to cope with pathology in the early stages without surgical intervention.

[ 8 ]

Pain in inguinal hernia in women

Pain from an inguinal hernia can be of varying intensity and severity (severe, moderate, nagging, etc.). The hernia can develop in an acute form, in which case the symptoms appear unexpectedly, the patient complains of severe pain and a characteristic bulge in the lower abdomen.

If the disease develops slowly and the hernia is small, the pain is usually mild or completely absent.

With a long-term course of the disease or large sizes of the hernia, there is constant pain in the groin area, which can radiate to the sacrum and lower back.

Why is an inguinal hernia dangerous in women?

An inguinal hernia is a dangerous pathology that requires surgical treatment. During the process of protrusion of the peritoneum, pinching may occur, which will lead to hardening of the hernial sac, tissue death, and inflammation of the internal organs.

In some cases, at early stages, a prolapsed organ can be returned to its place by pressing, but if the operation is delayed, inflammation of the internal organs and pinching may occur.

Hernia reduction surgeries are contraindicated only for women during pregnancy (if there is no strangulation); in this case, the specialist recommends temporarily wearing a bandage to keep the internal organs in place.

Consequences

The consequences of an inguinal hernia begin from the moment it appears, first of all, the inguinal area changes. Since the internal organs penetrate the groin area and form a kind of "bag", various diseases can begin, in particular, inflammatory processes, pinching, infertility, injuries, intestinal obstruction, stagnation in the intestines, tuberculosis of internal organs.

[ 9 ]

Complications

The most common complication of an inguinal hernia is strangulation, which requires immediate surgical treatment. When strangulation occurs, tissue necrosis may begin - intestinal loops, omentum, fallopian tube, etc. that have entered the hernial sac, as well as inflammatory processes in the abdominal cavity.

Less dangerous complications include bowel movements, digestive problems, bloating, etc.

[ 10 ], [ 11 ], [ 12 ]

Diagnosis of inguinal hernia in women

If an inguinal hernia is suspected, an examination is carried out, the specialist palpates the inguinal area in various positions (standing, lying, sitting). If the hernia is small or at an early stage, the specialist also establishes a preliminary diagnosis by palpation - he puts a finger to the inguinal canal, and the patient should cough at this time, if a characteristic protrusion is felt at the moment of tension, this indicates the development of pathology.

In women, inguinal hernia is more difficult to diagnose than in men, since pain in the lower abdomen leads women to the gynecologist and the hernia is often mistaken for other pathologies (cyst, tumor, etc.).

[ 13 ], [ 14 ]

Tests

If a hernia is detected, tests are prescribed before surgery. It is mandatory to take a blood test (general, biochemical, sugar), urine, tests for hepatitis and venereal diseases (AIDS, syphilis).

[ 15 ], [ 16 ], [ 17 ], [ 18 ], [ 19 ], [ 20 ], [ 21 ], [ 22 ], [ 23 ]

Instrumental diagnostics

In case of inguinal hernias, various instrumental diagnostic methods can be used to confirm the diagnosis.

Ultrasound examination of the inguinal canals is widely used in inguinal pathologies.

Usually, an ultrasound is prescribed when a specialist has doubts or in special cases (for example, when formations are too small).

This diagnostic method is effective only if part of the entrails has already penetrated into the groin area; in other cases, the ultrasound will not show anything.

Irrigoscopy also helps to identify inguinal formations, usually this method is prescribed if the specialist suspects a sliding hernia, which is quite difficult to diagnose and has few pronounced symptoms.

This method of examination involves introducing a contrast agent into the intestine and taking X-ray images. Irrigoscopy allows you to study the condition of the intestine, identify pathologies and various diseases.

If a sliding hernia is suspected, an ultrasound of the bladder, cystoscopy, and cystography may also be prescribed.

Herniography is widely used in diagnosing hernias. With this method of examination, a special substance is introduced into the abdominal cavity using a thin needle, then the person must lie on his stomach, cough, strain his stomach, at this time the specialist takes several X-rays, which will show the location of the hernia.

Differential diagnostics

Differential diagnosis involves excluding diseases that do not fit the symptoms or other indicators until ultimately only one probable diagnosis remains.

It is important to distinguish an inguinal hernia from a lipoma, tumor, inflammation of the lymph nodes, femoral hernia, and a cyst of the round ligament of the uterus.

[ 24 ], [ 25 ], [ 26 ], [ 27 ]

Treatment of inguinal hernia in women

When an inguinal hernia is detected in a woman, treatment is prescribed depending on the size of the hernia, concomitant diseases, etc. If the hernia does not cause severe discomfort, the doctor may decide to conduct dynamic observation, which will show how the hernia develops. If stable, additional treatment may not be required, the doctor prescribes a special diet and gentle exercise so as not to provoke deterioration. If the hernia increases and preventive measures are ineffective, the only possible treatment method is prescribed - surgery.

During the operation, the surgeon returns the prolapsed organs to their normal position, removes the hole through which the prolapse occurred, and restores the impaired blood circulation.

Hernia removal surgery is not a complicated procedure and almost always has a favorable outcome. About 14 days after the surgery, a woman can return to her normal lifestyle, she just needs to stick to a gentle regimen and not lift heavy objects to avoid relapse.

Bandage for inguinal hernia in women

Wearing a bandage is the only conservative treatment for inguinal hernias. It is recommended to wear a bandage for large hernias that developed after groin surgery or when surgical treatment is impossible (in case of suppurative processes, relapses, in old age or childhood, during pregnancy, any contraindications to surgery).

Wearing a bandage does not correct the situation, but only relieves unpleasant symptoms and improves the patient's well-being, prevents pinching and further growth of the hernia. When you stop wearing the bandage, all signs of the pathology immediately return.

The bandage should be put on the naked body and only when lying down. At first, a person may experience discomfort, but over time the bandage does not cause any discomfort.

It is usually recommended to remove the bandage at night, but if a person is bothered by coughing or sneezing during sleep, it is better to leave it on at night, in which case it can only be removed while taking a bath or shower.

With prolonged wearing of the bandage, the abdominal muscles may atrophy, so surgical treatment remains the most effective method of treating the pathology.

[ 28 ], [ 29 ], [ 30 ]

Medicines

There are no special medications for inguinal hernia, as this condition is caused by weak abdominal muscles, injuries or surgeries in the groin area, excessive physical exertion. Prolapse of internal organs is treated exclusively surgically, in some cases, wearing a bandage, a gentle regimen (reducing physical activity, not carrying heavy objects, etc.) is prescribed to relieve symptoms, and nutrition is regulated.

Treatment with folk remedies

After consulting a doctor, you can use some folk remedies to relieve the symptoms of an inguinal hernia:

• 500 ml boiling water, 4 tsp gooseberry leaves, leave for about two hours, strain and drink 4 times a day, half a glass before meals.
• make a compress with sour cabbage leaf daily
• make a compress with a strong infusion of wormwood (1 tbsp. of herb, 200 ml of boiling water, leave for 2-3 hours).
• Mix crushed nettle leaves with high-fat sour cream and apply to the skin (thickly), cover with a cabbage leaf or burdock and secure with a bandage, leave overnight. The course of treatment is 1 month.

Surgical treatment

The surgeon may use the patient's own tissue or mesh implants during the operation.

Most often, an open method of performing surgery using special equipment is chosen.

In young girls and girls, their own tissues are usually used, since at a young age the risk of recurrence is extremely low and recovery after surgery is better. At a more mature age, the hernia is eliminated using a mesh implant, since this reduces the risk of recurrence and speeds up the recovery process.

Usually the operation is performed under light general anesthesia; in exceptional cases, local anesthesia is used.

After the incision, the surgeon returns the prolapsed organs to their normal position, after which he sutures the cut area layer by layer.

Laparoscopy (surgery performed through small incisions - up to 1 cm) can also be performed. Just as with open surgery, general anesthesia is used, several small incisions are made in the groin area, then the patient's abdomen is inflated with carbon dioxide to expand the surgical area.

The operation is performed using a laparoscope (a miniature optical device with a camera), which is inserted into one of the incisions, and surgical instruments are inserted into the others. The surgeon can control his actions using a monitor.

Laparoscopy is a less traumatic method, so the recovery process is much faster, and due to small incisions, the risk of infection is reduced.

Postoperative period

After the operation, the patient is advised to have complete rest for several days, usually these days are spent under the supervision of doctors in the hospital. Every day, medical staff changes the dressings, the sutures are treated with special means. The patient is discharged from the hospital on the 7-10th day (in case of laparoscopy on the 3-5th day).

For a month after the operation, a gentle regime is prescribed - avoid physical activity, wear a bandage, do not lift heavy objects, etc.

Full recovery occurs within 3-6 months, depending on age, the chosen method of surgery, concomitant diseases, etc.

Exercises for inguinal hernia in women

A hernia often develops when the muscles of the anterior abdominal wall are weakened, so experts recommend doing special exercises to strengthen this group of muscles, which will help not only prevent the development of pathology, but also prevent the recurrence of a hernia after surgery.

The following exercises are suitable for people of any age and help strengthen the rectus and oblique abdominal muscles:

• lie on your back, straighten your legs, put a 1 kg weight on your stomach (you can use a bag filled with sand) and while inhaling, lift the bag with your stomach as high as possible, while exhaling, lower it as low as possible. Over time, you can increase the weight to 2 and 3 kg.
• lying on your back, lift first the left, then the right and both together to an angle of 45 ^o, (arms along the body). Over time, you can put weights on your legs.
• lying on your back, spread your legs and bend them slightly, while exhaling, lift your pelvis (support is only on your elbows, feet and shoulders).
• lying on your back, fix your legs (under the sofa or ask someone to hold them). As you exhale, sit up, then inhale and lean forward, as you exhale, return to the starting position.
• sitting on a chair, lean on the back, grab the seat with your hands, while inhaling, lift your pelvis (lean on your arms and legs), while exhaling, relax.

It is recommended to do special exercises three times a day.

If you have an inguinal hernia, you should not engage in heavy physical exercise (doing abdominal exercises, using dumbbells, etc.).

If there are contraindications to surgery, exercises should be done throughout life, but a set of exercises should be selected by a specialist, taking into account the degree of the disease and the general condition of the patient.

[ 31 ], [ 32 ], [ 33 ]

Nutrition

In some cases, inguinal hernia in women is the result of regular constipation, so proper nutrition is one of the main preventive measures. The diet should contain a sufficient amount of fiber, which improves bowel function.

After the operation, a special diet is also prescribed for the first few days; food should be liquid and warm (diet broths, herbal infusions, vegetable soups, fruit and berry juices, porridge, soft-boiled eggs, protein omelets).

You only need to follow a diet after surgery for a few days, but you should adjust your future diet and exclude caffeine, alcohol, chocolate, fatty foods, and eat small portions.

[ 34 ]

Prevention

The main preventive measures for inguinal hernias are:

• Reduce physical activity (do not lift heavy objects, avoid overexertion)
• do physical exercises
• control your weight
• adjust your diet (eliminate pickles, fatty foods, include more fiber).

Forecast

The prognosis for inguinal hernia is favorable in most cases; relapse is possible, but if you follow your doctor’s recommendations and basic preventive measures, you can significantly reduce the risk of recurrence of the hernia.

After the operation, full restoration of working capacity is observed.

Inguinal hernia in women is not as common as in men. In the female body there is a whole mechanism of properties that prevent the development of pathologies, in particular, in women the inguinal space is much narrower than in men, and there is no spermatic cord, which interferes with the resistance of the inguinal muscles.

[ 35 ]