An inguinal hernia occurs when soft tissue — usually part of the membrane lining the abdominal cavity (omentum) or part of the intestine — protrudes through a weak point in the abdominal muscles. The resulting bulge can be painful, especially when you cough, bend over or lift a heavy object.

An inguinal hernia isn’t necessarily dangerous by itself. It doesn’t get better or go away on its own, however, and it can lead to life-threatening complications. For this reason, your doctor is likely to recommend surgery to fix an inguinal hernia that’s painful or becoming larger. Inguinal hernia repair is a common surgical procedure.

Some inguinal hernias don’t cause any symptoms. You might not know you have one until your doctor discovers it during a routine medical exam. Often, however, you can see and feel the bulge created by the hernia. The bulge is usually more obvious when you stand upright, especially if you cough or strain.

Inguinal hernia signs and symptoms include:

• A bulge in the area on either side of your pubic bone
• A burning, gurgling or aching sensation at the bulge
• Pain or discomfort in your groin, especially when bending over, coughing or lifting
• A heavy or dragging sensation in your groin
• Weakness or pressure in your groin
• Occasionally, pain and swelling around the testicles when the protruding intestine descends into the scrotum

You should be able to gently and easily push the hernia back into your abdomen when you’re lying down. If not, applying an ice pack to the area may reduce the swelling enough so that the hernia slides in easily. Lying with your pelvis higher than your head also may help.

Some inguinal hernias have no apparent cause. Others occur as a result of:

• Increased pressure within the abdomen
• A pre-existing weak spot in the abdominal wall
• A combination of increased pressure within the abdomen and a pre-existing weak spot in the abdominal wall
• Straining during bowel movements or urination
• Heavy lifting
• Fluid in the abdomen (ascites)
• Pregnancy
• Excess weight
• Chronic coughing or sneezing

In many people, the abdominal wall weakness that leads to an inguinal hernia occurs at birth when the abdominal lining (peritoneum) doesn’t close properly. Other inguinal hernias develop later in life when muscles weaken or deteriorate due to factors such as aging, strenuous physical activity or coughing that accompanies smoking.

In men, the weak spot usually occurs in the inguinal canal, where the spermatic cord enters the scrotum. In women, the inguinal canal carries a ligament that helps hold the uterus in place, and hernias sometimes occur where connective tissue from the uterus attaches to tissue surrounding the pubic bone.

Men are more likely to have an inherent weakness along the inguinal canal because of the way males develop before birth.

Weaknesses can also occur in the abdominal wall later in life, especially after an injury or a surgical operation in the abdominal cavity. Whether or not you have a pre-existing weakness, extra pressure in your abdomen from straining, heavy lifting, pregnancy or excess weight can cause a hernia.

Complications of an inguinal hernia include:

• Pressure on surrounding tissues. Most inguinal hernias enlarge over time if they’re not repaired surgically. Large hernias can put pressure on surrounding tissues. In men, large hernias may extend into the scrotum, causing pain and swelling.
• Incarcerated hernia. If the omentum or a loop of intestine becomes trapped in the weak point in the abdominal wall, it can obstruct the bowel, leading to severe pain, nausea, vomiting, and the inability to have a bowel movement or pass gas.
• An incarcerated hernia may cut off blood flow to part of your intestine. This condition is called strangulation, and it can lead to the death of the affected bowel tissue. A strangulated hernia is life-threatening and requires immediate surgery.

A physical exam is usually all that’s needed to diagnose an inguinal hernia. Your doctor is likely to ask about your signs and symptoms and to check for a bulge in the groin area. Because standing and coughing can make a hernia more prominent, you may be asked to stand up and cough or strain as part of the exam.

If your hernia is small and isn’t bothering you, your doctor may recommend a watch-and-wait approach. Enlarging or painful hernias usually require surgery to relieve discomfort and prevent serious complications.

There are two general types of hernia operations — open hernia repair and laparoscopic repair.

In this procedure, also called an open hernia repair, the surgeon makes an incision in your groin and pushes the protruding omentum or intestine back into your abdomen. The surgeon then sews together the weakened or torn muscle. The weak area often is reinforced and supported with a synthetic mesh (hernioplasty).

After the surgery, you’ll be encouraged to move about as soon as possible, but it may be four to six weeks before you’re fully able to resume your normal activities.

In this minimally invasive procedure, the surgeon operates through several small incisions in your abdomen. A small tube equipped with a tiny camera (laparoscope) is inserted into one incision. Guided by the camera, the surgeon inserts tiny instruments through another incision to repair the hernia using synthetic mesh.

Most people who have laparoscopic repair experience less discomfort and scarring after surgery and a quicker return to normal activities. Laparoscopy may be a good choice for people whose hernias recur after traditional hernia surgery because it allows the surgeon to avoid scar tissue from the earlier repair. Laparoscopy also may be a good choice for people with hernias on both sides of the body (bilateral inguinal hernias).

Some studies indicate that a laparoscopic repair may have an increased risk of complications and of recurrence following surgery. These risks can be reduced if the procedure is performed by a surgeon with extensive experience in laparoscopic hernia repairs.

Laparoscopic hernia repair may not be for you if:

• You have a very large hernia
• Your intestine is pushed down into the scrotum
• You’ve had previous pelvic surgery, such as prostate surgery (prostatectomy)
• You can’t receive general anesthesia