Our bodies are encased in muscles from the ribs to the groin. These muscles have a variety of functions one of which is to hold the internal structures in place. For a number of reasons, the muscles in the groin or inguinal region may separate at a weak point and an internal structure may protrude through the gap producing a bulge. When this bulge occurs, it is termed a groin hernia. Both boys and girls have an opening to the groin from the abdominal cavity called the inguinal canal. In girls, the canal contains a ligament that supports the uterus. In boys, the spermatic cord traverses the inguinal canal. This structure includes blood vessels and the vas deferens that are the tubes that carry sperm from the testicles to the inside of the body. There are other types of hernias although they are much less common in adolescents than inguinal hernias. These include umbilical hernias that occur around the navel, incisional hernias that develop in surgical scars and femoral hernias. Femoral hernias occur slightly below the groin and are more common in girls than boys.
Who is likely to develop a hernia?
Boys are much more likely than girls to develop a groin or inguinal hernia. There are two major causes of groin hernias the so-called congenital factors and the acquired defects. Most hernias in this region are due to a congenital problem in the groin region. This could include, for example incomplete closure of the processus vaginalis in the groin. If this area has failed to close completely prior to birth, the defect allows internal structures to enter the inguinal canal and produce a hernia. One may acquire a groin hernia due to injury and the wear and tear stresses of daily life. The following factors that increase the pressure in the abdomen may produce a groin hernia in susceptible adolescents:
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Lifting heavy objects
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Obesity
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Pregnancy
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Constipating and resultant straining
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Recurrent coughing or sneezing
These types of activities or conditions may lead to injury and weakening of the groin muscles and in some individuals a hernia could occur.
What are the symptoms of hernia?
An adolescent with a groin hernia usually presents to the clinician with a painless bulge in the groin or lower abdominal region. Much of the time, the bulge may be pushed back into the body. In males, the hernia and resulting bulge may also extend into the scrotum. Coughing or straining can make the bulge more evident. If the hernia cannot be pushed back into the body, it may be incarcerated or strangulated. In that case, the blood supply may be compromised and then the adolescent may have severe and unremitting abdominal or scrotal pain.
How is a hernia evaluated?
If an adolescent has a bulge in the groin, then a clinician should him or her. Not all bulges in the groin are hernias. For example, a swollen lymph gland, fatty tumor, collection of blood, swollen vein in the scrotum called varicocele and a sac of fluid around the testicle termed hydrocoele are some of the other entities that cause a bulge in the groin.
A careful history and physical examination should be performed on all teens with a bulge in the groin. A clinician will visually inspect the groin and then perform a digital examination of the region. Usually no further testing other than an examination is necessary to diagnose groin hernias.
How is a groin hernia treated?
Surgery is usually performed on adolescents who have a groin hernia. This will prevent incarceration and possible strangulation of the hernia, which could be a serious medical problem. The adolescent will be given local, spinal or general anesthesia before the surgery begins. Most typically, general anesthesia is administered and this allows the muscles to relax and the patient feels no pain since he or she is asleep.
An incision is made in the lower part of the groin and the bulge, typically due to presence of the intestines, is pushed back into the body. The opening in the muscle wall that allowed the bulge is strengthened either by covering it with strong tissue from the body, or by placement of mesh over the spot. The surgeon will make the defect that allowed internal structures to move into the inguinal canal smaller in order to prevent future hernias.
Most adolescents may go home later on the day of the surgery. Activities need to be limited for six to eight weeks to ensure complete healing. This includes no participation in athletics or other vigorous physical activities.
A small percentage of adolescents will develop complications after hernia surgery. These complications include but are not limited to a recurrence of the hernia, swelling of the testicle, damage to the vas deferens or the artery supplying blood to the testicle. The recurrence rate for groin hernias varies from one percent to seven percent.
How is a hernia prevented?
Teens should learn to push, lift and pull objects in a proper way. If an adolescent is overweight, then he or she should begin a safe and nutritious diet and exercise program. If a teen suffers from constipation, then he or she should learn to adjust the diet to achieve normal bowel habits. Smoker’s cough can be avoided by not smoking. Any teen who notes a bulge in his or her groin should see their physician for an evaluation.
Related topics:
Constipation, exercise, musculoskeletal disorders, obesity, pain, abdominal, scrotal disorders
