The internal organs and tissues of the abdomen are held in place by a tough outer wall of tissue called the "abdominal wall.” An abdominal hernia is an area in that wall that is weak or torn. Often when there is a hernia, organs or tissues that were normally held in place by this abdominal wall will bulge or stick out through the weak or torn spot.

The resulting bulge can be painful, especially when you cough, bend over or lift a heavy object.

A groin hernia (also called an inguinal hernia) is a bulge in the part of the body where the thigh meets the trunk. In men, the bulge can extend into the scrotum, the sac that holds the testicles. In girls, the bulge can extend into the outer lips of the genitals.

Hernias are more common in men compared with women, and in whites compared with non-whites. Men are eight times more likely to develop a hernia and 20 times more likely to need a hernia repair surgery compared with women. The lifetime risk of developing a groin hernia is about 25 percent in men but less than 5 percent in women. Women manifest groin hernias at a later age.

A groin hernia isn’t necessarily dangerous. It doesn’t improve on its own, however, and can lead to life-threatening complications.

Most groin hernias in adults have no specific cause, although multiple factors are known to increase one’s risk of developing a groin hernia such as; history of hernia or prior hernia repair (including childhood), older age, male sex, caucasian race, chronic cough, chronic constipation, abdominal wall injury, smoking and a family history of hernia.

A common symptom associated with groin hernia is a heaviness or dull discomfort in the groin, which may or may not be associated with a visible bulge. Groin hernias in women can also result in vague pelvic discomfort. Groin discomfort is most pronounced with physical exertion such as with heavy lifting, straining, or prolonged standing. Very little pressure is needed to create the discomfort, which resolves when the one stops straining or lies down. The groin swelling (hernia) usually goes back into the abdomen by itself upon one resting or can be pushed back into the abdomen with a slight push, and failure to push it back raises the risk of developing serious complications and warrants medical attention

It is important to know that moderate to severe pain with hernias is unusual, and, when present, should raise the possibility a serious complication requiring urgent medical attention.

Groin hernias in newborns and children result from a weakness in the abdominal wall that’s present at birth. Sometimes the hernia will be visible only when an infant is crying, coughing or straining during a bowel movement. He or she might be irritable and have less appetite than usual.

In an older child, a hernia is likely to be more apparent when the child coughs or strains during a bowel movement or stands for a long period.

In men, tests are not usually needed to diagnose a groin hernia. Clinicians can usually tell if a man has a hernia by learning about his symptoms and doing a physical exam. In some rare cases, the doctor might also do an ultrasound to see if the bulge is a hernia or if there is another cause for the swelling.

In girls, an ultrasound to see if the ovary is trapped in the hernia can be done.

Almost all adults who have groin hernias need to have surgery. Doctors usually do surgery soon after the hernia is found to prevent life threatening conditions, such as intestines getting trapped in the hernia.

The surgery to repair the hernia defect can be done as laparoscopic surgery or open surgery depending on a number of considerations such as; the surgeon’s skills, the patient’s and doctor’s decision, resources available.

Laparoscopic surgeries are still limited country-wide, due to the less availability of the laparoscopic equipment, and also to a large extent due to limited number of personnel with skills to do laparoscopic surgeries.

It is also important to know that hernias are managed by surgery, and no known medicine or other therapy will heal a hernia. Most patients who come to our emergency departments with life threatening complications have noticed the problem for years but ignored it since hernia rarely causes serious pain before it develops complications. Other patients come to hospital after trying different alternative sources of medicines, such as herbal and other traditional therapies.

Dr. Ian ShyakaResident in Surgery, Rwanda Military Hospital,iangashugi@gmail.com