A groin hernia occurs when soft tissue, usually part of the intestine or fatty tissue, pushes through a weak spot in the muscles or connective tissue of the groin. This creates a bulge that may be visible or felt under the skin. There are two main types of groin hernia: inguinal hernias and femoral hernias. Both occur in similar areas but pass through different anatomical spaces

Inguinal hernias pass through the inguinal canal, higher up in the groin. These are the most common type of groin hernia and occur more often in men than in women
 
Femoral hernias pass through the femoral canal, a narrow space just below the inguinal ligament, slightly lower than an inguinal hernia. These are less common overall but occur more frequently in women than men, partly due to differences in pelvic anatomy
 
Because femoral hernias pass through a narrower less flexible space, femoral hernias carry a higher risk of becoming trapped (incarcerated) or losing blood supply (strangulated) compared to inguinal hernias, which is why femoral hernias are generally treated with more urgency once diagnosed

• A bulge in the groin, which may extend into the scrotum in males
  1. The bulge may appear or become more noticeable when standing, coughing or straining
  2. It may reduce or disappear when lying down
• Associated with dull ache, heaviness, dragging sensation or burning in the groin
  1. Can worsen with lifting, bending or physical activity
• Femoral hernias may present as a smaller less obvious bulge lower in the groin
• May have no symptoms and can be found incidentally during an exam

Groin hernias develop when a weakness in the muscle or connective tissue of the groin combines with increased pressure in the abdomen

• A naturally weak spot present from birth
• Ageing which weakens supporting tissues over time
• Heavy lifting or straining
• Chronic cough from smoking or lung disease
• Chronic constipation or straining during bowel movements
• Pregnancy and childbirth
• Obesity
• Previous abdominal or pelvic surgery

Groin hernias are usually diagnosed through a physical examination, checking for a bulge that becomes more prominent while standing or coughing
 
Imaging such as an ultrasound, CT or MRI scan may be used to confirm the diagnosis and assess other clinical factors

Surgery is the only way to permanently repair a groin hernia

Small symptom-free inguinal hernias may be monitored rather than repaired immediately particularly in older patients or those with significant surgical risk. Femoral hernias however, are usually repaired promptly once diagnosed due to their higher risk of complications even if symptoms are mild

• Most people go home the same day or after 1 night in hospital
• Mild to moderate discomfort is common for 1-2 weeks
• Light activity can usually resume within a few days
• Heavy lifting and strenuous exercise should be avoided for 4-6 weeks
• Most people return to desk-based work within 1-2 weeks and physical jobs after 4-6 weeks

A groin hernia can become a medical emergency if the protruding tissue becomes trapped (incarcerated) or loses its blood supply (strangulated). The risk of this occurring is higher with femoral hernias