Q. I have a left inguinal hernia. It is quite annoying because there is always a bulge on my left scrotum. The bulge has not gotten bigger and it is not bothering my urination or sex life. My concern is, if I take it for granted would it lead to complications in the future? I am already 47 years old with three kids. My hernia appeared after the birth of our second child. Is this hereditary as my father and brother also had such but my father never underwent any operation and died from other causes. Please advise me?

-- sirbo@yahoo.com

A. An inguinal hernia (luslos, in Filipino) occurs when soft tissue from the abdomen—usually a segment of the intestine and/or mesentery—protrudes through an opening in the abdominal wall into the inguinal canal in the groin, or even as far down as the scrotum. Usually, an inguinal hernia presents as a painless bulge in the groin or scrotum (as in your experience). Sometimes, there is also heaviness in the groin and occasionally, the bulge is painful especially when the person coughs, bends over, or lifts a heavy object.

Many inguinal hernias are present at birth. Others develop later in life when a tear in a weakened part of the abdominal wall occurs. The weakness on the abdominal wall may already be present at birth or it may be secondary to factors such as aging, injury, abdominal surgery, and strenuous physical activity.

It is not certain whether the tendency to develop inguinal hernia is genetically transmitted but the disorder runs in families. The risk of developing the condition is greater if a close relative, such as a parent or sibling (as in your family’s case) have the condition. Other risk factors include premature birth, chronic cough, occupations that require standing for long periods or doing heavy physical labor, chronic constipation (that results in straining during defecation), excess weight, and, in women, pregnancy.

Inguinal hernias are 10 times more common in men than women. This is so because in the male fetus, the testicles that form in the abdomen descend into the scrotum via the inguinal canal. The inguinal canal normally closes shortly after birth, but sometimes, it does not close properly, leaving a weakened area.

Usually, in inguinal hernias, the intestine slides back and forth through the opening in the abdominal wall with gravity, thus, the bulge enlarges a little when the person stands and shrinks when the person lies down. Also, most people are able to gently push back the intestine and/or mesentery into their abdomen when lying down.

Per se, an inguinal hernia is not dangerous and many people, your father for one, go through life with the condition. However, it can lead to life-threatening complications, which is why most doctors recommend surgical repair of an inguinal hernia especially if it is painful or becoming larger.

The most serious complications of inguinal hernia are incarceration and strangulation. Incarceration occurs when a segment of intestine becomes trapped in the weak point in the abdominal wall resulting in bowel obstruction that manifests as severe pain, nausea, vomiting and the inability to pass gas or move the bowel. Strangulation, on the other hand, occurs when the blood vessels that supply the segment of the intestines that have become incarcerated get compressed resulting in diminution of blood flow to the incarcerated intestinal segment. A strangulated hernia is life-threatening and requires immediate surgery.

In your particular case, you should consider having your hernia surgically repaired to ensure that it does not complicate. In any case, while you are still contemplating surgery, the following measures can prevent your hernia from complicating: maintain a normal weight; take a high-fiber diet to prevent constipation and straining during defecation; avoid heavy lifting; and, if you smoke, stop.

(E-mail inquiries on health matters to: medical_notes@yahoo.com or wellbeing@mb.com.ph.)