Symptoms of Bladder Contained in a Hernia
The primary symptoms of a bladder contained in a hernia include inguinal or scrotal swelling, lower urinary tract symptoms (LUTS), two-stage micturition, lower abdominal discomfort, and pain during urination or coughing. 1
Common Presenting Symptoms
Pain and Discomfort
- Suprapubic discomfort or pain that may worsen during urination or physical activities such as coughing 1
- Lower abdominal discomfort that may be exacerbated by increased intra-abdominal pressure 1
- Pain or discomfort in the groin area, which may extend to the scrotum in males 2
Urinary Symptoms
- Two-stage micturition (needing to urinate twice in succession) - patients may need to manually compress the hernia to completely empty the bladder 1, 2
- Urinary frequency - increased number of urinations during the day 3, 1
- Urinary urgency - sudden compelling desire to pass urine 4, 1
- Symptoms of urinary retention in severe cases 5
- Possible urinary incontinence, particularly in cases with large hernias 6
Physical Findings
- Visible or palpable groin mass that may increase in size with standing or straining 1, 2
- Scrotal swelling in males with inguinoscrotal bladder hernias 2, 7
- The swelling may reduce in size after urination, which is a characteristic sign 2
Advanced or Complicated Presentations
Urinary Tract Complications
- Hydronephrosis (swelling of the kidney) in severe cases where the ureter is involved in the hernia 7
- Urinary tract infections due to incomplete bladder emptying 1
- Hematuria may be present in some cases 8
Severe Complications
- Acute urinary retention - sudden inability to empty the bladder 9
- Bladder ischemia or necrosis in cases of incarceration 9
- Potential concurrent bowel ischemia in complicated cases 9
Risk Factors
- Advanced age (≥50 years) 1, 2
- Male gender 1, 2
- Obesity 1
- Weak abdomino-pelvic musculature 1
- Bladder outlet obstruction, such as from benign prostatic hyperplasia 1
- Chronically distended bladder 1
- Decreased bladder tone 1
Diagnostic Considerations
- Symptoms may be mistaken for other conditions such as simple inguinal hernia, overactive bladder, or interstitial cystitis 4, 3
- Bladder hernias are often diagnosed intraoperatively rather than preoperatively 2
- Imaging studies such as ultrasound, CT scan, or retrograde cystogram are helpful for preoperative diagnosis 1, 7
Clinical Pitfalls
- Bladder hernias are rare (1-5% of inguinal hernias) and may be overlooked during initial assessment 2
- Symptoms can mimic other urological conditions, leading to delayed diagnosis 3
- Failure to diagnose preoperatively increases the risk of bladder injury during hernia repair 2
- Newly developed lower urinary tract symptoms in patients with inguinal hernias should raise suspicion for bladder involvement 2