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American Journal of Epidemiology Vol. 146, No. 9: 721-726
Copyright © 1997 by The Johns Hopkins University School of Hygiene and Public Health
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Risk Factors for Inguinal Hernia in Women: A Case-Control Study
1Department of General Surgery, University Hospital Utrecht Utrecht, The Netherlands
2Department of Epidemiology & Public Health, University of Utrecht Utrecht, The Netherlands
3The members of the Coala Trial Group are as follows: W. S. Meijer, St. Clara Hospital, and R. U. Boelhouwer, Ikazia Hospital, Rotterdam; G. J. Clevers, Diakonessenhuis, and Y. van der Graaf, M. S. L. Liem, A. J. P. Schrijvers, and Th. J. M. V. van Vroonhoven, University Hospital, Utrecht; J. P. Vente, Hofpoort Hospital, Woerden; and L. P. S. Stassen, C. J. van Steensel,* and W. F. Weidema,* Reinier de Graaf Gasthuis, Delft, The Netherlands. (*Presently at the Ikazia Hospital, Rotterdam, The Netherlands.)
Reprint requests to Dr. M. S. L. Liem, Department of General Surgery, G04.228, University Hospital, P.O. Box 85.500, 3508 GA Utrecht, The Netherlands
Potential risk factors for inguinal hernia in women were investigated and the relative importance of these factors was quantified. In women, symptomatic but nonpalpable hernias often remain undiagnosed. However, knowledge on this subject only concerns hernia and operation characteristics, which have been obtained by review of case series. Virtually nothing is known about risk factors for inguinal hernia. The authors performed a hospital-based case-control study of 89 female patients with an incident inguinal hernia and 176 agematched female controls. Activity since birth with two validated questionnaires was measured and smoking habits, medical and operation history, Quetelet index (kg/m2, and history of pregnancies and deliveries were recorded. Response for cases was 81% and for controls 73%. Total physical activity was not associated with inguinal hernia (univariate odds ratio (OR) = 0.8, 95% confidence interval (Cl) 0.6–1.1), but high present sports activities was associated with less inguinal hernia (multivariate OR = 0.2, 95% Cl 0.1–0.7). Obesity (Quetelet index >30) was also protective for inguinal hernia (OR = 0.2, 95% Cl 0.04–1.0). Independent risk factors were positive family history (OR – 4.3, 95% Cl 1.9–9.7) and obstipation (OR – 2.5, 95% Cl 1.0–6.7). In particular, smoking, appendectomy, other abdominal operations, and multiple deliveries were not associated with inguinal hernia in females. The protective effect of present sports activity may be explained by optimizing the resistance of the abdominal musculature protecting the relatively small inguinal weak spot in the female. The individual predisposition for inguinal hernia may be quantified by these risk factors, and, with this in mind, the authors advise that further evaluation might be needed for the patient with unexplained inguinal pain.
family characteristics; hernia; inguinal; obesity; physical fitness; sports; women's health
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  C. E. Ruhl and J. E. Everhart Risk Factors for Inguinal Hernia among Adults in the US Population Am. J. Epidemiol., May 15, 2007; 165(10): 1154 - 1161. [Abstract] [Full Text] [PDF]
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