Why Does a Hernia Need Surgery? Risks of Waiting & Treatment
Medically reviewed by Prof. Dr. Zahid Mahmood, MBBS, FCPS — General, Laparoscopic & Laser Surgeon, Lahore.
A hernia occurs when fat, bowel or another internal structure pushes through a weak area in the abdominal wall. Surgery is the only treatment that repairs this weakness. Medicines, exercises, belts and changes in diet may reduce discomfort, but they cannot close the defect.
Not every hernia needs an immediate operation. Some small, minimally symptomatic inguinal hernias in men can be observed after surgical assessment. Surgery is usually recommended when a hernia causes pain, enlarges, limits normal activity or has a higher risk of trapping bowel.
Why does a hernia not heal by itself?
The abdominal wall is made of layers of muscle and strong connective tissue. Once a true defect develops, normal pressure from standing, coughing, lifting or straining repeatedly pushes tissue through it. The opening may remain stable for a time, but it does not close naturally in an adult and often becomes larger.
Strengthening surrounding muscles may improve general fitness, but it cannot repair the hole. Forceful exercise can worsen pain or make the bulge more noticeable.
Main reasons a hernia needs surgery
1. Pain or discomfort
A hernia may cause aching, pulling, burning or pressure, especially during standing, coughing, exercise or lifting. When symptoms affect work, sleep, walking or daily life, planned repair is usually appropriate.
2. The swelling is getting larger
Progressive enlargement may make the operation more difficult and can lead to greater discomfort. A large hernia may also become harder to push back inside.
3. The hernia becomes irreducible
A reducible hernia disappears when lying down or can be gently returned. An incarcerated hernia is trapped and cannot be reduced. It requires urgent assessment because the trapped bowel may become obstructed or lose its blood supply.
4. Risk of bowel obstruction
If intestine becomes trapped, food and fluid cannot pass normally. This can cause cramping abdominal pain, vomiting, abdominal swelling and inability to pass stool or gas. Bowel obstruction is an emergency.
5. Risk of strangulation
A strangulated hernia occurs when the blood supply to trapped tissue is cut off. The bowel can become gangrenous or perforate, causing severe infection. Emergency surgery may require removal of damaged bowel and carries greater risk than a planned operation.
6. Certain hernia types are higher risk
Femoral hernias have a narrow opening and a relatively high risk of incarceration and strangulation. Timely repair is generally recommended even when symptoms are mild. Groin hernias in women also deserve early specialist assessment because an underlying femoral hernia may be missed.
When may watchful waiting be reasonable?
Watchful waiting may be considered for a man with an inguinal hernia that causes no pain or only minimal symptoms, remains reducible and does not restrict activity. International guidelines consider this approach reasonably safe when the patient understands the warning signs and has access to review.
However, observation is not a cure. Many patients eventually choose surgery because pain or limitation develops. The decision should consider age, health, occupation, hernia type and size, symptoms, ability to obtain emergency care and personal preference.
Watchful waiting is generally unsuitable for a painful or enlarging hernia, a femoral hernia, a hernia that is difficult to reduce, or symptoms suggesting obstruction.
When is hernia surgery urgent?
Seek emergency medical care if a hernia develops any of the following:
- Sudden severe or rapidly worsening pain
- A firm, tender swelling that will not go back inside
- Red, purple or dark skin over the lump
- Repeated vomiting or increasing abdominal swelling
- Inability to pass stool or gas
- Fever, faintness or severe weakness
Do not repeatedly or forcefully push a very painful hernia. A trapped or strangulated hernia needs immediate surgical assessment.
Is planned surgery better than emergency surgery?
When repair is indicated, an elective operation allows time to control diabetes, blood pressure and other conditions; stop smoking; review blood-thinning medicines; and select the most suitable technique. Emergency repair is performed after a complication has already developed and may involve bowel resection, a longer hospital stay and a higher risk of complications.
How is a hernia repaired?
The surgeon returns the protruding tissue to its proper position, closes or reinforces the defect and restores the strength of the abdominal wall. Repair may be performed by:
- Open surgery: repair through an incision over the hernia.
- Laparoscopic surgery: keyhole repair through small abdominal incisions.
- Robotic surgery: a form of minimally invasive repair available in selected centres.
No single approach is best for everyone. The choice depends on the hernia type and size, whether it is on one or both sides, previous operations, recurrence, general health and the surgeon’s expertise.
Why is mesh often used?
Mesh reinforces the weak area and reduces tension on the patient’s tissues. International guidelines recommend mesh-based repair for most adult groin hernias because it lowers recurrence without increasing chronic pain overall. A non-mesh tissue repair may be suitable for carefully selected patients when an experienced surgeon is available and the options have been discussed.
Mesh infection, persistent pain, fluid collection and recurrence are recognised complications, but serious mesh problems are uncommon. The benefits and risks should be explained for the proposed operation rather than treating every mesh or every hernia as identical.
What are the risks of hernia surgery?
Possible complications include bruising, bleeding, wound or mesh infection, seroma, urinary retention, numbness, persistent groin pain, recurrence and injury to nearby structures. In men undergoing groin repair, uncommon complications can affect the testicle or spermatic cord.
Most patients recover well, but no operation is risk-free. The aim is to operate when the expected benefit is greater than the risk of surgery and continued observation.
Can a hernia belt or truss replace surgery?
No. A belt may temporarily support a reducible hernia in someone who is waiting for surgery or cannot undergo an operation, but it does not repair the defect. An incorrectly fitted truss can cause skin damage and does not prevent strangulation. It should be used only after professional advice.
Can weight loss, avoiding lifting or treating cough help?
These measures can reduce pressure and improve surgical safety, but they do not close an established hernia. Useful steps include stopping smoking, treating chronic cough and constipation, controlling diabetes, achieving a healthier weight and learning safe lifting technique.
Frequently asked questions
Does every hernia require immediate surgery?
No. Selected men with an asymptomatic or minimally symptomatic reducible inguinal hernia may choose watchful waiting. Symptomatic, enlarging, femoral, irreducible or complicated hernias usually need repair.
Will my hernia become strangulated?
It is impossible to predict this for an individual patient. The risk varies by hernia type and patient factors. Femoral hernias and hernias that become painful or difficult to reduce need particular attention.
Should I wait until the hernia becomes large?
No. If surgery is already indicated, waiting for progressive enlargement can increase discomfort and make repair more complex. A surgeon can compare the risks of planned repair with observation.
Can I exercise while waiting?
Walking and comfortable activity are usually reasonable. Avoid exercises or lifting that cause pain or make the bulge difficult to reduce. Seek individual advice for work involving heavy lifting.
Can a hernia return after surgery?
Recurrence is possible after any repair, but modern mesh and carefully selected tissue techniques provide durable results. Smoking, obesity, wound infection, poor tissue quality and technical factors can increase recurrence risk.
Key message
A hernia needs surgery because an adult abdominal-wall defect does not heal naturally. Surgery is advised when symptoms, enlargement or the risk of bowel trapping outweigh the risks of repair. Watchful waiting can be reasonable for selected minimally symptomatic male inguinal hernias, but femoral, painful, irreducible or complicated hernias require timely treatment.
Hernia surgery consultation in Lahore
Prof. Dr. Zahid Mahmood assesses inguinal, femoral, umbilical, incisional and recurrent hernias and explains whether observation, open repair or laparoscopic surgery is most appropriate.
For an appointment, call 0300 413 0159 or visit professorzahid.com.
This article provides general education and does not replace personal medical assessment. Sudden severe pain, vomiting or a tender irreducible hernia requires emergency care.
Medical references
- Williams NS, O’Connell PR, McCaskie AW, editors. Bailey & Love’s Short Practice of Surgery. 28th ed. CRC Press; 2023. Chapter 64, “The abdominal wall, hernia and umbilicus,” pp. 1059–1082.
- HerniaSurge Group. Update of the international HerniaSurge guidelines for groin hernia management. BJS Open. 2023.
- HerniaSurge Group. International guidelines for groin hernia management. Hernia. 2018.
- NHS. Hernia: symptoms, urgent warning signs and treatment.
- NHS. Inguinal hernia repair.