Hernias are among the most common conditions requiring surgery, and among the most commonly postponed. Patients live with a swelling for years, wearing a belt and hoping it settles.
Hernias do not resolve spontaneously. They enlarge, and the risk of a surgical emergency accumulates.
What a Hernia Is
A hernia is a protrusion of tissue or an organ through a weak point in the muscle wall that normally contains it.
The weakness may be present from birth, may develop from ageing tissue, or may follow a previous surgical incision. Anything that raises pressure inside the abdomen pushes tissue through it.
- Inguinal: in the groin, by far the most common, particularly in men
- Femoral: just below the groin crease, more common in women and more prone to strangulation
- Umbilical: at the navel
- Incisional: through a previous surgical scar
- Hiatus: stomach pushing up through the diaphragm, which causes reflux rather than a visible lump
What Causes Them
A weakness plus sustained pressure produces a hernia.
- Heavy lifting, particularly with poor technique or in manual work
- Chronic cough, including from smoking
- Chronic constipation and straining
- Difficulty passing urine from prostate enlargement
- Obesity
- Pregnancy
- Previous abdominal surgery
- Ageing and connective tissue disorders
Addressing the underlying cause matters, because operating on a hernia in someone with an untreated chronic cough or prostatic obstruction invites recurrence.
Recognising One
The characteristic feature is a swelling that changes with position and pressure.
- A lump that appears on standing, coughing or straining and disappears on lying down
- A dragging or aching discomfort, often worse at the end of the day
- A sensation of heaviness in the groin
- Discomfort on lifting or exertion
- In men, swelling extending into the scrotum
Once a hernia stops reducing, meaning the lump no longer goes back in when lying down, it has become irreducible and the risk of complications rises considerably.
The Emergency That Justifies Not Waiting
Strangulation is the reason hernias are repaired rather than watched indefinitely.
If a loop of bowel becomes trapped in the hernia and its blood supply is cut off, the bowel dies within hours. This requires emergency surgery, often involving removal of a segment of bowel, and it carries far higher risk than a planned repair.
Go to hospital immediately for:
- A hernia that suddenly becomes painful, hard and cannot be pushed back
- Redness or discolouration over the swelling
- Severe abdominal pain
- Vomiting
- Absence of bowel movements or wind
- Fever
Do not force a painful hernia back in. Our surgical emergency service assesses these urgently.
Belts and Trusses Do Not Work
Hernia belts are widely used and widely misunderstood. They hold the contents in temporarily but do not repair the defect, which continues to enlarge.
They can also cause problems: skin damage, pressure on the hernia contents, muscle wasting under the belt, and a false sense that the problem is managed.
A truss is a reasonable temporary measure for someone genuinely unfit for surgery, or while waiting a short period for an operation. It is not a treatment.
There is similarly no exercise, medication or manipulation that closes the defect. Surgery is the only definitive treatment.
Open Versus Laparoscopic Repair
Both approaches place a mesh to reinforce the weak area, and both are effective. The choice depends on the hernia and the patient.
Open repair: a single incision over the hernia. Can be done under spinal or local anaesthesia, which suits patients unfit for general anaesthesia. Well established with excellent long term results.
Laparoscopic repair: several small incisions with a camera. Less postoperative pain, faster return to work, and particularly advantageous for hernias on both sides or recurrent hernias, since it approaches from behind the defect.
Mesh has substantially reduced recurrence rates compared with suture only repair, and it is standard for adult hernias. Our hernia surgery department and laparoscopic team discuss which approach suits your situation.
Recovery
Recovery is quicker than most patients expect, particularly after laparoscopic repair.
- Day of surgery: most patients go home the same day or the next morning
- Days 1 to 3: walking encouraged, discomfort controlled with simple painkillers
- Week 1: light activity, no lifting over five kilograms, wound kept dry
- Weeks 2 to 3: return to desk work
- Weeks 4 to 6: gradual return to lifting and exercise
- Week 6 onward: heavy manual work and full activity
Bruising and swelling in the groin or scrotum after inguinal repair is common and settles over weeks. Contact your surgeon for fever, spreading redness, discharge, or increasing rather than decreasing pain.
Preventing Recurrence
Modern mesh repair has low recurrence rates, and the factors that raise them are largely modifiable.
- Stop smoking, which impairs healing and causes cough
- Treat chronic cough and constipation
- Address prostatic obstruction if straining to pass urine
- Reduce weight, since abdominal weight increases pressure on the repair
- Learn correct lifting technique, using hips and knees
- Build core strength once healed and cleared to do so
- Follow the activity restrictions in the first six weeks rather than testing them early
Smoking is the strongest single modifiable risk factor for recurrence, and stopping before elective surgery measurably improves outcomes.
A hernia will not close on its own and a belt will not fix it. Planned repair is a straightforward day case procedure. Emergency repair after strangulation is a considerably bigger operation with a much harder recovery, and that is the trade off in waiting.
Our general surgery department at T. Nagar assesses hernias, and Dr. Pinak Dasgupta sees surgical referrals.
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