“It’s not that bad yet.” “I’ll get it sorted when things quieten down.” “It only hurts when I lift.” “I’ll just avoid heavy work for now.”
These are the kinds of things patients say – sometimes for months, sometimes for years – while living with a hernia they know needs to be addressed but keep putting off. It is an understandable response. Life is busy, surgery seems daunting, and if the hernia is not causing severe pain, it can be easy to rationalise waiting.
The problem is that hernias do not stay the same. They grow. They become more complex. And in a small but significant number of cases, they become a life-threatening emergency.
In this guide, Dr Devesh Kaushal – upper GI and general surgeon in Liverpool – explains honestly what happens when a hernia is left untreated: the risks, the complications, and when it becomes critical to act.
Appointments available within 4-8 weeks depending on urgency Book online 24/7 at drdeveshkaushal.com.au | Urgent cases: Call (02) 7906 8312 |
Can a Hernia Be Left Untreated? The Honest Answer
Yes – in strictly limited circumstances. A small number of patients with specific hernia types may be managed with watchful waiting rather than immediate surgery. Specifically:
- Small, asymptomatic inguinal hernias in men: Research has shown that in men with a small inguinal hernia causing no symptoms, watchful waiting is a reasonable short-term strategy. However, approximately 70% of these patients will develop symptoms within 5 years and require surgery – and emergency rates are higher in those who delay.
- Elderly patients with very high surgical risk: In frail or elderly patients where the risk of surgery is significant, careful observation may be appropriate – with the understanding that emergency surgery carries far higher risk than elective repair.
For every other patient – and for the vast majority of people with a hernia – surgery is recommended once the diagnosis is made. The longer you wait, the more complex the repair, the longer the recovery, and the higher the risk of complications.
The one thing that is never acceptable: Deciding to “just watch” a hernia without having a proper surgical assessment first. Watchful waiting is only appropriate after a surgeon has confirmed the hernia is genuinely low risk in your specific case. Doing it without assessment means making a critical health decision without the information to make it safely. |
What Happens to a Hernia If Left Untreated?
Hernias do not heal themselves. The muscle defect that allowed the hernia to form does not repair on its own – and the forces that created it (abdominal pressure, gravity, physical activity) continue to act on it every day. Over time, untreated hernias typically follow a predictable progression:
1 | The Hernia Gets Bigger Most hernias enlarge gradually over time. A hernia that starts as a small, easily reducible groin lump may grow to involve a significant portion of bowel or omentum. Larger hernias are technically more challenging to repair, require more extensive mesh, carry a higher recurrence rate, and have a longer recovery. A hernia that could have been repaired laparoscopically as a day procedure may eventually require major open surgery with an overnight hospital stay. |
2 | The Hernia Becomes Symptomatic Even hernias that start with minimal symptoms almost always become progressively more symptomatic over time. Activities that were once fine – long walks, playing with children, sport, manual work – become increasingly uncomfortable or impossible. Many patients adapt their lives around the hernia without realising how significantly their quality of life has been reduced. |
3 | The Contents Become Irreducible (Incarceration) An incarcerated hernia is one where the hernia contents – typically bowel or fatty tissue – become trapped in the hernia sac and cannot be pushed back inside. The hernia becomes fixed, firm, and tender. Incarceration causes pain, may obstruct the bowel, and cannot be treated with watchful waiting. Surgery becomes urgent rather than elective – increasing complexity, anaesthetic risk, and recovery time. |
4 | Bowel Obstruction If bowel is caught in an incarcerated hernia, the passage of intestinal contents is blocked. Bowel obstruction causes severe cramping abdominal pain, nausea and vomiting, abdominal distension, and the inability to pass wind or stool. This requires emergency hospital admission and urgent surgical intervention – often with far higher complication rates than elective repair. |
5 | Strangulation – The Surgical Emergency Strangulation is the most dangerous complication of an untreated hernia. It occurs when the blood supply to the trapped bowel or tissue is cut off – causing bowel ischaemia (death of the bowel wall) within hours. Strangulation is a life-threatening surgical emergency. Without immediate surgery, the affected bowel perforates, causing peritonitis and sepsis. Mortality from strangulated hernia repair is significantly higher than from elective repair – and is far higher in older or medically complex patients. |
Warning Signs of Strangulation: Act Immediately
Every patient with a hernia – and their family members – should know the warning signs of strangulation. These are a medical emergency requiring immediate presentation to hospital.
Call 000 or Present to Emergency NOW if You Have: • A hernia lump that suddenly becomes hard, fixed, and cannot be pushed back in • Severe, worsening pain at the hernia site – especially if it was previously mild • The hernia site becomes red, purple, or discoloured • The area around the hernia feels hot and tender to touch • Nausea, vomiting, or retching associated with hernia pain • Inability to pass wind or open the bowel (bowel obstruction) • Fever with hernia pain • Feeling very unwell, sweaty, or faint with hernia symptoms
Do not call your GP and wait for a callback. Do not drive yourself. Call 000 or have someone take you to the nearest emergency department immediately. Time is critical – hours matter with a strangulated hernia. |
Elective vs Emergency Hernia Surgery: Why the Difference Matters
One of the most important reasons to have hernia surgery when it is recommended – rather than waiting for a crisis – is the dramatic difference in risk, complexity, and outcome between planned elective repair and emergency surgery.
Factor | Emergency Repair | Elective Repair (Planned) |
Surgical complexity | Higher – inflammation, oedema, distorted anatomy | Lower – normal anatomy, well planned |
Bowel resection risk | High – may require bowel removal if strangulated | Very low |
Wound infection risk | Significantly higher – contaminated field | Low – clean elective procedure |
Laparoscopic possible? | Often not – open surgery required urgently | Usually yes – keyhole approach preferred |
Hospital stay | Multiple days – ICU possible | Day surgery – home same day |
Mortality risk | Significantly higher – especially older patients | Very low in fit patients |
Recovery time | Weeks to months | 4 – 6 weeks to full recovery |
Anaesthetic risk | Higher – unprepared patient, urgent circumstances | Lower – pre-assessed, optimised |
Recurrence rate | Higher – emergency repairs less durable | Lower – planned mesh repair in optimal conditions |
Is There Anyone Who Can Safely Wait?
This is a legitimate question – and the honest answer is yes, in a narrow set of circumstances. But it requires a surgical assessment to determine whether you are in that group.
Watchful waiting may be appropriate for:
- A man with a small, completely asymptomatic inguinal hernia who has been assessed by a surgeon and confirmed to be at low short-term risk
- An elderly patient with significant medical comorbidities where the anaesthetic risk of elective surgery is genuinely high – and where the hernia is small and asymptomatic
- A patient who clearly understands the risks of waiting and agrees to report any change in symptoms immediately
Watchful waiting is NOT appropriate for:
- Any femoral hernia – femoral hernias carry a very high risk of strangulation and should be repaired promptly regardless of symptoms
- Any hernia that is already symptomatic – causing pain, discomfort, or limiting activity
- A hernia that has previously been incarcerated
- A hernia that is enlarging
- Any hernia in a woman – femoral hernias are more common in women and carry high complication risk
- An incisional hernia – these tend to enlarge and become more complex over time
- A hernia containing bowel – higher strangulation risk
Bottom line: Only a surgeon who has examined you and your hernia can determine whether watchful waiting is appropriate in your case. Deciding to wait without that assessment is not a safe strategy. |
How Does a Hernia Get Worse Over Time?
Not all hernias worsen at the same rate – but the direction of travel without treatment is almost always the same: progressive enlargement and increasing risk. Here is what drives this progression:
- Gravity: Every time you stand, sit, or move, gravity pulls the hernia contents downward through the defect – gradually enlarging it.
- Increased abdominal pressure: Every cough, sneeze, strain, or lift pushes abdominal contents against the defect. Over time, this widens the opening.
- Loss of elasticity: As the hernia defect enlarges, the edges lose their elastic recoil. What was once a small, easily reducible hernia becomes a large, fixed one.
- Progressive stretching of the hernia sac: The tissue making up the hernia sac gradually stretches and thins – reducing the protection around the hernia contents and increasing strangulation risk.
- Adhesion formation: Over time, the hernia contents may form adhesions (scar tissue) to the hernia sac, making reduction more difficult and repair more complex.
The bottom line is that a hernia that is manageable today may be a significantly more complex surgical problem in 2 to 3 years – and a potential emergency in 5 to 10 years.
Common Reasons Patients Delay - Addressed Honestly
What Patients Say | What Dr Kaushal Says |
“It doesn’t hurt that much.” | Pain is not a reliable measure of how serious a hernia is. Strangulation can develop in hernias that were only mildly symptomatic beforehand. Size and reducibility matter more than pain level alone. |
“I’ll have surgery when things quieten down.” | This is the most common reason patients present as emergencies. ‘When things quieten down’ rarely comes – and by then, what was a 45-minute day procedure may become major open surgery with a week in hospital. |
“Surgery sounds scary. I want to avoid it.” | Laparoscopic hernia repair is day surgery – most patients are home the same day. The fear of surgery is understandable, but elective repair is far less frightening and far less risky than emergency surgery under difficult circumstances. |
“I can manage with a support belt.” | A hernia support belt or truss provides temporary comfort but does not repair the hernia, does not prevent enlargement, and does not prevent strangulation. Prolonged truss use is associated with worse surgical outcomes when repair is eventually performed. |
“The doctor said it’s small.” | ‘Small’ today does not mean ‘small’ in two years. All hernias deserve surgical assessment and a plan – even if that plan is careful monitoring. Check with Dr Kaushal what ‘small’ means for your specific hernia. |
“I’m worried about taking time off work.” | Laparoscopic hernia repair typically means 1 to 2 weeks off desk work. Emergency surgery typically means 2 to 6 weeks in hospital and off work. Acting early costs less time, not more. |
Why Acting Now Is Almost Always the Right Decision
If you have a hernia and have been putting off seeing a surgeon – here is why the right time to act is now, not later:
- Elective repair is safer than emergency repair – by a significant margin
- Laparoscopic day surgery today vs potentially open surgery with an overnight stay later
- A hernia repaired now is a hernia that cannot strangulate in the future
- Your recovery from planned surgery is predictable and manageable – emergency recovery is not
- Earlier repair means a less complex procedure and a lower recurrence rate
- Catching a femoral hernia before strangulation can be life-saving
- An assessment does not commit you to surgery – it gives you the information to decide
One Appointment Changes Everything A consultation with Dr Kaushal takes one appointment. From that appointment, you will know exactly what type of hernia you have, whether surgery is needed now or can be monitored, what the surgery involves, and what your recovery will look like. You leave with information – not a commitment. And with that information, you can make a genuinely informed decision about your health. |
Frequently Asked Questions
My hernia does not hurt – do I still need surgery?
Pain is not a reliable indicator of how serious a hernia is or how urgently it needs repair. Hernias that are painless can still incarcerate or strangulate. Femoral hernias in particular are often small and relatively painless – yet carry a very high strangulation risk. All hernias should be assessed by a surgeon, regardless of pain level.
My hernia has been there for years – is it safe to keep waiting?
A hernia that has been present for years without complication does not mean it is permanently safe. Strangulation can occur suddenly in hernias that have been stable for a long time – triggered by an episode of straining, coughing, or physical exertion. The longer a hernia is present, the larger it typically becomes and the more complex the eventual repair. If you have not had a recent surgical assessment, now is the time.
What is the risk of strangulation with an untreated hernia?
The lifetime risk of strangulation for an untreated inguinal hernia is estimated at approximately 0.3% per year – or roughly 3% over 10 years. For femoral hernias, the risk is significantly higher – approximately 22-45% over two years in some studies. Emergency hernia surgery carries a mortality rate of approximately 5-10%, compared to less than 0.5% for elective repair. The risk is real and rises with time.
Can I use a hernia belt or support to avoid surgery?
A hernia belt or truss can provide temporary symptom relief – but it does not repair the hernia, does not prevent growth, and does not prevent strangulation. Prolonged truss use can cause scarring around the hernia sac that makes eventual surgical repair more difficult. It is a temporary comfort measure, not a treatment.
How quickly can I get an assessment in Liverpool?
Appointments with Dr Kaushal are available within 4 to 8 weeks depending on urgency. For hernias with concerning features – pain, irreducibility, rapid growth, or suspected incarceration – please call (02) 7906 8312 directly so the team can prioritise your appointment. Book online at drdeveshkaushal.com.au.
Do Not Wait – Book Your Hernia Assessment in Liverpool Today
If you have a hernia – or suspect you might – the right decision is always to get it assessed. Dr Devesh Kaushal provides expert, clear, and unhurried hernia assessment for patients across Liverpool and South Western Sydney.
One appointment is all it takes to find out exactly what you have, what the risk is, and what the right plan is for you. A hernia that is repaired on your terms – planned, prepared, and at the right time – is a very different experience from a hernia repaired as an emergency.
Do not let the hernia make the decision for you.
Contact Dr Devesh Kaushal Liverpool Consulting Rooms Phone: (02) 7906 8312 Email: [email protected] Book Online: drdeveshkaushal.com.au Office Hours: Monday – Friday, 9:00 AM – 5:00 PM Operating at: Sydney Southwest Private Hospital Liverpool | Campbelltown Public Hospital | Campbelltown Private Hospital | The George Hospital Appointments available within 4-8 weeks depending on urgency | Book online 24/7 | Medicare & Private Health Insurance Accepted |