How Long Can A Hernia Go Untreated

Hernias are common problems, especially in men. They usually don’t go away without surgical intervention. Interestingly, surgical treatment is not always necessary. Sometimes doctors would prefer to recommend watchful waiting rather than surgery. But how long can a hernia go untreated (without surgery)?

Diagnosis and treatment options

Many times, physical examination is enough to diagnose a hernia. Typically, your doctor asks you to strain, stand, or cough while pressing the bulge (swelling).

The bulge of hernia usually becomes larger (more obvious) when you put more pressure in the abdomen such as when coughing, straining, or standing upright. On the other hand, typically it gets smaller when you’re lying down. So in general, no bulge to feel or see in the areas of the abdomen commonly associated with hernia means ‘no’ hernia.

But in some cases, people may have a hernia without an obvious swelling, making the disease more difficult to detect. Hernia without a lump is more common in women, see more in this section!

If necessary, a number of additional tests are required, these may include:

1. In some cases, your doctor may refer you to a hospital to take an ultrasound exam, a procedure similar to the ultrasound scan used on pregnant women. This test can help assess the extent of the problem.
2. Other imaging tests such as X-ray, CT-scan, or MRI.

Treatment depends on several factors, especially the symptoms and severity of the disease. Sometimes the type of your hernia may also have an effect.

Hernias come in a number of different sizes and shapes. Also, they can occur in different areas of the abdominal wall fascia (fascia is a tough sheet /layer of connective tissue in the abdominal wall, and it extends from the chest down below to the groin).

Umbilical hernias in babies may relieve and heal without treatment within a couple of years. For all others, hernias usually don’t go away without hernia-repair surgery. Once a hole (hernia) develops in the abdominal wall, there usually will be no improvement without surgical intervention, because it cannot repair itself. Typically, the abdominal wall fascia doesn’t regrow to repair/ close the hole.

However non-surgical approaches can help, too. They can help ease the symptoms and prevent your hernia from worsening – but not to cure the disease. For examples, it’s important to treat chronic coughing, maintain a healthy weight, stop smoking, and restrict activities that can cause more pressure in your abdominal cavity. For hiatal hernias, a few changes in diet can help prevent acid reflux and relieve heartburn.

Treatment can vary because each case is different, so it could be very individualized. Therefore a discussion of the benefits and risks of non-surgical vs. surgical treatments needs to take place between you and your doctor!

How long can a hernia go untreated?

Although conventional hernia-repair surgery is the standard treatment for most cases of hernia, it’s also possible to simply live with the disease and monitor it. This watchful waiting approach is more likely to be recommended if the disease causes minimal or has no symptoms (especially true in men).

Surgery is not always necessary since it’s not going without risks. Sometimes the risks of this treatment approach outweigh the potential benefits.

In most cases, hernias are not necessarily dangerous. Also, they won’t necessarily get worse, though they tend to get bigger over time. But if your doctor recommends ‘watchful-waiting’ approach, how long can you go with it?

How long a hernia can go ‘safely’ untreated without surgery is so individualized! There is no single formula to calculate it since each case varies. It can take a few months or years, depending on several factors. Even some men may never need surgery if it’s small and doesn’t cause any symptoms.

The risks and benefits of surgery vs. watchful waiting are often debatable. But in general, some studies have shown that immediate surgery is not always necessary. For example, a study published in the Journal of the American Medical Association (2006), showed that there didn’t appear to a significant risk for watchful waiting option.

The study randomly selected 720 men with inguinal hernias who took early surgery and assigned to watchful waiting. Those with minimal symptoms were followed and observed for at least 2 years – some up to 4 years or more (from 1999 to 2004), depending on when they got into the study.

After 2 years of observation, the incidence of pain bad enough to affect activities was similar in both groups. And serious complications of hernia were very rare in the watchful-waiting group.

After 2 years, only about 23 % of the patients with watchful waiting approach took surgery (mostly because of increasing their hernia-related pain). And the rates of surgical complications were similar between men treated with hernia-repair surgery after the symptoms increased and those operated on early.

This study suggests that sometimes watchful-waiting option could be a better choice. However, it’s important to not underestimate a hernia since it could turn into serious. The main risk of delaying surgery is that the protruding organ may get trapped (incarcerated) and even strangulated (a condition that cuts off the blood supply to the affected area). Though incarcerated and strangulated hernias are rare in adults, they could be fatal if not immediately treated with surgery.

So should you wait or take surgery early? Again, there are a number of factors that usually will be taken into account in deciding whether hernia-repair surgery is appropriate. Here are some you need to know!

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Key points to remember

In general, it’s safe to put off surgery if:

1. Your hernia is small and doesn’t cause any discomforts /symptoms.
2. The bulge is reducible with manual pressure, it can be easily pushed back or get smaller with lying down.

Your doctor may also recommend delaying surgery if:

1. You’re taking particular medications that make surgery dangerous such as blood thinners.
2. You’re in a situation in which taking surgery can be too much of a risk! For examples if you have a skin infection, poor general health, uncontrolled diabetes, or other health problems.

And you cannot delay surgery or you can only delay it for a short time if:

1. Your hernia gets incarcerated (trapped) and strangulated. In such case, immediate surgery is required.
2. Your hernia contains a part of your intestine or other abdominal tissue that may increase the risk of strangulation.
3. It is able to be reduced with manual pressure, but it causes symptoms severe enough to interfere with your daily life.
4. In women, surgery is often recommended including for small hernias. Female hernias are less likely to occur without an obvious lump, but they are more likely to cause serious complications such as strangulation. In most cases, a watchful-waiting option is probably not appropriate for women.

Sometimes the type of your hernia matters, too. Because some types tend to cause obstruction or become strangulated!

Compare your options!

Since there are different benefits and risks between surgery and watchful-waiting approach, it’s not bad idea to compare your options. For example, see the following table:

Also, ask yourself the following questions!

1. Will you need to travel to a region /an area where comprehensive health care may be difficult to get? Remember that hernia strangulation is unpredictable and it could occur anytime!
2. If you take early surgery, do you have a worker’s compensation or an insurance that will help cover the costs? Or are you not worried about the costs?
3. How about the symptoms? Do they really bother you a lot or do they not bother you at all?
4. Write down other important reasons that matter most to you!