When does hernia surgery become an emergency?

Updated May 2020

Many inguinal hernia repairs are considered elective procedures, because patients often have the option of when to schedule surgery. This does not mean that these surgeries are not necessary or cosmetic. There is always a chance that a hernia could become strangulated, leading to emergency hernia surgery. Most of the time, people have warning signs before their hernia becomes an emergency. Patients who have worsening pain, intestinal or urinary symptoms should have their hernia repaired more urgently to avoid emergency hernia surgery.

An inguinal hernia occurs when there is a weakness or defect in the abdominal wall that allows the contents of the abdominal cavity to protrude outside. The majority of these hernias can be described as reducible – meaning that can be pushed back in, or returned to the abdominal cavity. Reducible hernias are not life threatening. A small percentage of hernias cause a situation where emergency hernia surgery is necessary every year.

We evaluate about 1200 new patients every year for a suspected hernia.  We feel that most patients fall into one of 4 categories:

  • Groin strains – About 15% of the patients we see have pain and no bulge. This is often due to a groin strain and requires physical therapy in conjunctions with strength training.
  • Asymptomatic hernias – Some patients have a reducible, painless bulge. These patients are able to do all activities with no discomfort at all.  For asymptomatic inguinal hernias, the risk for becoming strangulated is only 0.1-0.2% per year. We typically let these patients continue with their everyday life and follow up when they become symptomatic. 
  • Symptomatic hernia – Many patients present to us with pain at the site of hernia, pain in the abdomen, intestinal or urinary issues. Some patients are able to perform daily activities, but not exercise. Symptoms can become severe enough to restrict patients from going to work, standing or sitting for long periods of time. Patients in this category need surgery to resume their daily lives, improve their quality of life and avoid emergency hernia surgery. A hernia specialist can help determine when a hernia requires more urgent surgery to avoid an emergency. Waiting too long to have a symptomatic hernia fixed can lead to longer and more complicated surgery. 
  • Incarcerated Hernia –  Some patients show up with a hernia that can not be pushed back in, with or without severe pain.  Patients without severe pain can have urgent surgery within a few weeks.  Patients with severe pain often need emergency surgery and are best evaluated in an emergency room. When an inguinal hernia is no longer reducible, the abdominal contents – specifically if these including intestine – are permanently stuck outside of the abdominal cavity. When an incarcerated hernia becomes strangulated, the piece of intestine stuck outside of the abdominal cavity no longer receives adequate blood supply. As the tissues spend longer periods of time with little or no blood supply, they begin to die. This strangulated hernia is a surgical emergency, and requires surgery to save the dying tissues.

It’s important follow up with a hernia surgeon any time there is an increase in the pain you are experiencing from your hernia. If this pain is not relieved by the usual methods, then you should be evaluated to see if more urgent surgery is required. Waiting too long can lead to more problems down the road. Emergency surgery for inguinal or umbilical hernia can be serious and sometimes life threatening. If you have symptoms from a hernia it is important to meet with a surgeon who has expertise with hernia surgery in order to schedule surgery.  You can learn more from our hernia glossary or about the minimally invasive approach we utilize.