Diagnosis and Treatment

Is having NO treatment an option?



Take Care!

Do NOT go on any kind of active holiday or travel anywhere far from good surgical care with a known hernia condition. You are at risk AND may well find yourself uninsured under the terms of your travel insurance.

There is always the option to do nothing – but what happens then?

Doing nothing leaves things as they are – and avoids any surgery (for the time being). This is obviously an attractive proposition on first sight, especially in cases where the hernia does not hurt so we think to ourselves it cannot be serious. However:

any symptoms, such as discomfort and pain will also worsen, affecting your quality of life and ability to work (and play)
delaying surgical repair and allowing the hernia to enlarge significantly is likely to make later operations more complicated if (when!) you do eventually have surgery
there is always the risk of strangulation (where the bowel becomes trapped in the hernia and loses its blood supply) which requires emergency surgery

Do I have any non-surgical options?

Wearing a corset or belt or truss. Not ideal, can cause additional problems and it is difficult to find a good one. They were popular when surgery was complex, dangerous and had a universally poor success rate. Wearing a truss can also lead to weakening of the muscles in the area and compromise the success of future surgery The truss can also give a sense of false reassurance that it is holding the hernia contents in, whilst it could actually be pressing of the hernia contents, especially risky if the content is a loop of bowel.

Watchful Waiting

A number of trials have looked at what would happen if you did not fix the hernia and just observe. It is called ‘watch and wait’.

One of them, from the US, published in the Journal of the American Medical Association (JAMA) in 2006 showed that almost one-quarter of the non-operated patients converted to surgery within 2 years. The conclusion of this study was that ‘Patients assigned to watchful waiting who requested surgical repair most commonly reported increased pain as the reason for the crossover, and nearly half reported that pain interfered with normal activities. These symptoms improved for most patients after hernia repair.

A subsequent update on this trial with a longer follow-up, published in the Annals of Surgery in 2013 found that the vast majority of patients who were on watchful waiting, ended up having surgery anyway.

Another UK trial showed similar results with nearly 3 in 4 patients having surgery by 7 years. The conclusion of this study was that ‘most patients with a painless inguinal hernia develop symptoms over time. Surgical repair is recommended for medically fit patients with a painless inguinal hernia’.

In other words, watchful waiting is considered NOT to be an effective strategy. Our advice is to find a specialist hernia unit and have the hernia repaired as soon as possible.