Do All Hernias Need Surgery?

Why the question matters

Hernias are one of the most common things a general surgeon deals with — tens of thousands of repairs are done in Australia every year. But not every hernia needs fixing urgently, and the right decision depends on the type of hernia, what symptoms you are having, your age and overall health, and the risk of something going seriously wrong if it is left alone.

Getting this decision right — fix it now, or keep an eye on it — takes a proper examination and an honest conversation with your surgeon. This page explains the approach that guides that decision.

What the evidence says about watchful waiting

International hernia guidelines — the gold standard that guides surgeons worldwide — do allow a "watch and wait" approach for small groin (inguinal) hernias in men that are causing no symptoms at all. Well-designed clinical trials have shown that men with a hernia they can barely feel can be safely monitored in the short to medium term without a meaningful increase in the chance of something going wrong suddenly.

That said, both major trials also showed that most men who chose to watch and wait ended up having surgery anyway — because symptoms eventually developed. The risk of a hernia becoming dangerously trapped each year is relatively low (around 0.3–0.5%), but it adds up over time. A hernia that causes no bother at age 60 is quite likely to be causing problems — and may be harder to repair — by age 65.

The guidelines are clear on one thing: watchful waiting is only appropriate if the hernia is truly causing no symptoms, if you are reviewed regularly by your surgeon, and if you understand that repair will most likely be needed at some point. It is not the same as ignoring the hernia indefinitely.

Femoral hernias are different — always repair promptly

Femoral hernias sit just below the groin crease, in a small passage called the femoral canal. They are more common in women than men. Unlike inguinal hernias, femoral hernias have a much higher chance of becoming dangerously trapped — studies suggest around 40% will strangulate at some point in their lifetime if they are left unrepaired.

For this reason, all femoral hernias should be repaired as soon as they are diagnosed, whether or not they are causing symptoms. Even a small, seemingly harmless femoral hernia can strangulate without much warning. Waiting for things to get worse is simply not the right approach for this type of hernia.

Watchful waiting vs surgery: when each is appropriate

Incarceration and strangulation: the serious risks

A hernia becomes incarcerated when what has pushed through the gap (usually a piece of bowel or fatty tissue) gets stuck and cannot be pushed back in. This is urgent — you need to be seen by a surgeon quickly, even if the pain is not yet severe.

A hernia becomes strangulated when the blood supply to the trapped tissue gets cut off. This is a surgical emergency. Without restored blood flow within hours, that tissue can die — and you may then need bowel removed, face a much longer recovery, and have a significantly higher chance of serious complications. Emergency hernia surgery carries far more risk than a planned, elective repair done in advance. This is one of the most important reasons not to leave a hernia indefinitely.

Symptoms that indicate surgery is needed

Even without a strangulation emergency, these symptoms are signs that elective repair should not be put off:

• A dragging, heavy, or aching feeling in the groin after being on your feet for a while
• Sharp pain when you cough, sneeze, or lift
• Difficulty doing your usual physical activity or exercise
• The hernia is getting bigger — larger hernias are harder to repair well and have a higher chance of coming back after surgery
• Swelling extending into the scrotum (when the hernia has tracked downward — this is called an indirect inguinal hernia)
• The hernia is getting harder to push back in

One thing worth knowing: hernia symptoms almost never improve on their own. A hernia that causes occasional discomfort today is very likely to be causing more trouble in a year or two. Getting it fixed while it is still straightforward is genuinely the easier path.

Why earlier surgery is generally easier surgery

Many people assume that waiting is always the more cautious choice — but from a surgical point of view, that is often not true. Smaller hernias are technically easier to repair, need less dissection of surrounding tissue, and have a lower rate of coming back after surgery. Hernias that have been there for years can become complex — they may involve a significant amount of bowel, become stuck to nearby structures, or be associated with a weakened area of the wall that is harder to reconstruct.

If you are younger and fit, there is a genuine case for repairing the hernia while it is still small and straightforward. The risk of an elective keyhole or open hernia repair is very low in a healthy person — and far lower than the risk of emergency surgery if the hernia strangulates down the track.

Special considerations

Belly button (umbilical) and incisional hernias

Umbilical hernias in adults are generally recommended for repair if they are causing symptoms or getting bigger. Small ones that cause no trouble can sometimes be watched. Incisional hernias — those that appear through a previous surgical scar — have a strong tendency to grow over time, which is why repair is usually recommended rather than ongoing observation.

Women with a groin hernia

If you are a woman and you have been told you have a groin hernia, it is worth knowing that the hernia is more likely to be femoral (which carries a higher risk of becoming trapped) than it would be in a man. Watchful waiting is generally not appropriate for women with groin hernias, and careful assessment by an experienced surgeon is important.

Older patients with other health conditions

If you have significant heart, lung, or other health conditions, the risk of surgery and anaesthesia may genuinely outweigh the risk of leaving the hernia alone — particularly if it is causing minimal symptoms. This is a very personal calculation, and it deserves a careful, honest conversation between you and your surgeon about what the realistic risks and benefits are in your specific situation.

Frequently asked questions