A hernia occurs when an organ or fatty tissue squeezes through a weak spot in a surrounding muscle or connective tissue called fascia. The most common types of hernia are inguinal (inner groin), incisional (resulting from an incision), femoral (outer groin), umbilical (belly button), and hiatal (upper stomach). Hernias are very common, especially in men. Some hernias never cause any problems and don’t require treatment. However, others can become incarcerated or strangulated, which means the blood supply to the trapped organ or tissue is compromised. This is extremely painful and dangerous, requiring emergency surgery. So while it’s possible for a man to live with certain types of hernia, even large ones, the risks make repairing it the best option in many cases.
What causes a hernia?
Hernias often develop due to a combination of muscle weakness and strain. Some key factors include:
– Congenital defects – Some people are just born with weaker abdominal muscles or connective tissue that makes them prone to hernias.
– Chronic coughing/sneezing – Any activity that causes repeated spikes in abdominal pressure can eventually cause fascia to weaken.
– Constipation/straining – Chronic bowel straining leads to increased pressure in the abdomen.
– Pregnancy – Abdominal pressure from the growing fetus can cause hernias.
– Weight lifting/heavy exercise – Lifting too much weight can stress and weaken abdominal muscles.
– Obesity – Increased fat in the abdomen adds extra pressure.
– Prior surgery – Incision sites from past surgeries can be susceptible to hernias.
Types of hernias in men
Here are some of the most common hernia types found in men:
Inguinal hernia
Most hernias in men are inguinal, occurring in the inner groin region where the leg meets the lower abdomen. They occur when part of the small intestine or inner lining of the abdominal wall protrudes through a weak spot in the inguinal canal. There are two types:
– Indirect inguinal hernia – Develops in the same area as the spermatic cord that holds up the testicles. This is the most common hernia type in men.
– Direct inguinal hernia – Develops directly through weakened abdominal muscles instead of along the spermatic cord. More common in middle-aged and elderly men.
Femoral hernia
Femoral hernias protrude through the femoral canal, a passageway that normally allows blood vessels to go from the abdomen to the legs. More prevalent in women due to wider pelvises, but men can get them too.
Umbilical hernia
Common in babies due to the small umbilical opening that doesn’t close properly after birth. But umbilical hernias can affect adults too, especially pregnant women, the obese, and those with prior abdominal surgeries.
Incisional hernia
An incisional hernia occurs when the site of a prior abdominal surgery doesn’t fully heal, allowing abdominal tissue or organs to bulge through the weakened area. Obesity, poor wound healing, and multiple surgeries increase the risk.
Hiatal hernia
This occurs when part of the stomach pushes upward through the diaphragm muscle and into the chest cavity. Can be caused by obesity, frequent coughing, constipation, or old age. Not externally visible like other hernias.
Common symptoms of a hernia
Many hernias cause no symptoms at all, especially when they’re small. The most distinctive symptom is a visible bulge under the skin, often accompanied by pain or discomfort. Other possible symptoms include:
– A heavy/dragging feeling in the groin, scrotum or abdomen
– Pain/discomfort when lifting, coughing, bending over or during bowel movements
– Weakness, pressure or a feeling of heaviness in the abdomen
– Incarcerated hernia – Severe pain, swelling, and inability to push the hernia back in
– Strangulated hernia – Extreme pain, tenderness, vomiting, fever, rapid heart rate, overall ill feeling, bowel obstruction
Potential complications of an untreated hernia
While many hernias are harmless, some can become dangerous if left alone too long, including:
– Incarceration – The protruding tissue becomes so tightly squeezed through the weak spot that it becomes trapped and blood supply is cut off. Requires emergency surgery.
– Strangulation – The trapped tissue’s blood supply is completely cut off, leading to tissue death (gangrene) if not treated quickly. Life-threatening condition.
– Bowel obstruction – Part of the intestine becomes trapped, twisting and causing a dangerous blockage. Leads to vomiting, constipation, abdomen swelling.
– Tissue death (gangrene) – Lack of blood causes the trapped tissue to die. Can spread a deadly infection throughout the body.
– Peritonitis – Bacteria leaks from the dead bowel or tissue into the sterile abdominal cavity (peritoneum), causing severe infection/inflammation.
So while it’s possible to live with a hernia, there are risks to leaving it alone, which is why repair is often recommended before any serious complications develop. Certain types of hernia like femoral or large inguinal hernias are more prone to emergency issues and require quick treatment.
When is hernia surgery needed?
Repairing a hernia is always optional if no concerning symptoms are present. But doctors typically recommend hernia surgery if:
– The hernia is growing larger or more painful
– It becomes stuck outside the abdominal wall (incarcerated)
– The contents become strangulated, cutting off blood flow
– There are signs of infection or tissue death
– It’s interfering with daily activities
– There is high risk of incarceration/strangulation based on location
– Bowel habits change, suggesting potential obstruction
Surgery is nearly always required for strangulated or incarcerated hernias to prevent potentially life-threatening complications. Otherwise, the risks and benefits of surgery are considered on an individual basis.
Can a man live with an untreated hernia?
It’s certainly possible for a man to live with a hernia, even a large one, as long as it’s reducible – meaning it can be pushed back into place within the abdomen using gentle pressure. However, this doesn’t mean living with a hernia is advisable long-term.
Here are some key considerations about living with an untreated hernia as a man:
– There’s always a risk of incarceration or strangulation if tissue becomes trapped. This can develop suddenly and is extremely painful.
– Larger hernias won’t improve over time without treatment. They usually continue growing and become more prone to complications.
– A hernia can expand into the scrotum over time, which is very uncomfortable. Tight underwear and trusses provide only temporary relief.
– Coughing, straining, heavy lifting, constipation, or obesity can make the hernia worse. Modifying activities may only help so much.
– Some men report feeling self-conscious about a visible bulge from their hernia. This can affect confidence and quality of life.
– Even without complications, a hernia may cause worsening pain, discomfort, or physical limitations that interfere with work and activity.
– There are minimally invasive surgical options with quick recovery times. The risks of watchful waiting often outweigh benefits.
So while living with an untreated hernia may be possible short-term, most men elect to have the hernia repaired via surgery to prevent future complications and improve comfort, function, and quality of life.
What are the limitations of living with a hernia?
Here are some of the main limitations men face when living long-term with an untreated hernia:
– Inability to lift heavy objects – Strenuous lifting should be avoided, along with other activities that increase abdominal pressure.
– Difficulty exercising strenuously – Sports, weightlifting, high-impact exercise will likely need to be curtailed or modified.
– Discomfort during sex – Pressure from sexual activity may cause pain or a feeling of pushing on the hernia.
– Problems with urination and bowel movements – Large hernias can press on the bladder and colon, making urination and defecation difficult.
– Constant risk of serious complications – At any time, the hernia may become incarcerated or strangulated.
– Worsening pain or limitation of activities – The hernia can continue growing and become more debilitating over time without repair.
– Potential testicular damage – Inguinal hernias that extend into the scrotum can compress blood vessels and cause testicular atrophy.
– Negative body image – Men may feel self-conscious about the appearance of a pronounced, bulging hernia.
– Trouble performing job duties – Hernia symptoms may interfere with physical labor and certain career activities.
– Difficulty caring for children – Inability to lift children or keep up with their energy due to activity restrictions.
So without treatment, a hernia can negatively impact many aspects of a man’s daily routine, comfort, function, self-image, career, relationships, and quality of life.
When should a hernia be treated immediately?
In most cases, hernia repair is an elective surgery that can be planned in advance. However, some circumstances require emergency treatment to avoid potentially life-threatening complications. Seek immediate medical care for:
– Incarcerated hernia – Cannot be pushed back into the abdomen, accompanied by severe pain, swelling, tenderness, nausea, vomiting. Surgical emergency.
– Strangulated hernia – Extreme pain, vomiting, fever, rapid heart rate, weakness, dizziness. Medical emergency requiring urgent surgery.
– Signs of shock – Rapid heart rate, falling blood pressure, confusion, clammy skin, loss of consciousness. Indicates organ damage or sepsis.
– Bowel obstruction – Abdominal swelling, vomiting, high fever, constipation, absence of gas/stool. Risk of bowel tissue death.
– Hernia turns dark purple or black – Indicates loss of blood supply (ischemia). Dead tissue can cause life-threatening infection.
– Sudden, severe hernia pain – Potential warning sign of incarceration or strangulation. Better to get checked.
– Inability to urinate – Large hernia may press on bladder/urethra and prevent emptying. Can damage kidneys.
Don’t hesitate to go to the ER or call 911 if a hernia causes sudden, concerning symptoms. Getting rapid surgical treatment can prevent dangerous, even fatal complications.
How do doctors determine if hernia surgery is needed?
Doctors use several criteria to decide whether hernia repair surgery is appropriate, including:
– Hernia size – Larger hernias are more prone to complications and symptoms so warrant repair.
– Reducibility – Hernias that cannot be pushed back into place often require surgery.
– Pain and discomfort – Worsening or frequent pain often prompts surgical correction.
– Location – Hernias in high-risk areas like the femoral canal have greater odds of emergencies.
– Incarceration episodes – Recurrent incarceration indicates eventual strangulation so surgery should be considered.
– Limitation of activities – Interference with sports, work duties, or lifestyle can prompt surgical treatment.
– Bowel/bladder changes – Problems urinating or passing stool due to the hernia may necessitate repair.
– Patient age and health – Older patients with medical issues are more likely to need surgery to prevent complications.
– Patient preference – Some patients opt for surgery due to pain/discomfort even if the hernia is small.
Doctors take a patient’s unique situation into account. But most recommend repair for larger, symptomatic hernias causing impairment to reduce the risks.
What are the disadvantages of living with an untreated hernia?
Some key disadvantages of leaving a hernia untreated include:
– Risk of serious complications – Strangulation, bowel obstruction, infection, tissue death. Hernias can suddenly become emergencies.
– Progressive discomfort and pain – Hernias tend to grow larger and more painful without surgical repair.
– Activity limitations – Worsening symptoms may curtail sports, work, recreational activities.
– Bowel/urinary problems – Large hernias can make going to the bathroom difficult.
– Poor body image – Men may feel self-conscious about noticeable, protruding hernias.
– Prevents weight loss – Activity restrictions hamper the ability to exercise and lose weight.
– Strains relationships – Pain, mobility issues, and emotional distress over the hernia can harm relationships.
– Financial costs – Missed work, reduced performance, medical expenses if complications develop.
– Risks of emergency surgery – Surgery for strangulation or bowel obstruction has higher risks than elective repair.
Overall, living with an untreated hernia often worsens over time and leads to preventable pain, limitations, complications, and psychological distress that impact quality of life.
Should men get hernias repaired right away?
There is no definitive timeframe for when a man should undergo hernia repair after diagnosis. Elective repair can often be safely postponed with watchful waiting if the hernia isn’t causing problems. Here are some factors men should consider regarding timing of repair:
– Size of the hernia – Larger hernias are more prone to complications and symptoms so may warrant quicker repair.
– Location – Hernias like femoral hernias have greater risks when left untreated, requiring prompt decisions about surgery.
– Reducibility – Hernias that cannot be pushed back into the abdomen are more dangerous and may need faster surgical correction.
– Rate of growth – Hernias that rapidly expand likely need earlier repair.
– Pain and discomfort – Worsening or frequent pain often leads doctors to recommend earlier surgery.
– Bowel/bladder function – Changes in urination or defecation may necessitate faster repair.
– Activity impairment – Quicker surgery may be worthwhile if the hernia interferes with daily activities.
– Patient age/health – Those with medical issues or age over 60 may require earlier repair.
– Patient preference – Some simply wish to have repair immediately for peace of mind.
Ultimately there is no set timeframe. It depends on each patient’s unique circumstances and risk factors.
Conclusion
While some men can live for years with a hernia, repairing it surgically is often advised to prevent serious complications, worsening symptoms, and reduced quality of life. The risks and limitations of living long-term with a hernia frequently outweigh the benefits of watchful waiting. Patients should have an in-depth discussion with their doctor regarding the pros and cons of repair versus ongoing observation without treatment. With today’s advantages of minimally invasive surgery, most men choose to undergo hernia repair, allowing them to resume normal activity and avoid the constant threat of bowel obstruction, strangulation, or other emergency issues. While individual factors like age, health status, hernia size, and personal preferences affect the decision, repairing a significant hernia often leads to the best outcome.