Untreated Hernias: What Are the Complications and Risks?

Understanding hernias and their risk factors

Hernias are a common condition that can affect anyone regardless of gender or background. They occur when an internal organ pushes through a weak spot in the muscles or tissues that normally hold them in place, often within the abdominal cavity. Hernias typically occur as a noticeable bulge that may appear or disappear depending on body position or activity. They can develop in various locations throughout the body, but most commonly in the groin and abdominal region:

• Along the front midline of the abdomen.
• In the lower chest, through the diaphragm.
• In the groin through the lower abdominal wall.
• Through an incision from prior abdominal surgeries.

Identifying the source or location of hernias is crucial in helping doctors determine the type of hernia. Hernias are typically classified based on their location, as well as the organs and tissues that are involved. As such, some of the most common types of hernias include:

• Inguinal hernia: an inguinal hernia is the most common type of hernia in Singapore, affecting roughly 6% of men [1]. It develops in the groin region, where a portion of the intestine bulges through the inguinal canal.
• Epigastric hernia: epigastric hernia occurs in the upper part of the abdominal wall, specifically in the epigastric region. The epigastrium is located below the breastbone or sternum and above the belly button.
• Femoral hernia: a femoral hernia is a sub-type of inguinal hernia that occurs in the femoral canal.
• Hiatal hernia: a hiatal hernia is developed when a portion of the stomach bulges through a weak opening in the diaphragm and into the lower chest.
• Incisional hernia: an incisional hernia occurs when tissue bulges through an incision from prior abdominal or pelvic surgery that weakens over time.
• Umbilical hernia: an umbilical hernia, typically a congenital condition, is when a portion of the intestine pushes through a weak spot in the abdominal wall near the naval.
• Congenital diaphragmatic hernia: a congenital diaphragmatic hernia is a serious congenital defect characterised by abdominal organs lumping together in the chest cavity during foetal development.

Pinpointing the exact location and type of hernia is crucial for two reasons. Firstly, it guides doctors in crafting the most effective treatment plan. Secondly, this information helps them anticipate potential complications and assess the surgical complexity required.

What happens if a hernia is left untreated?

Hernias can become complicated and cause severe health risks if left untreated for an extended period. Hernia complications:

• Incarceration: incarceration occurs when the hernia becomes stuck and unable to return to its usual location.
• Obstruction: obstruction occurs when the passage of food or waste causes digestive-related problems and pain.
• Strangulation: strangulation occurs when the tissue or organ protrudes through a weakened opening and becomes stuck. This then leads to the blood supply being cut off, causing tissue death.

Behind the bulge: What causes hernias?

Although the exact causes of hernias are unknown, medical practitioners believe they develop due to increased pressure within the abdomen. These pressures can stem from various factors, such as obesity, chronic coughing, pregnancy, and poor habits, such as frequently lifting heavy objects. Be that as it may, there are several risk factors which can increase the likelihood of developing hernias, including:

• Family history: a family history of hernias or medical conditions such as cystic fibrosis [2] or connective tissue disorders [3] indicates a higher risk of developing hernias [4].
• Medical conditions: chronic coughing [5], benign prostatic hyperplasia and chronic constipation [6] are some of the known risk factors associated with developing hernias.
• Obesity: if you are diagnosed with obesity or have a body mass index (BMI) over 30, then you are more at risk [7] of developing hernias.
• Pregnancy: while being pregnant does not immediately raise alarms for hernias, repeated pregnancies – especially within short intervals, can increase your likelihood [8] of developing hernias.
• Prior abdominal or pelvic surgery: a previous abdominal or pelvic surgery puts you more at risk [9] of developing hernias.

Even though hernia is a common condition often regarded as minor, it’s easy to overlook symptoms and be tempted to delay medical attention. However, hernias can be fatal when left untreated for too long, and they’re considered medical emergencies. In fact, early diagnosis and treatment are key components in treating hernias, preventing life-threatening complications, and reversing the damage done by severe
hernias.

Untreated hernias can cause life-threatening complications

Common as they are, hernias pose a threat to your health, especially when left untreated for an extensive amount of time. One of the major concerns of untreated hernias is that they get trapped in the opening that they bulge through. This results in severe abdominal pain or discomfort that grows more prominent when you’re straining, lifting heavy objects, coughing excessively, or even the simple act of laughing too hard. In worst-case scenarios, untreated hernias can result in tissue death as the blood supply is cut off.

Hernia-related complications are categorised into three groups, namely: mild, moderate, and severe. This categorisation helps doctors chart their next course of action in treating hernias. Each level of hernia-related complications exhibits varying symptoms; the common complications that can arise from untreated hernias are:

Increased size, chronic pain, or discomfort

An untreated hernia gradually grows and is often one of the earliest signs of hernia-related complications. As the hernia grows more extensive, it causes chronic pain that is more intense during laborious activities, such as standing for an extended period of time. While the pain is often likened to dull aches, it intensifies over time to the point that it interferes with daily life

Intestinal obstruction

Another common serious complication of untreated hernia is intestinal obstruction. Intestinal obstruction can cause blockages [10] that disrupt your bowel movements. It’s possible that you may have intestinal obstruction if you begin showing some tell-tale signs, including severe abdominal pain, nausea, vomiting episodes, and losing the ability to pass gas or motion.

Incarceration

Meanwhile, incarceration is when the tissue becomes trapped in the opening and is unable to return to the abdominal cavity. Similar to intestinal obstruction, incarceration causes a significant obstruction that affects the intestine [11] and nearby organs. In fact, you’re most likely at risk of incarceration if you’ve got a noticeable bulge that doesn’t go away, accompanied by persistent abdominal pain and tenderness over the hernia site. Because incarceration is regarded as a moderate-level complication, it requires immediate medical intervention, as any delay in treatment will lead to further complications, such as tissue death.

Strangulation

Speaking of tissue death, strangulation is the most severe complication of untreated hernia. It is considered a medical emergency as it often results in life-threatening consequences. When the blood supply to the hernia is cut off, the tissue gradually dies. Hernia strangulation [12] usually causes symptoms such as severe abdominal pain, redness, and tenderness over the hernia site. Additionally, the hernia site becomes swollen and often feels warm to the touch.

Perforation

Aside from strangulation, untreated hernias can result in perforation, where the trapped tissue within the hernia sac becomes so damaged that it develops tears. These tears pose a significant threat to your health as intestinal contents can leak into your abdominal cavity through the tears. Increasing your risk of developing a life-threatening infection known as peritonitis [13].

Doctors can confirm perforation by assessing your symptoms, such as severe abdominal pain, fever, and chills. However, perforation is even more evident when the body starts to show symptoms of septic shock [14], such as rapid heart rate and low blood pressure. Because perforation can trigger septic shock, it requires immediate surgical repair, accompanied by intensive medical care to facilitate recovery.

How are hernias and hernia-related complications treated?

When it comes to hernias, an early diagnosis is significant as it helps to prevent severe and life-threatening complications. Untreated hernias often result in hernias becoming larger, causing more pain, and are even more challenging to treat.

Diagnosing hernia often involves a simple physical examination that licensed medical practitioners perform. Hernia swelling is typically visible when you’re standing and can easily be felt when touched. Beyond a physical examination, your doctor may order imaging tests to determine the exact location of the hernia and to get a clearer idea of the severity of the condition. Imaging tests, such as an ultrasound and CT scans, can help doctors confirm if bowel obstruction is present.

Once a hernia diagnosis has been confirmed, surgical intervention is often the treatment route most doctors would take. However, this depends on the level of complications (if any), the type, and the size of the hernia. But generally, treatment options include:

• Regular monitoring and observation: for asymptomatic umbilical hernias, doctors will usually opt for a wait-and-see approach. This includes incorporating certain lifestyle, habitual, and dietary changes, along with medications to alleviate hernia symptoms. If the hernia worsens despite these interventions, your doctor will recommend undergoing a hernia repair surgery.
• Open hernia repair: an open hernia repair [15] involves a single incision near the hernia site to access the protruding tissue. Afterwards, the bulging organ or tissue is pushed back into place before the weakened connective tissue and muscle are repaired. A supportive mesh material is
  usually used to help strengthen the weakened area while it heals.
• Laparoscopic hernia repair: laparoscopic hernia repair [16] involves using a laparoscope with a
  built-in camera and light at the tip. This instrument aids doctors in better visualising the insides
  of your abdomen. Once the hernia site is located, the surgical tools are inserted through the
  scope to repair the hernia. However, it’s important to note that not all types of hernia are
  suitable to be treated laparoscopically, as it depends on the level of complexity of the hernia.

Hernia-related complications: A preventable situation

Hernias are common medication conditions caused by congenital defects or certain risk factors that weaken the abdominal muscle walls. Although there are different types of hernias, which are identified based on their location, abdominal pain and discomfort with a noticeable bulge over the hernia site are the most common symptoms of hernias. However, abdominal pain is a universal symptom that may indicate a variety of medical conditions, so it’s even more crucial to have it examined to confirm if it’s hernia-related.

By delaying medical attention and treatment, you’re putting yourself at risk of several hernia-related complications, such as chronic pain, intestinal obstruction, incarceration, strangulation, perforation, and even death. Hernia repairs are deemed low-risk surgeries with a high success rate. However, the critical component of a successful hernia repair is early intervention.

If you have been experiencing abdominal pain and a visible bulge on your abdomen that comes and goes, then we implore you to contact us. Rest assured that our team of qualified and experienced doctors will treat your symptoms with the utmost care and outline a treatment plan that will improve your condition without taking too much of your time.

References

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