A hernia is a common medical condition that affects people of all ages, yet many individuals are unaware of its potential complications until symptoms become severe. While some hernias may initially appear harmless, delaying treatment can lead to serious consequences, including emergency surgery.
General surgeon Dr. Kan Yuk Man explains the causes, symptoms and treatment options for hernias, and why early intervention is often the best way to prevent complications.
A hernia occurs when an internal organ or tissue pushes through a weakened area in the muscle or connective tissue that normally holds it in place. This weakness creates an opening through which structures such as fat or intestines can protrude.
“Think of the body as a muscular bag that keeps everything in place,” Dr. Kan explains. “When part of that muscle weakens, organs can move out of position. The concern is that if tissue becomes trapped in a narrow opening, it can lose its blood supply, causing severe pain and requiring emergency surgery.”
Although hernias can develop in various parts of the body, they most commonly occur in the abdominal wall and groin.
One of the most common types of hernia is the inguinal hernia, which develops in the groin area. These hernias are significantly more common in men due to natural anatomical structures that exist from birth.
“In men, there is a canal through which the testes descend during development,” Dr. Kan says. “Over time, this area can weaken and stretch, allowing tissue such as fat or even intestines to protrude through the opening.”
Another common type is an umbilical hernia, which develops near the belly button. While some people experience little discomfort, these hernias can enlarge over time and potentially trap segments of intestine.
Hiatus hernias occur higher up in the body, where part of the stomach protrudes through an opening in the diaphragm. These hernias are often associated with acid reflux and heartburn.
“In some patients, a hiatus hernia can contribute to significant acid reflux,” Dr. Kan cautions. “Over time, chronic acid exposure can damage the oesophagus and increase the risk of more serious complications.”
A fourth type of hernia is the incisional hernia, which develops at the site of a previous surgical incision. Although less common today due to advances in minimally invasive surgery, they can still occur months or years after an operation.
Regardless of where they occur, hernias often develop due to a combination of anatomical weaknesses and factors that increase pressure within the abdomen.
Several factors can contribute to the development of a hernia. Some people are born with areas of natural weakness, while others develop hernias as part of the ageing process as muscles gradually lose strength. Activities and conditions that increase pressure within the abdomen may also contribute to hernia development. Heavy lifting, strenuous exercise, chronic coughing and obesity can all place additional stress on weakened tissues.
“We know that sudden straining, such as heavy weightlifting, can sometimes trigger a hernia,” Dr. Kan notes. “In older adults, the muscles naturally weaken with age, making hernias more likely to develop.”
The most noticeable symptom of a hernia is often a lump or bulge that becomes more prominent when standing, coughing, exercising or straining. The lump may disappear when a person lies down or relaxes. In some cases, the protrusion can be gently pushed back into place temporarily.
However, the absence of pain does not mean the condition is harmless.
“A common misconception is that if a hernia doesn’t hurt, it doesn’t need treatment,” Dr. Kan notes. “The problem is that hernias tend to get larger over time. The longer they are left untreated, the greater the risk of complications.”
Other symptoms may include discomfort, a feeling of heaviness, bloating or worsening acid reflux, depending on the type of hernia.
While some hernias may remain relatively stable for a period of time, they do not heal on their own and, if left untreated, generally worsen over time.
One of the most serious complications is incarceration, where tissue becomes trapped within the hernia and cannot be pushed back into place. If the blood supply becomes compromised, the condition progresses to strangulation, a surgical emergency.
“When tissue becomes trapped, it can swell and lose its blood supply,” Dr. Kan stresses. “At that point, emergency surgery may be necessary, and in some cases part of the intestine may need to be removed.”
Emergency procedures often involve larger incisions, longer recovery times and a higher risk of complications compared to planned elective surgery. Early diagnosis and timely treatment can help prevent these complications and allow surgery to be performed under more controlled circumstances.
In many cases, a hernia can be diagnosed through a physical examination. Doctors may ask patients to stand, cough or perform movements that increase abdominal pressure, making the hernia more visible.
“Most hernias can be diagnosed clinically,” Dr. Kan says. “If the hernia is very small or difficult to detect, an ultrasound scan can help confirm the diagnosis.”
Ultrasound imaging is particularly useful for identifying subtle hernias that may not be obvious during a routine examination.
Unlike many other medical conditions, there is no medication that can repair a hernia. Surgery remains the definitive treatment.
Dr. Kan advises that most hernias should be repaired before they enlarge significantly or lead to complications.
“If a hernia is causing symptoms, it should be repaired,” he advises. “Even if it is not causing symptoms today, it will usually continue to grow over time. Addressing it earlier generally means a simpler operation and lower risk.”
Age alone should not prevent patients from considering surgery.
“It’s not about the number of years a person has lived,” Dr. Kan explains. “I have seen patients in their eighties who are healthier than some people in their fifties. The decision depends on the individual’s overall health.”
Modern hernia surgery has evolved significantly over the past few decades.
Today, many hernia repairs can be performed using minimally invasive or keyhole techniques. Instead of a large incision, surgeons make several small openings through which specialised instruments are inserted.
“The recovery is much faster than traditional open surgery,” Dr. Kan notes. “Most patients can return to their normal activities within a few weeks.”
During surgery, a mesh is often used to reinforce the weakened area. Rather than simply closing the defect with stitches, the mesh provides a framework that allows strong scar tissue to form.
“The mesh itself is not what ultimately prevents the hernia,” Dr. Kan explains. “It acts as a scaffold. As the body heals, scar tissue grows into the mesh and creates a durable barrier.”
Modern surgical meshes are lightweight, highly refined and tailored to different types of hernia repairs.
Thanks to advances in surgical techniques, recovery is straightforward for most patients. After an initial healing period, Dr. Kan states that his patients can typically return to exercise, sports and normal daily activities without restrictions.
Recurrence rates are also low, particularly when patients follow post-operative instructions and avoid heavy lifting during the early stages of healing.
Advances in surgical techniques and mesh technology have also significantly reduced recurrence rates compared to older methods that relied solely on stitches.
Although hernias are common, they should never be ignored. What may begin as a small, painless lump can gradually enlarge and eventually lead to serious complications.
“Hernias have a very simple treatment,” Dr. Kan emphasises. “You don’t want them to interfere with your activities, and you certainly don’t want to risk incarceration or emergency surgery. The earlier they are addressed, the easier they are to treat.”
Anyone who notices a persistent lump, experiences unexplained groin or abdominal discomfort, or suffers from worsening acid reflux symptoms should seek medical evaluation promptly. Early assessment and treatment can help prevent more serious complications and ensure better long-term outcomes.
