Is surgery the best choice for asymptomatic inguinal hernias?

They occur when part of the intestine or fatty tissue pushes through a weakened area in the abdominal wall, sometimes causing a lump, discomfort, or pain – but many have no symptoms.²

Understandably, there can be concern about potential complications like where the hernia becomes stuck (known as incarceration)³ or where the blood supply is cut off (known as strangulation)⁴, but does that mean surgery is always the right choice? Not necessarily – especially for older adults with existing health conditions. Let’s take a deeper look.

What causes a hernia and who is most at risk?

Inguinal hernias are especially common in men, who are eight times more likely to develop one than women.⁵ The risk also increases with age as muscles weaken over time.⁵ There are two main types of inguinal hernias, each with different causes:

• Indirect: These usually occur due to a gap in the lower abdominal muscles that has been present since birth.²
• Direct: These develop over time as the abdominal muscles weaken. Excessive straining during bowel movements or frequent coughing can increase the risk of developing a direct inguinal hernia.²

What are the surgical options for a hernia?

One of the most common ways to fix a hernia is tension-free mesh repair.² This involves placing a synthetic mesh over the hernia to strengthen the abdominal wall and lower the chance of it coming back.⁶

Though highly effective, this repair may not always be the ideal choice for those with other serious health conditions, especially if their hernia isn’t causing any symptoms. As we get older, the risks of surgery increase. Adults over 65 are more likely to have conditions like heart disease, diabetes, and respiratory issues,⁷ which can complicate both surgery and recovery. Potential risks include:

• Slow wound healing: Older adults tend to heal more slowly, increasing the risk of infection and the likelihood of the wound becoming chronic.^8,9
• Blood clots: Surgery can increase the risk of clotting, which can be dangerous.¹⁰
• Complications from anaesthesia: Older adults are more likely to have side effects from anaesthesia, like feeling confused or disoriented after surgery, which can slow down recovery (also known as postoperative delirium).¹¹

Research also shows that older patients take longer to recover from hernia surgery, sometimes needing more time to heal and therefore stay longer in hospital.¹² This makes it important to weigh the benefits of surgery against the risks.

Is it safe to leave an inguinal hernia if a patient is a high risk for surgery?

Many hernias, especially those without symptoms, don’t lead to serious problems.¹³ A study published in the Australian and New Zealand Journal of Surgery found that many asymptomatic hernias stay the same over time.¹⁴

Choosing Wisely, a government-funded initiative, helps patients make informed healthcare decisions based on evidence and necessity. For inguinal hernias with little or no symptoms, it recommends a "watch and wait" approach, as delaying surgery doesn’t increase the risk of severe symptoms and may even improve long-term health.¹⁵

In short, for older adults with serious health concerns, surgery should only be considered if the benefits clearly outweigh the risks.¹⁵ If you're unsure, talk to your doctor, seek a second opinion, and stay involved in your treatment plan.

Non-surgical options for asymptomatic inguinal hernias and how HBF can help

For people with an asymptomatic inguinal hernia, non-surgical strategies can help manage the condition and reduce the risk of worsening symptoms, including:²

• Avoiding strain: Minimise heavy lifting and avoid straining during bowel movements to reduce pressure on the hernia.
• Wearing a truss: A hernia truss or supportive garment may help keep the hernia in place and provide temporary relief, though it is not a permanent fix.
• Maintaining a healthy lifestyle: Keeping a healthy weight can reduce pressure on the abdominal wall, and gentle exercise, such as walking, may help support overall well-being.
• Regular check-ups: Routine medical reviews can help detect any changes early, allowing for timely intervention if needed.
• Monitoring symptoms: Watch for any new discomfort, swelling, or changes, and seek medical advice if the hernia becomes painful or grows.

If you have eligible cover with HBF, you may be able to claim benefits for services that support managing an inguinal hernia, such as:

• Physiotherapy: A physiotherapist can provide tailored exercises to strengthen your core and abdominal muscles, which may help to reduce discomfort and prevent worsening symptoms.
• Nutrition and dietetics: A dietitian can provide advice on maintaining a balanced diet to support weight management and overall wellness.
• CSIRO Total Wellbeing Diet: CSIRO’s Total Wellbeing Diet programs effectively combine high-protein, lower-GI foods to improve satiety, energy levels, and overall health. Best of all, the cost is fully covered for HBF members who hold an eligible level of hospital cover and meet the program eligibility criteria.*

If you’re an HBF member, you can check what you're covered for by logging on to myHBF or calling us on 133 423.