Can hernia be treated non-surgically?

A hernia is a part of an organ or fatty tissue protruding through a weak place in the encasing muscle wall or soft connective tissue. Hernias most commonly occur in the groin or in the abdomen. Generally, hernias do not get better with time. The protrusion increases and can lead to complications. This is why doctors usually recommend surgery to push back the bulging tissue or organ inside the encasement using mesh and to keep it there.

But not all kinds of hernias need surgical intervention. Treatment varies from case to case and depends on the severity of the symptoms and the size of the protrusion.

What kinds of hernias are treated without surgery?

The following are the types of hernias that can be treated without surgery in very specific cases:

• Congenital umbilical hernias:

  The condition is monitored carefully, and unless unusually large, umbilical hernias that are present at birth usually resolve themselves by the time the child is a year old. However, if the protrusion is present at age 3 or 4 or continues to grow, surgical intervention is needed.

• Certain cases of hiatal hernias:

  If a hiatal hernia is not at risk of causing serious GERD (gastroesophageal reflux disease) or getting strangulated, non-surgical treatment may be recommended. This includes medication to:

  • Reduce acid production and neutralise excess stomach acids.
  • Strengthening the bundle of muscles that prevent stomach acids from flowing backward into the oesophagus.

  Surgery is necessary if the medication is unable to prevent further herniation or control the symptoms.

• Asymptomatic umbilical or inguinal hernias:

  This approach is recommended for patients who are at high risk from anaesthesia or surgery. If the patient has an inguinal hernia (a groin hernia that is also the most common kind of hernia) or an umbilical hernia (an abdominal hernia) that is asymptomatic and negligible in size, the gastroenterologist may want to keep monitoring the situation carefully. The doctor may attempt to massage the hernia into place if possible. If the hernia is not at risk of getting stuck in the surrounding tissue nor growing too big, close monitoring and waiting may continue with frequent follow-up tests.

What are the non-surgical treatment options for hernias?

• Waiting and monitoring closely:

  This is the most common non-surgical option to deal with hernias. The hernia is monitored with regular follow-up appointments and tests to ensure that it is not growing in size or at risk of getting incarcerated or strangulated. This option is recommended only when the hernia is small and asymptomatic.

  While your condition is being monitored:

  • Avoid lifting heavy weights to avoid triggering abdominal pain.
  • Try to maintain a healthy body weight and strengthen your abdominal muscles with exercise for your core.
  • Avoid the risk of constipation by consuming a diet rich in fibre and fluids. Being constipated can make you strain in the bathroom, adding additional pressure on the herniated tissues.

  As long as the hernia is not getting strangulated, or incarcerated, or there is hope that the hernia can be pushed behind the damaged muscular wall, surgery can wait.

• Using hernia binders, trusses, and corsets:

  Wearing a binder, truss, or corset can keep the hernia in place and prevent further sagging by providing additional support to the damaged muscle walls. It is important to note that this treatment option is effective only if the hernia is completely reducible and can be pushed backthrough the muscle wall back in its proper place. The truss has to be worn and remain in place during all normal physical activities. Consequently, this is not an ideal solution and one that can cause skin irritation and infection. However, this treatment option may be recommended for elderly patients for whom undergoing surgery may be high risk.

When is surgery necessary to treat a hernia?

Surgery is recommended for hernia treatment if:

• The hernia (hernia sac) cannot be pushed back in place behind the damaged surrounding muscle.
• Incarceration: This happens if tissue or organ (such as the intestine) gets trapped in the muscle wall and cannot be pushed back into its respective cavity.Prompt intervention is needed to avoid complications such as strangulation.
• Strangulation: This happens if the incarcerated hernia is left untreated and blood and oxygen supply to the tissue gets blocked, leading to organ death. A strangulated hernia requires immediate surgical treatment.

Seek immediate medical help if your hernia turns dark, red, or purple or if you experience sudden pain that keeps getting worse. This may be accompanied by fever or nausea.

Though a hernia can cause significant inconvenience and discomfort, the outlook for hernia treatment is encouraging and positive. Small and asymptomatic hernias can be treated without surgery if they pose no further risk of incarceration. At the Department of Gastroenterology and Hepatology, our expert gastroenterologists have extensive experience in treating hernias without surgery as well as with surgical treatment for hernias of all kinds. If you feel that your symptoms warrant a deeper investigation andwant to discuss comprehensive treatment options available to you, consult the best gastroenterologists in Bangalore at the Department of Gastroenterology and Hepatology in Sagar Hospitals.