Flying Does Not Worsen Inguinal Hernias
Flying itself does not exacerbate inguinal hernias, as there is no evidence that cabin pressure changes or air travel directly worsen hernia symptoms or increase the risk of complications like incarceration or strangulation.
Understanding the Mechanism
The concern about flying and hernias stems from theoretical worries about cabin pressure changes affecting gas-filled spaces in the body. However, the evidence does not support this concern for inguinal hernias specifically:
Cabin pressure effects are minimal for hernias: While British Thoracic Society guidelines note that gas volume in air spaces increases by approximately 30% at typical cabin altitude (2438 m/8000 ft), this primarily affects closed air spaces like pneumothorax or recent surgical sites, not inguinal hernias 1
Inguinal hernias contain bowel or omentum: These structures are not significantly affected by the modest pressure changes during flight 2
What Actually Worsens Inguinal Hernias
The real risk factors for hernia complications are unrelated to air travel:
Activities that increase intra-abdominal pressure (heavy lifting, straining, chronic cough) can worsen hernias and increase incarceration risk 2
Time and hernia characteristics matter more: The duration of the hernia, size of the defect, and patient factors (age, comorbidities) are the primary determinants of complication risk, not environmental pressure changes 2, 3
Incarceration risk factors include female gender, femoral hernias, and history of hernia-related hospitalization—not air travel 4
Clinical Implications for Patients Planning to Fly
Symptomatic hernias should be repaired before elective travel: Patients with groin pain, irreducibility, or any signs of complications should undergo surgical repair rather than risk traveling with an unstable hernia 2, 5
Asymptomatic or minimally symptomatic hernias: These patients can safely fly, as the risk of hernia-related emergencies during travel is low, similar to their baseline risk 4
Post-operative flying: Aviators who underwent laparoscopic TEP repair returned to high-performance aircraft at 21 days without complications, suggesting commercial air travel is safe even sooner for most patients 6
Common Pitfalls to Avoid
Don't delay evaluation if warning signs develop: Redness, warmth, inability to reduce the hernia, severe pain, or systemic symptoms require immediate evaluation regardless of recent air travel 2
Don't attribute new symptoms to flying: If a patient develops hernia complications after flying, the flight itself is not the cause—these patients likely had an evolving complication that coincidentally manifested during or after travel 1, 2
Don't confuse venous thromboembolism risk with hernia risk: While long-haul flights increase VTE risk, this is a separate issue from hernia complications 1