Growing Abdominal Hernia: Immediate Action Required
If your abdominal hernia is enlarging, you need prompt surgical evaluation, as increasing size indicates progression that carries significant risk of incarceration (hernia becomes trapped) or strangulation (blood supply cut off), both of which are surgical emergencies. 1
Immediate Warning Signs Requiring Emergency Care
You must seek immediate emergency medical attention if you develop any of these symptoms: 2
- Inability to push the hernia back in (incarceration) 2
- Severe, sudden pain at the hernia site 1
- Nausea or vomiting 2
- Redness, warmth, or skin discoloration over the hernia 2
- Firm, tender mass that won't compress 3
- Abdominal distension or inability to pass gas/stool 4
These signs suggest strangulation, which requires emergency surgery within hours to prevent bowel death and carries mortality rates that increase dramatically with delayed diagnosis beyond 24 hours. 1, 3
Why Enlarging Hernias Are Dangerous
Parastomal and abdominal wall hernias enlarge over time due to intra-abdominal pressure, and up to 50% progress within 5 years. 1 An enlarging hernia indicates:
- The defect in your abdominal wall is widening 1
- Risk of bowel becoming trapped increases as the opening enlarges 1
- Incarceration occurs in up to 21% of untreated hernias 5
- Once incarcerated, strangulation can develop rapidly 1
What You Should Do Now
1. Schedule Urgent Surgical Consultation
Do not delay—contact a general surgeon within days, not weeks. 1 The surgeon will:
- Assess hernia size and risk of complications 1
- Determine optimal timing for elective repair (which is safer than emergency repair) 1
- Discuss mesh repair options, which have significantly lower recurrence rates than tissue repair 1
2. Temporary Protective Measures Until Surgery
While awaiting surgical evaluation: 2
- Avoid heavy lifting and straining (no lifting >10-15 pounds) 2
- Manage constipation aggressively with stool softeners to prevent straining 2
- Consider an abdominal binder for support (discuss with your surgeon first) 2
- Avoid activities that increase abdominal pressure (heavy coughing, straining during bowel movements) 2
3. Special Circumstances That Require Extra Caution
If you have cirrhosis with ascites: Hernias in this population have exceptionally high complication rates, and you need multidisciplinary evaluation involving hepatology, surgery, and anesthesia before any repair. 1, 3 Ascites control must be optimized first. 1, 3
If you are planning peritoneal dialysis: Surgical repair should be performed before starting dialysis, as the increased abdominal pressure from dialysis fluid will worsen the hernia. 1
Why Conservative Management Is Not Appropriate for Growing Hernias
Conservative management with binders is only appropriate for small, stable hernias—not enlarging ones. 2 Once a hernia demonstrates progression:
- The natural history is continued enlargement 1
- Risk of emergency complications increases 1
- Emergency repair has higher mortality (especially if bowel resection is needed) compared to elective repair 1
- Recurrence rates after emergency repair are higher 1
What to Expect from Surgical Repair
For clean, elective repair (no bowel compromise), synthetic mesh repair is the gold standard and provides: 1
- Significantly lower recurrence rates compared to tissue repair alone 1
- No increase in infection risk when performed electively 1
- Laparoscopic approach may be possible depending on hernia location and your anatomy 1
The key is getting evaluated and repaired before complications develop, as emergency surgery for strangulated hernias requires bowel resection in many cases and carries substantially higher risks. 1
Common Pitfall to Avoid
The most dangerous mistake is waiting to see if the hernia "gets better" or assuming symptoms will resolve on their own. 1 Hernias do not spontaneously improve—they only enlarge over time. Early detection and elective repair prevent the life-threatening complications of incarceration and strangulation. 2