Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Robotic Hernia Surgeon · Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad
In short
Most hernias are a nuisance rather than a danger. A small number stop being either, and become an emergency within hours.
This page is about spotting that change. It is the one piece of hernia information worth knowing by heart.
Incarcerated means the contents are stuck outside and will not go back. That on its own is not yet a disaster, but it is a warning.
Strangulated means the neck of the hernia has squeezed the blood supply shut. Tissue then starts to die. With bowel inside, that is measured in hours.
Between those two sits obstruction, where trapped bowel blocks. That brings vomiting, a swelling belly and no wind passed.
The signs, in the order they usually appear
You do not need all of them. Any one is a reason to go in.
Three states of the same hernia
| State | What you notice | What to do |
|---|---|---|
| Reducible | The lump comes and goes. It flattens on lying down. | Plan a repair in clinic |
| Incarcerated | The lump stays out. It may ache. No vomiting yet. | Be seen the same day |
| Obstructed | Vomiting, belly swelling, no wind passed. | Go to a hospital now |
| Strangulated | Severe pain, hard tender lump, skin colour change, fever. | Emergency. Go now |
If the lump will not go back and has turned hard or tender, go to a hospital now. Do not wait for a clinic appointment.
A gentle attempt while lying down, early on, is reasonable. Repeated forcing is not.
Pushing hard can return a loop of damaged bowel into the belly where nobody can see it. The lump disappears, everyone relaxes, and the problem carries on out of sight.
If it does not go back easily, stop and go in.
The trapped contents are released and the bowel is looked at. If it recovers colour, it is left alone. If a segment has died, it is removed and the ends joined.
The defect is then closed. Mesh is used if the field is clean. If the bowel was opened or the field is contaminated, the repair is usually done without mesh, and a definitive repair is planned for later.
Incarcerated means stuck outside and unable to go back. Strangulated means the blood supply to the trapped tissue has been cut off. The first is urgent. The second is an emergency.
It should not be left at all. Once the blood supply is cut off, bowel can be damaged within a few hours. Go to a hospital immediately rather than waiting for the morning.
One gentle attempt lying down is reasonable. If it does not go back easily, stop. Forcing it can push damaged bowel back inside where the problem is hidden rather than solved.
It is uncommon but possible, and more likely in older people and in those with diabetes. A lump that has turned hard and will not go back needs review even without much pain.
Often, yes. Watching is a reasonable plan for a small, easily reducible hernia in someone unfit for surgery. For most people, a planned repair is safer than waiting for the day it traps.
The main page on this site is robotic hernia surgery in Ahmedabad. These cover the neighbouring questions.
Where to find us
Dr Harsh Shah, MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Shah's Gastro, Cancer & Robotic Surgery Centre
Apollo Hospital, Bhat, Gandhinagar
Gota OPD, Ahmedabad
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