If you have a hernia and are experiencing discomfort, this guide will help you recognise possible signs of strangulation and understand the next steps to take.
What is a strangulated hernia?
A strangulated hernia occurs when tissue that has pushed through the abdominal wall becomes trapped and its blood supply is reduced or cut off. This most often develops from an incarcerated hernia, where the tissue is stuck and cannot be pushed back in.
As swelling increases, pressure builds around the trapped tissue, restricting circulation. Without adequate blood flow, the tissue can become damaged, making a strangulated hernia a medical emergency that requires prompt surgical treatment.
Progression from regular hernia > incarcerated hernia > strangulated hernia
Reducible hernia i.e. ‘normal’ hernia: The hernia can be pushed back into place, either on its own or with gentle pressure. This is the earliest stage.
Incarcerated hernia: The herniated tissue becomes trapped and can no longer be pushed back in. It is stuck, but blood supply may still be intact.
Strangulated hernia: The trapped tissue has lost its blood supply. This is the most serious stage and requires emergency surgery.
Not every incarcerated hernia will become strangulated, but it is impossible to know when that transition will occur. As such, all hernias, regardless of stage or symptoms, should always be assessed by a surgeon promptly.
How to tell if a hernia is strangulated
A hernia may be strangulated if it becomes suddenly painful, firm and non-reducible, particularly if there is skin discolouration, nausea, vomiting or fever. Prompt medical evaluation is recommended.
Sudden, severe pain at the hernia site
A strangulated hernia often causes intense, worsening pain that develops suddenly. If a hernia that was previously mild or intermittent becomes sharp and constant, this may be an important warning sign.
A hernia bulge that cannot be pushed back in
If the lump in your abdomen or groin was previously reducible but is now firm and cannot be pushed back, this may indicate incarceration, which can progress to strangulation.
The bulge becomes dark, red or discoloured
You may notice changes in the colour of the skin over the hernia. This can be a sign that the blood supply to the tissue is affected.
Nausea and vomiting
As the bowel is often involved in abdominal or groin hernias, strangulation may lead to obstruction of the digestive tract, resulting in nausea or vomiting.
General discomfort and fever
Some patients may develop additional symptoms such as cramping abdominal pain, fever, a rapid heart rate and a general feeling of unwellness.
What to Do if You Suspect a Strangulated Hernia
If you suspect your hernia may be strangulated, do not delay seeking medical attention.
Arrange urgent transport to the emergency department to see a hernia surgeon, where you can be assessed promptly and surgery can be performed if needed.
Do not attempt to push the hernia back in yourself. If surgery is being considered, you may be advised not to eat or drink while awaiting treatment.
A strangulated hernia can lead to serious complications such as tissue damage, gangrene and infection if treatment is delayed.
Can a strangulated hernia resolve on its own?
No. A strangulated hernia will not improve without treatment. Urgent surgery is typically needed to release the trapped tissue and restore its blood supply. In some cases, damaged tissue may need to be removed, followed by repair of the hernia.
Concerned about your hernia symptoms?
If you suspect you have a strangulated hernia, acting fast will make a difference.
If you are experiencing discomfort or new symptoms related to a hernia, a medical evaluation can help provide clarity and reassurance. Contact our clinic to arrange a consultation, where your condition can be assessed and your concerns discussed.
References:
- https://my.clevelandclinic.org/health/diseases/strangulated-hernia
- Bittner J. G., 4th (2016). Incarcerated/Strangulated Hernia: Open or Laparoscopic?. Advances in surgery, 50(1), 67–78. https://doi.org/10.1016/j.yasu.2016.03.006