Inguinal hernia: when does it become dangerous and what should men and women know?

In this article – created by VenaZiel® Berlin, your hernia center for Berlin, Brandenburg and the surrounding area – you will receive a layman-friendly, but scientifically sound explanation on the subject of inguinal hernias. We discuss causes, symptoms, treatment options and the risks of non-treatment. We also take a detailed look at the differences between inguinal hernias in men and women and answer common patient questions.

What is an inguinal hernia?

An inguinal hernia occurs when a gap develops at a weak point in the abdominal wall in the area of the inguinal canal, through which intestines can escape from the abdominal cavity. From the outside, this is often noticeable as a soft, displaceable swelling in the groin – typically visible and palpable as a “bump” in the groin area.

The protrusion can often be pushed back initially when lying down or by applying gentle pressure (repositionable hernia). However, if the protrusion remains permanent or cannot be pushed back, it is referred to as an irreducible hernia.

Symptoms: A hernia can lead to pulling or pressing pain in the groin, but does not always hurt immediately. The pain is often worse when lifting heavy loads, coughing, sneezing or pushing – in other words, anything that increases the pressure in the abdomen.

Some sufferers also experience a feeling of pressure or burning in the groin. In men, a large inguinal hernia can extend into the scrotum (known as a scrotal hernia), which is accompanied by swelling in the testicle area. Women are less likely to notice a bulge in the groin, as inguinal hernias in women are often smaller or can be mistaken for a deeper thigh hernia.

As a general rule, any new, unusual swelling or pulling in the groin should be examined by a doctor.

Causes and risk factors: Inguinal hernias can be congenital or acquired.

Congenital inguinal hernias occur more frequently in boys (especially premature babies) and are usually due to an incompletely closed inguinal canal. Acquired inguinal hernias are caused by the interaction of a weak spot in the connective tissue and increased abdominal pressure. Risk factors include

• Familial predisposition or congenital connective tissue weakness
• Chronic cough (e.g. smoker’s cough, asthma or COPD) – each cough increases intra-abdominal pressure in the short term
• Heavy lifting and carrying and frequent pushing (e.g. chronic constipation)
• Overweight (obesity) – leads to permanently increased pressure in the abdomen
• Pregnancy: In women, pregnancy can increase abdominal pressure and weaken the connective tissue (although women are less likely to suffer a hernia overall, pregnancy favors a femoral hernia, for example).
• Previous operations: Scars can form a weak point (incisional hernia).
• Smoking: Interestingly, smoking is a significant risk factor as it weakens connective tissue and causes chronic coughs.

Direct and indirect inguinal hernias: Doctors differentiate between indirect (lateral) inguinal hernias and direct (medial) inguinal hernias. Indirect hernias follow the course of the inguinal canal and often occur in younger men or as a result of a congenital disposition.

Direct hernias, on the other hand, are caused by a weak point directly in the posterior abdominal wall of the groin and are more common in older men.

In practice, this distinction is less important for patients – both forms present similarly (swelling, pain) and both require surgery if symptoms occur.

Important to know: A hernia never heals by itself . Once a hernial orifice has formed, this weak point remains or increases in size over time rather than closing. Strengthening exercises or rest cannot reverse the gap.

How dangerous is a hernia? Risks of non-treatment

Many sufferers ask themselves whether an inguinal hernia always needs to be operated on immediately or whether it is possible to wait and see. The fact is that an uncomplicated inguinal hernia is often not immediately life-threatening at first, but it does pose a constant risk. Without treatment, there is always a risk of abdominal tissue – usually a loop of intestine – becoming trapped in the hernial orifice. This condition is called incarceration.

The trapped organ parts are cut off from the blood supply and can die within a short time. In addition, an incarcerated intestine can cause intestinal obstruction and peritonitis. An incarceration is an acute emergency! Those affected usually suddenly experience severe pain in the groin or abdomen, often accompanied by nausea and vomiting.

The bulging area is then hard, painful under pressure and can no longer be pushed back – in such a case, call an emergency doctor immediately. If left untreated, such an incarceration can become life-threatening.

But what is the likelihood of incarceration if a hernia is left untreated? Medical statistics show that about 1-3 out of 100 untreated hernias per year turn into an emergency incarceration. That sounds like a small risk per year at first.

However, this risk adds up over the years and is unpredictable – an incarceration can theoretically occur at any time, even shortly after the hernia occurs, especially if a lot of strain is placed on it. In addition, it is not easy to tell which hernia is prone to complications: even an initially small, soft hernia can suddenly become incarcerated.

In addition to the potentially fatal incarceration, an untreated inguinal hernia also harbors other risks: The hernia gap can become larger over time, causing more and more tissue to protrude. This can make the hernia increasingly uncomfortable and impair quality of life (constant feeling of pressure, pain when moving). A very large hernia sac also makes subsequent surgery more difficult.

In short, although a hernia does not always require immediate surgery, in most cases it should be treated promptly to prevent complications.

Surgery is almost always recommended for women (see next section) and children in particular, as it is considered too risky to wait and see.

Only in some older or severely ill male patients can a controlled wait-and-see approach (“watchful waiting”) be considered in consultation with the doctor – provided that the hernia does not cause any symptoms and does not change over a longer period of time. However, patients must be closely monitored and be prepared to undergo surgery at the very first sign of symptoms.

Differences between men and women with inguinal hernias

A hernia is often regarded as a “man’s problem” – and not entirely without good reason, as men are affected much more frequently. As mentioned at the beginning, the lifetime probability for men is around 27%, while for women it is only around 3%.

The main reason for this is the different anatomy: in men, the inguinal canal (canalis inguinalis) runs through the abdominal wall with the spermatic cord and forms a natural weak point. In addition, the inner inguinal ring (entrance to the inguinal canal) in male fetuses is designed for testicular descent and remains a potentially open area throughout life.

In women, only the so-called uterine ligament (ligamentum teres uteri) runs through the much narrower inguinal canal. A hernia sac is less likely to fit through this narrower canal, meaning that women are actually less likely to suffer an inguinal hernia.

However, women can also develop inguinal hernias – especially slim middle-aged or older women are affected – and these are not always recognized immediately.

Femoral hernia (femoral hernia): A key difference is that women are more likely to have a femoral hernia in the groin area than a “true” hernia.

A femoral hernia occurs slightly lower on the thigh, below the inguinal ligament. A femoral hernia is often difficult to recognize from the outside, as it does not always cause a typical bump. Instead, femoral hernias usually first become noticeable through pain.

It is therefore important for doctors to always consider the possibility of a femoral hernia in female patients with groin swelling.

Why is this relevant? Femoral hernias are more dangerous: The risk of a femoral hernia becoming incarcerated is very high – femoral hernias lead to incarceration much more frequently than inguinal hernias.

In figures: Up to 30 % of all femoral fractures develop an incarceration . According to studies, around half of all women with an undetected femoral hernia later require emergency surgery. This explains why doctors are much less likely to advise women with a palpable or suspected hernia to wait and see.

On the contrary: In women, surgery is usually advised at an early stage even for small or symptom-free inguinal hernias, as this could conceal a hidden femoral hernia with a high risk of complications.

Different treatment strategies: While an adult man with a small, asymptomatic hernia may be able to wait for a while (provided that the patient is reliable and reports any changes immediately), surgery is practically always recommended for women, even if there are no current symptoms.

Women benefit from early surgery because this minimizes the risk of sudden incarceration. In addition, women tend to have a higher risk of recurrence after hernia surgery. For this reason, a mesh implant is always used to reinforce women during the first operation in order to prevent recurrences.

Hernia specialists also usually prefer the minimally invasive (laparoscopic) surgical technique for women, as studies have shown that women suffer recurrences more frequently after open (conventional) surgery than after keyhole surgery.

With the laparoscopic method (e.g. TAPP technique), the surgeon can also look directly during the procedure to see whether a femoral hernia is present and treat it at the same time.

This minimizes the risk of overlooking something. To summarize: Men are much more likely to develop hernias, but in certain cases they can wait under observation.

Women are less likely to develop inguinal hernias, but when they do, special care is required – prompt surgery is almost always recommended, usually using modern keyhole mesh techniques to avoid complications and recurrences.

Symptoms in women vs. men: The classic symptoms (protrusion, pulling in the groin) basically apply to both sexes. However, as mentioned, a hernia in women is more often overlooked or misinterpreted.

Women do not have the spermatic cord visible from the outside in the inguinal canal; a swelling may be smaller or be mistaken for a swollen lymph node, for example.

Women with unclear groin complaints should therefore consult a hernia specialist. Men, on the other hand, often notice their inguinal hernia earlier, especially when a bulge becomes visible in the testicles.

Important: For any patient – male or female – who shows signs of entrapment (severe pain, firm swelling, nausea), the motto “Emergency – off to hospital!” applies immediately.

Treatment: Does a hernia always require surgery?

The only way to heal an inguinal hernia is to surgically close the hernial orifice. Medication or bandages cannot reduce a true hernia. Without surgery, the gap remains (and tends to get bigger).

Therefore, surgery is almost always necessary in the long term, provided the patient’s state of health allows it. Modern hernia operations are now routine procedures and have a high success rate in experienced hands. The mortality rate for planned (elective) hernia operations is extremely low; serious complications are rare. Nevertheless, surgery – like any procedure – is not entirely free of risks. Possible complications of hernia surgery can include secondary bleeding, wound infections or nerve injuries.

There is a certain residual risk (less than 1%) of serious complications, but this is significantly lower than the risk of untreated incarceration.

Surgical scars after minimally invasive inguinal hernia surgery. The three small incisions (keyhole technique) usually heal quickly and leave only minimal scars.

Various surgical methods are used in hernia surgery, roughly divided into open procedures and minimally invasive (endoscopic/laparoscopic) procedures.

In addition, the hernia gap can either be closed with a suture (usually only in the case of very small hernias or in children) or a plastic mesh can be inserted to reinforce the abdominal wall. In Germany, the majority of inguinal hernias in adults are operated on with mesh reinforcement, as this significantly reduces the risk of recurrence.

Common techniques include open surgery according to Lichtenstein (with mesh) or Shouldice (without mesh, rarely used) as well as the laparoscopic procedures TAPP or TEP (keyhole methods with mesh).

Which method is best in an individual case depends on various factors – size of the hernia, whether it is unilateral or bilateral, first operation or repeat hernia, general condition of the patient, etc. An experienced hernia center such as VenaZiel® Berlin is proficient in all established procedures and can choose the method that offers the best prospects of success for the individual patient.

In general, keyhole surgery has the advantage of smaller incisions, usually less post-operative pain and faster recovery. This is why the minimally invasive technique is often the first choice today, especially for bilateral fractures or in women (see above). Open surgery, on the other hand, can be performed under local anesthesia and is sometimes indicated for very large or complicated fractures – this is decided by the surgeon depending on the findings.

In many cases, hernia operations can be performed on an outpatient basis, i.e. patients can return home on the day of the operation, provided there are no risk factors to the contrary.

Various surgical methods are used in hernia surgery, roughly divided into open procedures and minimally invasive (endoscopic/laparoscopic) procedures.

In addition, the hernia gap can either be closed with a suture (usually only for very small hernias or in children) or a plastic mesh can be inserted to reinforce the abdominal wall. In Germany, the majority of inguinal hernias in adults are operated on with mesh reinforcement, as this significantly reduces the risk of recurrence.

Common techniques include open surgery according to Lichtenstein (with mesh) or Shouldice (without mesh, rarely used) as well as the laparoscopic procedures TAPP or TEP (keyhole methods with mesh).

Which method is best in an individual case depends on various factors – size of the hernia, whether it is unilateral or bilateral, first operation or repeat hernia, general condition of the patient, etc. An experienced hernia center such as VenaZiel® Berlin is proficient in all established procedures and can choose the method that offers the best prospects of success for the individual patient.

In general, keyhole surgery has the advantage of smaller incisions, usually less post-operative pain and faster recovery. This is why the minimally invasive technique is often the first choice today, especially for bilateral fractures or in women (see above).

Open surgery, on the other hand, can be performed under local anesthesia and is sometimes indicated for very large or complicated hernias – this is decided by the surgeon depending on the findings. In many cases, hernia operations can be performed on an outpatient basis, i.e. patients can return home on the day of the operation, provided there are no risk factors to the contrary.

After the operation: Recovery after an inguinal hernia operation is usually rapid. Light activities are possible again after just a few days to a week.

It is important to avoid heavy physical exertion for about 2-6 weeks (depending on the doctor’s instructions) to give the abdominal wall time to heal stably. Pain after the operation usually subsides significantly within a few days. Around 10 % of those who have undergone surgery have longer-lasting, sometimes chronic pain in the groin area, which is usually caused by scar tissue or nerve irritation. Women are affected slightly more frequently than men.

Overall, however, satisfaction after elective hernia surgery is high, and most patients can return to their daily lives and sports without restrictions after 6 weeks at the latest.

Frequently asked questions from patients about inguinal hernias

Does every hernia need to be operated on?

– Basically yes, because a hernia never heals on its own and there is always a residual risk of complications. However, there are exceptions: In male patients without symptoms, a temporary wait-and-see approach can be tried in consultation with the doctor.

The hernia must be monitored closely. If symptoms occur or the hernia enlarges, surgery should be performed immediately. Women, on the other hand, are almost always advised to undergo surgery as soon as possible. In children, too, every hernia is operated on promptly because there is a high risk of incarceration.

How do I recognize an entrapment?

Alarm signs are sudden severe pain in the groin or lower abdomen, often accompanied by nausea/vomiting and possibly hard, painful swelling.

The protrusion can then no longer be pushed back. Redness and overheating of the area may also occur. In the event of such symptoms, call the emergency services immediately – there is an acute danger to life due to the imminent death of parts of the intestine!

How long can you wait with a hernia?

It depends on the circumstances. Small, non-painful hernias in adult men can be observed with caution for a while. Heavy physical exertion should be avoided and regular medical check-ups should be carried out.

As soon as the hernia causes discomfort, becomes larger or signs of incarceration appear, do not waste any more time and have an operation. Women and children should not wait, but should be operated on as soon as possible. If in doubt, a specialized clinic such as VenaZiel® Berlin will advise you on the right time for an operation.

What tests does the doctor carry out?

The diagnosis is usually made clinically by palpating the groin while standing and lying down. Typically, the patient is asked to cough or push while the doctor observes the groin, as this causes a hernia to bulge.

The opposite side is also routinely examined because in around 10-20% of cases there are fractures on both sides (even if one often goes unnoticed). If the findings are unclear, an ultrasound examination is often performed, which can show a hernia sac and its contents very reliably.

In rare cases, e.g. in severely overweight patients or if a very small fracture is suspected, MRI or CT is also used – for example to detect a deep-seated femoral fracture in women. These imaging procedures can also be used for surgical planning if complex conditions are present (e.g. after previous operations).

How does the operation work?

As a rule, surgery is performed either under general anesthesia (especially for laparoscopic surgery) or under spinal/local anesthesia (for open surgery).

In the open technique, an incision is made in the groin area, through which the hernia sac is moved back into the abdominal cavity and the hernial orifice is sutured or closed with a mesh.

In the minimally invasive technique (keyhole surgery), 3 small incisions (approx. 5-10 mm) are made: one at the navel and two further down on the abdomen. Using a camera and fine instruments from the inside, the hernia is closed and a mesh is inserted. This method is called TAPP (transabdominal preperitoneal plasty) or TEP (total extraperitoneal plasty). Both procedures are considered equivalent and very successful. The operation usually takes 30-60 minutes, depending on the findings. Afterwards, the patient remains in the recovery room for a few hours for monitoring.

Many patients can go home on the same day (outpatient surgery) – of course only if someone can help at home and no complications occur. Otherwise, the patient remains in hospital for one night for observation.

How high is the risk of relapse?

Thanks to modern techniques, the risk of a recurrent inguinal hernia is low. Overall, around 1-4% of those operated on later suffer another hernia in the same place. The recurrence rate is lowest when a plastic mesh is used and the operation is performed by experienced hernia surgeons.

As mentioned, women have slightly more recurrences than men, which is why meshes are consistently used for them. If a recurrent hernia occurs, this can usually also be successfully operated on again – often laparoscopically.

Where can those affected turn?

In Berlin and Brandenburg, specialized centers such as VenaZiel® Berlin – Hernia Center are available to help patients with hernias. As an experienced specialist center for hernia surgery, VenaZiel® offers individual consultation and modern treatment methods based on the latest scientific findings.

From diagnostics (including ultrasound) to the choice of the optimal surgical method and aftercare, patients from Berlin, Brandenburg and the surrounding area receive comprehensive care.

Thanks to our expertise (including minimally invasive techniques) and a high volume of operations, you can rely on low complication rates and excellent treatment results. So if you suspect a hernia, don’t hesitate to have an examination – because timely treatment is the best protection against dangerous complications.

Sources

1. BARMER Krankenkasse – Health lexicon: Hernia: Causes, signs and surgery. Last updated on 18.11.2024 .
2. Herniamed gGmbH – Patient information: 1.4.4 Inguinal hernia. (Hernia register Herniamed) .
3. netdoktor.de – Inguinal hernia: diagnosis, treatment and prognosis. (medical information portal) .
4. informedhealthonline.org (IQWiG) – “How is a hernia or femoral hernia treated in women?” (Patient information) .
5. European Hernia Society – Guidelines for the treatment of inguinal hernias (German translation, 2018) .
6. VenaZiel® Hernia Center Berlin – Inguinal hernia patient guide. (Retrieved 2025) .