It’s a common story I hear in the clinic. Someone’s had abdominal surgery – maybe a big open one, what we call a laparotomy, or even a less invasive keyhole procedure. They’re recovering, feeling a bit better, and then… they notice it. A new bulge, a lump near their scar that wasn’t there before. Understandably, that can be a bit of a worry. Often, what they’re seeing is something called an incisional hernia.
So, what exactly is an incisional hernia? Well, after an operation on your tummy, the muscles in your abdominal wall can be a bit weakened. It’s like a spot in a well-worn fabric that’s become a little thin. Sometimes, a bit of your intestine or some abdominal fat can push through this weakened area. That’s the hernia, and it creates that bulge or lump you might see or feel. It’s actually quite common; we think up to one in five people who have a major abdominal surgery might develop one. These hernias can show up months, or even years, after the initial operation.
For the most part, these aren’t urgent medical emergencies. But, like anything, it’s good to understand what’s going on.
What Might You Notice with an Incisional Hernia?
Sometimes, if an incisional hernia is small – say, around 2 inches or 5 centimeters – you might not have any symptoms at all. You might just feel a soft lump.
However, larger ones, those over 4 inches (10 cm), can be a bit more bothersome. Here’s what you might experience:
- A noticeable bulge or lump near your surgical scar. It might seem to pop out more when you stand up, cough, strain (like if you’re constipated), or lift something heavy.
- Pain or discomfort around the bulge. This could be a sharp pain, or sometimes more of a dull ache. It often gets worse with activities that put pressure on your abdomen.
Why Do Incisional Hernias Happen?
As I mentioned, the main reason is that abdominal surgery can weaken those tummy muscles. A laparotomy, the big open surgery, carries a higher chance, but it can happen after minimally invasive surgeries too. Think of it like this: your muscles need time to heal and get strong again.
Several things can slow down this healing process or put extra strain on the area, increasing the risk:
- Jumping back into strenuous activity too soon after your surgery.
- Conditions like diabetes, which can affect healing.
- Carrying extra weight (obesity).
- Lung problems that cause a persistent cough, like COPD (Chronic Obstructive Pulmonary Disease). This constant coughing puts a lot of pressure on your abdomen.
- Long-term use of certain medications like immunosuppressants or corticosteroids.
- Unfortunately, sometimes an infection at the surgical site (surgical site infection) can also weaken the tissue.
Can I Do Anything to Lower My Risk?
Honestly, the best thing you can do is give your body the time it needs to heal properly after surgery. I know it’s tempting to get back to normal, but this is when taking it easy really pays off. Your surgeon will give you specific advice on when it’s safe to gradually increase your activity levels. Listening to that advice is key.
What About Complications? Are They Serious?
Most incisional hernias behave themselves. But, rarely, things can get a bit more complicated.
There’s something called an incarcerated incisional hernia. This is when a part of your intestine gets trapped in that hernia sac, stuck in the abdominal wall. It can’t just slide back in.
If an incarcerated hernia isn’t dealt with, it can sometimes become a strangulated incisional hernia. This is more serious. The pressure on the trapped intestine can cut off its blood supply. If that happens, the tissue can start to die – a process called necrosis.
These situations – an incarcerated or strangulated hernia – are definitely medical emergencies. You’d likely feel sudden, severe pain. You might also see changes in the skin color around the bulge; it could look paler than usual, then maybe darker. If you experience anything like this, you need to head to the emergency room right away.
How Do We Figure Out if It’s an Incisional Hernia?
When you come to see me, or another healthcare provider, with a concern like this, we’ll start by having a good chat about your symptoms and your surgical history.
Then, a physical examination is usually the next step. I might ask you to sit, then stand, or even cough gently, to see if the bulge changes or becomes more prominent. We’ll be checking to see if it’s soft and can be gently pushed back in (reducible), or if it seems stuck.
Sometimes, to get a clearer picture, especially if we’re unsure or want to see the extent of it, we might suggest an imaging test like a CT scan.
What Are the Treatment Options for an Incisional Hernia?
How we approach an incisional hernia really depends on your specific situation.
If you have a small hernia that isn’t causing you any pain or problems, we might just decide to keep an eye on it. This is often called “watchful waiting.”
However, incisional hernias can sometimes get bigger over time. And a larger hernia does carry a slightly higher risk of those complications we talked about. So, if your hernia is large, causing pain, or making you uncomfortable, then hernia repair surgery is usually recommended.
Surgeons can perform this repair in a couple of ways:
- Open hernia repair: This is a more traditional approach where the surgeon makes an incision over the hernia.
- Laparoscopic hernia repair surgery: This is a keyhole technique, using smaller incisions and a camera.
With either method, the goal is the same: the surgeon will gently place the intestine or tissue that has pushed through, back into your abdomen where it belongs. Often, they’ll then use a special surgical mesh to reinforce that weakened spot in your abdominal wall, a bit like patching a hole in fabric to make it stronger.
What’s Recovery Like?
Recovery time can vary from person to person, and it depends on the type of surgery you have and how big the hernia was. Most folks are back to their usual daily routine within a few days to a couple of weeks. But, everyone’s different. Your surgeon will be able to give you the best idea of what to expect for your specific recovery.
When Should I Call My Doctor After Hernia Repair?
Like any surgery, there are always some risks. It’s important to keep an eye out for any signs of trouble after your hernia repair. You should definitely get in touch with your surgeon if you notice:
- Bleeding from the incision that doesn’t stop.
- Signs of infection, like a fever, or if the incision area becomes very red, swollen, warm, or starts draining pus.
What’s the Outlook?
Surgery to fix a large incisional hernia is generally very successful. It often sorts out the problem for good. However, it’s fair to say that incisional hernias can sometimes come back, even after a repair. We always aim for the best long-term result, of course.
One question I get asked sometimes is, “How long can I live with an incisional hernia?” If your hernia isn’t stuck (incarcerated) and isn’t causing major issues, you can live with it for a long time. The main concern is if it becomes incarcerated or, worse, strangulated. As we discussed, a strangulated hernia is a serious situation that needs immediate medical attention because it can lead to life-threatening problems if not treated quickly.
Take-Home Message: Understanding Your Incisional Hernia
So, to quickly recap the main points about an incisional hernia:
- It’s a bulge that can appear near a surgical scar on your abdomen, due to weakened muscles.
- Many are small and don’t cause symptoms, but larger ones can be painful.
- They happen because surgery can weaken abdominal muscles, and things like early strenuous activity or chronic coughing can increase the risk.
- Diagnosis usually involves a physical exam and sometimes a CT scan.
- Treatment isn’t always needed for small, asymptomatic hernias. For larger or symptomatic ones, surgery (often with mesh) is the usual approach.
- While most are not dangerous, watch out for signs of a stuck (incarcerated) or blood-supply-cut-off (strangulated) hernia – like sudden severe pain – as these are emergencies.
Remember, if you’ve had surgery and you notice a new bulge or have concerns, it’s always best to have a chat with your doctor. We can figure out what’s going on and discuss the best way forward for you.
You’re not alone in this. We’re here to help.