A hernia that occurs after surgery is called an incisional hernia. Cesarean delivery is a surgical procedure that can create a weakness in the abdominal wall. A hernia occurs when part of the intestines or stomach protrudes outward through this weakened area, creating a bulge.
In this article, we explain how to identify a hernia after cesarean delivery. We also cover the risk factors, treatment, and recovery.
Symptoms of a hernia after cesarean delivery
A slowly intensifying pain in the stomach can be a symptom of a strangulated hernia.
The primary symptom of an incisional hernia is an unusual bulge near or attached to the site of the surgical incision. The bulge can be as small as a grape in size, or it can be very large. A hernia may change position or grow over time.
Sometimes a person can only feel a hernia, but it is often possible to see a visible bulge when looking at the stomach. The bulge is usually the same color as the skin.
Hernias can develop many years after the surgery. If this is the case, the individual may notice a bulge along a faint scar.
Sometimes a hernia becomes strangulated, or constricted. This can occur if herniated tissue becomes trapped, or incarcerated. A strangulated hernia will cut off the blood supply to vital organs in the stomach, including the intestines.
The symptoms of a strangulated hernia include:
- slowly intensifying pain in the stomach
- tenderness or pain on or near the hernia
- nausea and vomiting
- redness and swelling of the stomach
A strangulated hernia is a medical emergency. Anyone who experiences pain or gastrointestinal problems following a cesarean delivery should go to the emergency room.
Are hernias common after a cesarean delivery?
Hernias following a cesarean delivery are rare.
A 2014 study of 642,578 women in Australia found that just 0.2 percent of participants needed a hernia repair. The likelihood of hernia repair surgery increased with the number of cesarean deliveries.
Another 2014 study of women in Denmark estimated that 0.2 percent of women who had a cesarean delivery needed a hernia repair within 10 years. The risk was higher in the first 3 years after the birth.
A doctor should usually be able to diagnose a hernia by examining the area. Sometimes a hernia is only visible in certain positions, or when coughing, so a doctor may touch the incision and ask the individual to bend forward or cough.
A general anesthesia is required for emergency hernia removal.
When a hernia becomes strangulated, it requires emergency surgery.
A person may also need treatment for the side effects of a complex hernia, which may include bowel perforations or infections. They may require additional surgery, antibiotics, or monitoring in the hospital.
Even if a hernia is not yet strangulated, most doctors still recommend removal to prevent this from occurring in the future. This type of surgery is called elective surgery, and people can schedule it at their convenience.
Emergency hernia removal requires general anesthesia. The person will be fully asleep and unaware of what is happening. Sometimes, local anesthesia may be sufficient for elective hernia removal, depending on the hernia and its location. With local anesthesia, the individual is awake, but the area around the hernia is numb.
A surgeon may perform the hernia removal through either a cut in the stomach or keyhole surgery, also called laparoscopic surgery. Laparoscopic surgery uses a tiny incision, often in the bellybutton. These incisions tend to heal more quickly and allow a more rapid recovery.
It is important to discuss the relative merits of each type of surgery with a doctor. In some cases, it may only be possible to treat the hernia through a large incision.
Most people recover quickly from hernia repair surgery. Unless the hernia was large or complex, they are usually able to walk around and go home on the day of surgery. Experiencing pain and tenderness following the procedure is normal.
Remaining active following surgery can help to speed up healing and reduce the risk of complications such as blood clots.
People should notify their doctor if they develop a fever, notice excessive bleeding, or experience extreme pain.
People who work in offices can usually return to work within a week or two. Those who work in more physically demanding environments may need to wait longer. A doctor will discuss the recovery time and restrictions with the individual before surgery.
Multiple cesarean deliveries can be a risk factor for a hernia.
Certain factors increase the likelihood of a person experiencing an incisional hernia after cesarean delivery.
The risk of having a hernia is higher among women who have multiple cesarean deliveries. According to a 2014 study, having two cesarean deliveries makes a hernia three times more likely, while having five cesarean deliveries increases the risk sixfold.
A hernia can occur any time after cesarean delivery, but it is more likely in the 3 years after surgery.
People who have a history of abdominal hernias may be more likely to experience a hernia after cesarean delivery, as there may be an existing weakness in the abdominal wall. However, because hernias are rare, no recent research has shown a direct link between previous hernias and the likelihood of an additional one.
It is important to discuss risk factors with a doctor. People who have had hernia surgery previously should ensure that their doctor is aware of this.
In some cases, a small hernia can heal on its own. However, there is a risk of the hernia becoming trapped or strangulated, so it is essential to seek medical care.
The primary complication of a hernia is strangulation, which can be life-threatening. It may cause problems such as:
- perforated bowels
- blockages in the bowels
- internal bleeding
- fluid in the abdominal cavity
Some people go into shock when experiencing a strangulated hernia. People awaiting elective surgery for a hernia should ask their doctor about the warning signs and symptoms of a strangulated hernia. If they experience any of these, they must seek emergency medical care.
Outlook and recurrence rate
Surgical repair of hernias following cesarean delivery is usually effective, but people should discuss the possibility of recurrence with a doctor.
According to the American College of Obstetricians and Gynecologists (ACOG), people who attempt a vaginal birth following a previous cesarean delivery have a 60–80 percent chance of success. Therefore, a person who is concerned about experiencing another hernia may prefer to avoid surgery and attempt a vaginal delivery instead.
Hernias are rare after cesarean delivery, so there is little data available on the rate of recurrence. It is not possible to predict whether or not a person will develop another hernia.
With proper care, the majority of people recover from incisional hernias after cesarean delivery. Most will be able to have healthy subsequent births, and vaginal delivery might be possible.