A cesarean delivery involves making an incision in a woman’s abdomen and uterus to access the baby. There are many reasons your doctor may recommend a cesarean delivery, including if your baby is breech or you’ve had a cesarean delivery before. A hernia is one of the possible but rare complications of a cesarean delivery.
What is a hernia?
A hernia is when a part of the body protrudes or pushes through another part of the body where it’s not supposed to. In the case of an incisional hernia, a person’s abdominal lining comes through the surgical incision from a cesarean delivery.
Women are more at risk for this if they:
- are obese (the extra weight puts added pressure on the stomach)
- have a larger cesarean incision
- have diabetes
- have tissue that isn’t as strong
While incisional hernias don’t usually cause symptoms beyond their physical characteristics, they won’t go away without treatment. Surgical intervention is the sole treatment for an incisional hernia after a cesarean delivery.
The most common symptom of hernia after a cesarean delivery is a bulge of tissue that seems to come out of an area of your surgical scar. Or you may experience just a bulge of skin in or around your scar.
Hernias don’t always develop immediately after your cesarean delivery, so it’s possible to notice this bulge months after you’ve had your baby. Usually it’s more noticeable in the following circumstances:
- when you’re standing very straight and tall
- when you’re involved in physical activity, such as lifting an object above your head
- when you’re coughing
The skin on the abdomen (from where the uterus shrinks after pregnancy) may appear loose, dimpled, or bulging postpartum. This can make it more difficult to tell if a woman is having hernia symptoms or is simply healing from a cesarean delivery.
Pain and/or discomfort
Sometimes, an incisional hernia can cause pain and discomfort, especially when the bulge in the stomach is more noticeable. This symptom can be a challenge for a new mom to recognize at first. The healing process after a cesarean delivery can cause discomfort. But discomfort from a hernia will continue after the normal healing time from a cesarean delivery.
Nausea and/or constipation
An incisional hernia affects the areas around the stomach, so it can cause stomach upset. This includes nausea and even vomiting. Constipation is another symptom because the hernia can cause the intestines to move out of place. This makes having a bowel movement more difficult.
A research study published in the journal PLoS One found that an estimated 2 out of every 1,000 cesarean deliveries caused a hernia that required surgical repair within 10 years of delivery.
It’s possible that more women have hernias after cesarean delivery, but they may not get surgery to fix them for some time, or at all.
The study also found that women who have a midline (up and down) incision are more likely to have a hernia after a cesarean delivery than women with a transverse (side to side) incision. Half of the hernias that occurred after cesareans caused symptoms within the first year.
This kind of incisional hernia is a type of ventral hernia, which means the hernia bulges through the abdominal muscles. This type accounts for 15 to 20 percent of hernia cases.
Doctors can often diagnose a hernia by looking at its appearance and conducting a physical exam. But there are some conditions that can occur after a cesarean with similar symptoms to hernia.
Examples of these conditions include:
- abdominal wall endometriosis
- uterine rupture
- wound infection
Doctors sometimes also use imaging studies to rule out other conditions and to confirm the diagnosis of a hernia, or to assess if bowel is trapped inside the hernia. Examples include ultrasound or CT scan.
Surgery is the usual treatment for an incisional hernia. But doctors don’t usually recommend surgery unless a woman is having certain symptoms.
- hernia is getting much bigger and more noticeable
- hernia is causing discomfort that makes it hard for a woman to complete her daily activities
- hernia is incarcerated (bowel is trapped in the hernia and doesn’t get much blood flow, usually causing a lot of pain)
An incarcerated hernia is rare. When it does happen, it’s a medical emergency.
There aren’t any medications you can take to make a hernia smaller. Some women wear an abdominal binder, which is an elastic belt that keeps the hernia from protruding. This won’t make the hernia go away but it can help alleviate symptoms. Only surgery can definitively reduce the appearance of the hernia.
A surgeon can evaluate your hernia and recommend a specific approach to repairing it. For example, some surgeons will use an “open” technique. This involves making a larger incision to repair the hernia. Alternatively, laparoscopic or minimally invasive techniques involve making small incisions to access the affected area.
Typically with both surgical approaches, the doctor will place a piece of surgical mesh over the weak area. This helps to hold it in place properly.
Surgical repair for an incisional hernia is usually a successful procedure. An estimated 5 to 20 percent of patients who’ve had incisional hernia repairs experience a hernia again.
If a mother is considering having another baby, she’s at greater risk for recurrence. Sometimes doctors recommend waiting until a woman no longer wishes to conceive to reduce the risk that a hernia would happen again after surgical repair.