Overview
An incisional hernia happens when a weakness in the muscle of the abdomen allows the tissues of the abdomen to protrude through the muscle. The hernia appears as a bulge under the skin, and can be painful or tender to the touch. In the case of an incisional hernia, the weakness in the muscle is caused by the incision made in a prior abdominal surgery. An incisional hernia is typically small enough that only the peritoneum, or the lining of the abdominal cavity, pushes through. In severe cases, portions of organs may move through the hole in the muscle.
Who Gets It ?
Incisional hernias occur in people who have had previous abdominal surgery, and are more likely to occur in people who are obese or pregnant.
What Causes It ?
Incisional hernias are caused by thinning or stretching of scar tissue that forms after surgery. This weakened scar tissue then creates a weakness in the abdominal wall. Excessive weight gain, physical activity that places pressure on the abdomen, pregnancy, straining during bowel movements because of constipation, severe vomiting, or chronic and intense coughing causes the scar tissue to thin or stretch. Because the abdominal wall is weak, the hernia occurs during abdominal strain.
What Are The Symptoms ?
An incisional hernia causes a bulge in the abdominal area. This type of hernia is often painless, but may be tender and can cause discomfort during any type of physical strain, such as lifting or coughing. The bulge may disappear when the patient is lying down, and be more visible when standing up. A hernia can often be pushed gently back into place. This is called a reducible hernia. When a hernia cannot be pushed back into place, it means a piece of the organ has become trapped, or incarcerated. Symptoms include pain, nausea, vomiting, inability to have a bowel movement, and a bulge that remains even when lying down. When a portion of an organ is incarcerated, its blood supply can be cut off, which means the organ’s tissue will die. This condition is called a strangulated hernia. Incisional hernias can increase in size with time.
How Is It Diagnosed ?
To diagnose an incisional hernia, a doctor must perform a physical examination. Your doctor will look for a bulge in the abdominal area and may ask you to cough as he puts light pressure on the area. Coughing causes the hernia to bulge out further.
Incisional Hernia Treatment
An incisional hernia may be small enough that surgical repair is an option, not a necessity. If the hernia is large, causes pain or is steadily growing, surgery may be recommended. Another option is a truss, a garment that is similar to a weight belt or girdle, that applies constant pressure to the hernia.
When Is Incisional Hernia Surgery Necessary ?
An Incisional hernia may require surgery if:
- It continues to enlarge over time
- It is very large
- It is cosmetically unappealing
- The bulge remains even when the patient is relaxed or laying down
- The hernia causes pain
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