Hernia After C-Section: Symptoms, Causes & Treatment

Introduction

Hernia After C-Section

Childbirth by cesarean section, commonly called C-section, is a medical procedure that has become increasingly prevalent in recent years. C-sections are often performed for various medical reasons; like any surgical procedure, there are associated risks and complications. One such complication that can occur after a C-section is a hernia.

A hernia is a medical disorder in which an organ or tissue protrudes through a weakness or opening in the muscle or connective tissue surrounding it. In C-sections, hernias that develop afterward are hernias or incisional hernias after the C-section. We will explore how it can occur, the risk factors, common symptoms to watch for, diagnosis, available treatment options, and post-operative care.

The Connection

The Connection between C-Section & Hernia

This lies in the surgical process and the changes it introduced to the abdominal wall. Here is an explanation of this connection:

The incision in the abdominal wall

• To deliver the baby, a surgical incision is made into the uterus and abdominal wall during a C-section.
• This disrupts the normal integrity of the abdominal muscles and connective tissue.

Weakened abdominal wall

• The incision site, while carefully sutured and closed after the procedure, may still result in weakened or compromised abdominal muscles and fascia (the connective tissue that surrounds muscles).
• This weakening can create vulnerabilities in the abdominal wall.

Pressure and strain

• After a C-section, the abdominal muscles experience increased pressure and strain, especially during activities requiring core strength, such as lifting, bending, or coughing.

Risk of herniation

• Combining weakened abdominal structures and increased intra-abdominal pressure can create favorable conditions for Hernia.
• They can occur when internal organs or tissue protrude through these areas in the abdominal wall.

Location of incisional Hernia

• They typically occur near or at the site of the C-section incision.
• They can manifest as bulges or lumps under the skin and may cause pain or discomfort. ⁴ The Connection | Researched based study from ScienceDirect

Symptoms

Symptoms of Hernia after C-Section

• Pain and discomfort
• Swelling or bulge
• Tenderness
• Changes in appearance
• Nausea and vomiting
• Discomfort during activities
• Changes in size or shape

Following a C section, the following typical signs of a hernia may appear:

Pain and discomfort

• You may experience pain or discomfort near the C-section scar or in the abdominal area.
• From mild to severe, this pain might come on suddenly or gradually.

Swelling

• A noticeable bulge or lump may develop at or near the C-section incision.
• When you strain or stand up straight, as well as when you lie down, this bulge may become more noticeable.

Tenderness

• The area around it may become tender or sensitive to touch. You might feel discomfort when you press on or around the bulge.

Changes in appearance

• The appearance of the scar may change. It may look distorted or irregular due to the protrusion of tissue through the weekend wall.

Gastrointestinal symptoms

• It can sometimes lead to gastrointestinal symptoms such as nausea, vomiting, or changes in bowel habits.
• These may become more common if the tissue becomes trapped or incarcerated.

Discomfort during activities

• Activities that pressure the abdominal area, such as lifting heavy objects or coughing, may lessen the discomfort or cause pain at the site.

Changes in size or shape

• The size and shape of the bulge may change over time, becoming more noticeable or increasing as the Hernia progresses. ¹ Symptoms | Researched based study from National Institutes of Health , ² Symptoms | Researched based study from National Institutes of Health

 How severe is Hernia after a C-section?

• The severity can change according on the type of hernia, its size, location, symptoms, and if it has become imprisoned or strangulated, among other considerations.

Causes

What Causes Hernia after C-Section?

Surgical technique

• The surgical technique used during the C-section can influence the risk of a hernia.
• Strategies that involve a larger incision or multiple incisions may increase the risk.

Obesity

• This places additional strain on the abdominal muscles and connective tissue.
• These structures can become weakened and more prone to herniation as a result of excessive body weight.

Age

• Advanced age, particularly for women over 35, may be associated with a higher risk.

Multiple pregnancies

• Women who have had multiple pregnancies, especially if they have undergone various C-sections, may have an increased risk of hernia development due to repeated stress on the abdominal wall.

Infection or complications

• Postoperative complications such as infections or poor wound healing can increase the risk.

Chronic coughing or straining

• Chronic coughing or straining can cause the abdominal muscles to experience repetitive stress, which can lead to the development of hernias.
• These conditions include smoking, chronic obstructive pulmonary disease (COPD), and constipation.

Genetic predisposition

• Some persons may be genetically predisposed to developing hernias, making them more likely to do so following surgery.

Pregnancy-related factors

• Larger babies, multiple pregnancies, or a history of high-risk pregnancy can increase the risk.

Strenuous activities

• Engaging in heavy lifting or strainers physical activity soon after a C-section before the abdominal muscles have had sufficient time to heal can increase the risk.

Lifestyle factors

• Smoking and inadequate nutrition can hinder the healing of tissues and may promote the development of hernias. ³ Causes | Researched based study from ScienceDirect,⁴ Causes | Researched based study from ScienceDirect, ² Causes | Researched based study from National Institutes of Health

Diagnosis

Hernia After C-Section: Diagnosis

Clinical examination

• The doctor will often conduct a physical examination. They will enquire about your health background and symptoms.

Visual inspection

• During the examination, the healthcare provider with a visually impaired area pays close attention to the C-section scar site.
• They can ask you to cough or stretch, which occasionally makes the hernia more noticeable.

Palpation

• The provider will gently press on and around the area of concern.
• They will assess for tenderness and feel for any bulging or irregularities in the abdominal wall.

Imaging studies

• It is occasionally necessary to order imaging studies to verify the diagnosis and assess the size and placement. Typical imaging techniques include:

Ultrasound

• This examination produces images of the abdomen using sound waves.

CT scan (computed tomography)

• An abdominal region’s detailed cross-sectional images from a CT scan can be used to evaluate the area and any prospective consequences.

MRI (Magnetic resonance imaging)

• In some circumstances, MRI scans are useful because they can provide extra details about the hernia and the tissues around it.

Differential diagnosis

• Consider other conditions that can cause symptoms similar to those of a hernia, such as muscle strains or other abdominal wall issues.
• The goal of the diagnostic process is to eliminate these potential diagnoses. ⁵ Diagnosis| Researched based study from National Institutes of Health

Treatment

Hernia after C-Section Treatment

Observation and lifestyle changes during treatment

• Small, asymptomatic hernias might not need surgery right away. Your healthcare provider may recommend monitoring the Hernia while making lifestyle changes to reduce the risk of its worsening.
• Maintaining a healthy weight, avoiding strenuous exercise, and treating diseases like chronic cough or constipation are examples of this.

Belt or support for hernia

• Sometimes supporting the abdominal wall and easing discomfort can be accomplished by wearing a hernia belt or truss.
• Usually, those who are not surgical candidates or those who are awaiting surgery are advised to do this.

Surgical repair (herniorrhaphy or hernioplasty)

• It is the most common definitive treatment for Hernia after a C-section.
• Depending on the size, location, and the surgeon’s preference, the repair can be done through open or minimally invasive laparoscopic surgery.
• The surgeon will reposition the projecting tissues and strengthen the weak abdominal wall using sutures, mesh, or other materials during the treatment.
• Laparoscopic surgery involves smaller incisions and may offer quicker recovery times and less scarring than open surgery.

Emergency surgery (for incarcerated Hernia)

• If the hernia becomes strangulated (the blood supply to the herniated tissue is impaired) or imprisoned (the trapped tissue cannot be pushed back into the abdomen), immediate surgery is required.
• This is a serious problem that needs to be treated by a doctor right now. ⁵ Treatment| Researched based study from National Institutes of Health

Recovery

Hernia After C-Section: Recovery & Postoperative Care

Hospital stay and discharge

• The majority of hernia repair procedures are outpatient, so you can anticipate leaving the hospital the same day as the surgery or the day after.
• Sometimes, especially if you have other medical issues or difficulties, you might need to spend the night in the hospital.

Treatment of pain

• After surgery, you’ll probably feel some pain and discomfort. To address this, your healthcare practitioner will prescribe painkillers.
• Take pain medications as prescribed and follow any recommendations for over-the-counter pain relief.

Activity restrictions

• Avoid strainer activities and heavy lifting sizes that engage the abdominal muscles for the recommended period specified by your surgeon. Typically, this may be for a few weeks.
• Gradually resume light activities and increase your activity level as advised.

Diet and hydration

• Follow your surgeon’s recommendations, including a soft diet or nutritional restrictions immediately after surgery.
• Drink plenty of fluids, but avoid carbonated beverages that cause gas and discomfort.

Bowel movements

• Anesthesia and painkillers used during surgery might cause constipation. Your surgeon may recommend tools, softeners, or tips to help prevent it.
• Reintroduce high-fiber foods into your diet gradually to encourage normal bowel motions.

Incision care

• Keep an eye out for infections at the incision site, such as redness, swelling, heightened discomfort, or discharge.
• Keep the incision site protected from excessive moisture and avoid exposure to direct sunlight unless fully healed.

Driving and returning to work

• Please consult with your surgeon about when it is safe to resume driving and return to work.
• This may depend on your work type and the specific surgical procedure.

Physical activity and exercise

• Gradually introduce physical activity and exercise following your surgeon’s guidance.

C-section after hernia mesh repair

• If your hernia repair involved the use of surgical mesh, your surgeon will provide specific care instructions to it, including any limitations of precautions. ⁵ Recovery| Researched based study from National Institutes of Health