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Hernia Archive Questions

Below are Dr. Patricia Turner’s answers to Hernia questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.


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Questions about this topic have been organized into several categories.
Click on a category name below or select "View All" to read all the Q&As in this archive.

. Inguinal hernia
. Hiatal hernia
. Pregnancy and Hernia
. Spiegelian hernia
. Sports hernia
. Umbilical
. Ventral hernia
. View all Questions
. Pregnancy and Hernia

Now displaying records 1 to 8 of 8.

1


Q : 1

03/11/2008
I am 7 months pregnant and have a ventral hernia. I saw a surgeon and he said he would like to operate to repair it 2 months after my baby is born. Is this a common thing to do right after giving birth? I had an ultrasound done over a month ago to determine the size which at the time was 2cm. The surgeon said it would grow in size due to my growing belly. I'm weary about putting anything foreign into my body (i.e. mesh) and my husband and I may want to have more children. Would the hernia come back if I repaired it before becoming pregnant again or should I wait and repair it until after I am done having kids?

If the hernia is not symptomatic, it is not unreasonable to wait until you have completed having all of your children. There is a small risk of an incarcerated hernia with pregnancy which could require emergency surgery. However, if repaired, the hernia could reoccur with pregnancy. I would not place a mesh in a woman that desires to have further children. The mesh will not stretch and can potentially prevent the uterus from expanding and can also cause pain. These are general guidelines, but this is a highly controversial area.


Q : 2

12/05/2007
I am currently 22 weeks pregnant and had a strangulated hernia repaired last February that was done with mesh. I am having extreme pain and my surgeon keeps sending me home and telling me I am fine. I have been to the emergency room at my local hospital and they send me home too. Could the mesh in my stomach be giving me this pain and is there anything I can do about it? I am trying to schedule an appointment with you, but don't know what to do in the meantime.

Surgery during pregnancy is only an option if it is emergent. The hernia mesh will not stretch. I try to avoid mesh in women that plan to become pregnant as the enlarging uterus may cause the mesh to tear from the abdominal wall and result in pain or hernia recurrence as a result of the mesh not stretching along with the abdomen. If you have developed a recurrent hernia, it should be managed with a binder unless it incarcerates or strangulates. If your problem is only pain without a hernia recurrence, then you will likely need to do your best to manage your pain until after delivery. If the pain persists after delivery, you may need to have further diagnostics tests or procedures to determine the etiology of your symptoms and hopefully resolve them without surgery. Many patients with pain from hernia repair without a recurrent hernia can be treated with nerve blocking injections. This is a difficult problem without an easy answer. Surgery during pregnancy puts both you and the baby at increased risk and is not appropriate except for emergency conditions.


Q : 3

02/17/2007
I'm 16 weeks pregnant and my doctor just confirmed that I have an umbilical hernia. I started to notice it a month ago and it has gotten bigger and more painful, especially after certain activities. I have to call a specialist but am interested in your opionion on surgery. Should I have it now or wait until after delivery?

I would wait until after delivery. The hernia will certainly reoccur if repaired during pregnancy. You need to make sure that the hernia remains reducible. Once the uterus is above the umbilicus (20-22 weeks), the likelihood of a strangulated hernia will likely decrease as the uterus will be blocking the hernia defect preventing bowel from becoming trapped. You should have this repaired 6-12 weeks after delivery.


Q : 4

01/25/2007
I am 12 weeks pregnant and have been sent to a surgeon to have my umbilical hernia repair done at 18 weeks due to the fact it has omentum tissue in it. How dangerous is this for me during pregnancy to have the surgery?

Surgery during the second trimester is the safest although it still carries increased risk to you and the baby. In general, I do not recommend hernia repair during pregnancy as the enlarging uterus will strain the repair and will likely cause a hernia recurrence. I typically recommend hernia repair one year prior to conception. In your situation, the risk of an incarcerated hernia requiring emergency surgery has to be weighed against the risk of complications to you or your baby with an elective operation during pregnancy. this can only be determined with a thorough history and physical examination. You have time to get another opinion. The second trimester begins at 14 weeks. If you need the repair now, I would favor a repair at 14 weeks. This would give the repair longer to heal prior to the uterus enlarging significantly and stretching the new hernia repair. As you can see, there is no clear answer to your question and this relies on sound judgement and decision making based on the available information.


Q : 5

12/11/2006
I am nine weeks pregnant. I had, and still have, an ingunial (but very small) hernia before my pregnancy but was diffucult for doctors to make a solid diagnose.(I had tomography as well). So I was left untreated (for more than two years). Only now that I am pregnant they came to their final diagnosis. I am thinking of having a repair operation after the 14th week. What is your suggestion? (in terms of risks) Is it more wise than waiting and see how it develops? I might not be able to manage with extreme pain. Thank you in advance for your response. Maria Lamprou

I would not recommend repair during pregnancy. Although surgery is safest during the second trimester, any operation puts you and your baby at increased risk. I would only recommend emergency surgery during pregnancy. If your pain is unbearable and you are willing to accept the risk, this may be a possiblity. However, I have never seen a patient that has not been able to delay surgery until after delivery.


Q : 6

08/02/2006
I had an umbilical hernia from pregnancy that was fixed with mesh well over a year ago. I still have a small hard knot in the belly button area and a sharp pain when I push on it. Could this be part of the mesh, a suture, or just scar tissue? And would a second pregnancy cause more pain in the area?

The knot you feel may be a hernia recurrence, the mesh or scar tissue. An experienced physician should be able to tell the difference by examining you. A CT scan may also be helpful. Further pregnancies will stretch the repair and may increase your discomfort or the risk of recurrence. However, it would likely be repairable if it recurred. I would not let the hernia repair affect your family planning.


Q : 7

02/19/2006
I am currently six weeks pregnant and just found out I have a small unilateral inguinal hernia. I will be undergoing a cerclage procedure at 13 weeks for incompetent cervix, which will be under spinal anesthesia. I have consulted two surgeons who have differing opinions on when to have my hernia repair. One surgeon at one hospital thinks that it would be best to do an open repair at the same time as the cerclage because of the risk of incarceration during delivery and increased IAP, and since I will be having a cerclage procedure anyways. The other surgeon believes that the risk of incarceration is less than 5% and that it would be better to wait until after I deliver and then do the surgery laparoscopically. What do you think?

The risk of incarceration is very low. A recent study published in 2006 demonstrated a risk of incarceration of about 1.8 per 1000 patient years. This was the first study to suggest it is reasonable to watch the hernia. This study did not include pregnant women however. But at the time of delivery, the uterus would be protecting the hernia from any bowel incarcerating. I doubt that increased pressure at the time of labor will be a problem, I would not recommend repair until after delivery. The growing uterus may result in the hernia recurring before your pregnancy was complete due to the stretch on healing tissues. I favor observation and elective repair after delivery with laparoscopic surgery.


Q : 8

01/18/2006
After pregnancy I had an umbilical hernia and some ventral muscle separation above. I've since had the umbilical hernia repaired with mesh, but there is still an inch or so above of muscle separation. Will a second pregnancy be likely to cause a ventral hernia?

Not necessarily. The separation of the abdominal muscles is called rectus diastasis. This is a thinning of the fibrous layer between the two abdominal muscles. This can result in a hernia but usually does not. The muscles have already been stretched by the first pregnancy. I would recommend trying to avoid significant weight gain as this may further contribute to hernia formation. In the event of a hernia, this can be repaired easily with laparoscopic surgical techniques.


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