Incisional Hernia

“Doctor, I had this abdominal surgery a couple of years ago, and now where my scar is, there’s a bump on the bottom half. It doesn’t usually bother me, but when I cough; wow, it’s like a knife. What is it?”

Many people develop an Incisional Hernia after they have had abdominal surgery. It’s a weakening of the tissue/muscle at the incision site where the surgeon cut through the abdominal wall.

The outside of our stomachs is skin. Underneath the skin is a layer of tissue (for us Americans, usually a fat pad) and then there is muscles of the abdoman. You know those “six packs” the athletic people are always trying to build, when you look at their belly, it isn’t the skin that is the six pack, it is the muscles underneath. This is where the “hernia” or “herniation of the muscle” occurs. During surgery, to get to your inner organs, surgeons must cut through this abdominal muscle.

More often than not, once the surgeon sews the muscle back together, it heals and is usually as stronger than ever. In few cases the muscle weakens at the incision area in the muscle and allows the intestine, stomach or other organ to push through the muscle and push up against the skin. (Woah; that’s gross.) The fact is, sometimes the intestine may squeeze out if the tear in the muscle is big enough. If it is unable to fall back in when you lay on your back, it may get stuck protruding out and cut off the circulation. This is known as an emergency called a “Strangulated Hernia”. If the circulation is cut off too long, the intestine may die. If the intestine dies, the person will become ill very fast and becomes a life threatening situation.

Little or big bumps or soft areas can occur at the incision site on your abdoman. If you cough or sneeze, it may get a little bigger during coughing due to the pressure you make in your belly during it. After the coughor sneeze, it goes back to what it was before. You may experience some pain at the sight; that usually means the already injured tissue may be tearing just a little more. If you have one of these abdominal/incisional hernias, just apply a little pressure with your hand right at the sight whenever you cough or sneeze; this helps support the tissue and won’t hurt as much.

What you need to do is get this hernia repaired before it gets any bigger. Most often, a surgeon will go through the skin right where your first surgery was, so there usually is not a new scar. Depending on what the physician finds, the physician can repair the muscle without inserting a mesh however the patient may have a reoccurrence.

There are multiple different types of meshes that can be implanted. Most of the meshes go right in the incision whole, and are sewn into place the tissue will grow in and around it to make that area stronger than it was. Many of the old style meshes were like a flat piece of cheese-cloth you sewed over the tear. Now, the meshes have become so sophisticated that the surgeon can usually use the style and size that is best for the patient.

If you have one of these bulging areas in an old incision, you should go see your Primary Care Provider and get a referral to your local surgeon. Hernia Repair is one of the most frequent surgeries performed at your local hospital. Incisional Hernia Repairs is a same day surgery and most times done with Local Anesthesia (Xylocaine injected into the surrounding tissue) and some sedation from the Anesthetist. Procedures are usually less than an hour long and you can go home within the hour after the procedure.

It will be so nice to move around, hack, cough and sneeze without that nagging hernia discomfort anymore. I strongly recommend having your hernia repaired. The only ‘Hernia’ I ever liked was the daughter of Hagar the Horrible in the cartoon strip. Yes, I believe her name was Hernia.