The natural stretching that occurs during pregnancy could put patients at risk of a hernia, especially if they’ve experienced one during a prior pregnancy. While some postpartum hernias are resolved on their own, others require surgical intervention.
“A common misconception is that hernias during pregnancy resolve and the abdominal wall goes back to the way it was before. This is not always the case and repair of the hernia and the abdominal wall anatomy can be necessary and essential for proper function of the abdominal wall and core muscles,” said Andrew Duffy, MD, Medical Director, Yale New Haven Health’s Hernia Program and Associate Professor of Surgery, Yale School of Medicine. “Your abdominal wall is the center of your core. If you don’t fix that, patients get out of balance and can develop worsening back pain over time. It will impact your daily function.”
What can cause a postpartum hernia?
A hernia is a hole in the abdominal wall, and some are visible, while others are not. The most common type of hernia in postpartum patients is an umbilical hernia. Those are typically easy to spot because they result in a bulge in the belly button.
Hernias happen in natural weak points and anything that increases pressure in the abdominal wall over time can cause those holes to open. Pregnancy causes a lot of pressure in the abdominal wall. Weight gain, smoking and diabetes can also contribute to the risk of hernia.
Postpartum hernia symptoms
The bulge is the most common symptom, but a hernia can also be accompanied by abdominal pain. It is possible for the intestines to get stuck in a hernia, which would warrant immediate emergency care. In that case, Dr. Duffy says, “you’ll know.” The pain is severe and can be accompanied by nausea and vomiting.
In most cases, the bulge becomes noticeable during pregnancy and if it does not resolve a few weeks after delivery, that’s when patients should seek an evaluation from a clinician who specializes in treating postpartum hernias.
While rare, hernias can also occur in a c-section incision. Those are harder to discover and sometimes are only diagnosed after CT imaging.
Treatment for umbilical hernia
Dr. Duffy explains that you can’t fix a hernia without surgery. However, minimally invasive techniques for routine umbilical hernias have a higher success rate and a shortened recovery time.
Those surgeries are conducted in an outpatient surgical setting, and patients can go home the same day. The inclusion of mesh, even for smaller hernias, can reduce the recurrence rate to less than 5%.
Dr. Duffy says it’s important for patients to seek an expert in hernias for their repair because often they can be accompanied by diastasis recti, which is separation of the abdominal muscles.
“Hernia repair comes down to patching the hole, but if the whole area is stretched out, we can stitch the muscles back together from the inside and repair any hernias at the same time,” he said.
Due to the nature of the surgery, it’s best to wait for repair until after patients are done having children.
Patients can get a referral to a hernia surgeon through their primary care clinician or Ob/Gyn, but they can also make an appointment on their own. For more information, fill out Yale New Haven Health’s Hernia Information Request form.
