Hernia during pregnancy and how should you prevent complications

What is a hernia?

A hernia is a bulge or an outpouching of organs or tissue from their normal position through a gap in the muscle or fascia. They often seem like a lump under the skin. Hernias can happen anywhere in the body, although they are most often common in the trunk. Some different types of hernias are:

Umbilical hernia

In an umbilical hernia, where the organs and tissue seem to bulge at the level of the belly button. For newborns, umbilical hernias most common near the navel (belly button), and most will eventually close before the infant reaches the age of five.

Inguinal hernia

A lower abdominal bulge leading to the groin often called an inguinal hernia. However, it is far more common in males who are born with weak abdominal muscles and are more likely to develop a hernia.

Incisional hernia

In an incisional hernia, where the organs and tissue bulge out through a weakness in muscle that was caused by previous surgery (therefore, at the previous incision). This is most common in elderly or overweight people who are inactive after an abdominal procedure.

What causes hernia during pregnancy?

If there is a pre-existing muscle gap/weakness due to any reason (congenital, incision, aging, etc), any condition in which abdominal pressure is increased can lead organs and tissue to herniate through the weakness, some of the common situations which increased abdominal pressure include obesity, chronic constipation (which has led to the patient bearing down on the toilet often), chronic cough, heavy lifting, etc. These increase abdominal pressure by itself can also contribute to the weakening of the muscles!

Is it a common hernia in pregnancy?

During pregnancy, as the belly swells, the muscles thin and weaken while simultaneously, abdominal pressure increases. This is why pregnancy is also a risk factor for hernias. Further, all of the previously mentioned risk factors may also compound this, for example, pregnant women who have had previous surgery may be at risk of having an incisional hernia. Not all pregnant women do have hernias. However, this is most often seen in people who have already had a hernia long before pregnancy.

Is a hernia during pregnancy dangerous?

Most cases of a hernia during pregnancy are minor. Women might notice the hernia lump and worry but usually, there isn’t any pain or tenderness involved. On pressing down on the lump, it might reduce by itself.

If there are pain and tenderness, a visit to the doctor is warranted to check the status of the hernia. In the rare situation that the hernia is stuck at its position through the gap, it might be a precursor to a more dangerous situation where the blood supply or outflow from the trapped organ is cut off. It is to be careful and rule this out that the visit to the doctor is advised. Most cases of pain and tenderness are also often only a minor hernia causing temporary discomfort so there’s no reason to worry.

We highly recommend that your hernia be regularly monitored by ultrasound and physical examination by your doctor throughout your pregnancy.

Do I need to get surgery for my hernia in pregnancy?

Surgery is generally not done for hernias during pregnancy. While rarely, hernias might disappear after childbirth, most do persist but need only to be operated on well after childbirth and postnatal healing (at least 6 months to 1 year after).

However, if the hernia is strangulated (blood supply cut off) or incarcerated (outflow from the bowel/organ is not possible), a serious life-threatening situation as previously described will set in. In this case, emergency surgery is necessary to save the life of both the mother and child.

Similarly, if the hernia is evaluated routinely and considered to be at high risk of incarceration, then surgery can be done during pregnancy. In this special case, the second trimester is the best time to do it.

At Chennai Hernia Centre, we understand that it is a difficult situation to be having another condition while being pregnant. Dr. Rengan has many years of experience as a clinician and can definitely advise you on the best course of action. If any further management is necessary, we will arrange for a multi-disciplinary team of action, involving your obstetrician as well.

What type of surgery is done, if needed?

Two types of surgeries are usually performed:

Keyhole/Laparoscopic surgery:

The relatively newer method in which multiple small incisions are made in the area in order to pass some thin devices. These devices can be used to visualize the area and manipulate the organs and tissue to perform the required reparations. The devices are then removed and the incisions are sewn up with minimal blood loss.

Open surgery:

The traditional model of surgery where a large incision is made in order to reach in and perform the repair. This is usually the option of choice for large defects and emergencies.

Both can require inserting a mesh at the hernia site to prevent it from happening again. If the baby is near term, simultaneous delivery of the baby and repair the hernia at the same time. This is not done often though.

I have a small asymptomatic umbilical hernia. I have also recently found out I am 6 weeks pregnant. What can I do to prevent complications?

Waitful watching is the best option if you have a hernia during pregnancy. Be mindful to avoid activities that can aggravate the hernia like heavy lifting, bearing down on the toilet, strenuous activity, etc. It is also important to support your abdomen while coughing or sneezing by holding it or wear an abdominal support belt. Do not forget to tell your obstetrician and your GP about the hernia, so that they can help with further management. If you are unable to manage certain things like morning sickness or constipation, which might worsen the hernia; ask your doctor for help with the same, so that they can prescribe you anti-vomiting medicine or stool softeners.

If your hernia suddenly starts swelling and becomes red and painful, please be careful and contact your doctor immediately. This may be accompanied by symptoms like fever, nausea, and painful abdomen with the inability to pass stool despite feeling bloated. These are warning signs and you should go to the hospital immediately or call an ambulance if this happens.

Originally published at https://www.surgeonrengan.com on August 19, 2020.

Dr ( Major ) R S Rengan MS, DNB, DLS ( France ) HOME OF HEALING SURGICAL CENTRE. General, Laparoscopic and Gastrointestinal surgeon in Chennai, India.