Check-Up: Hernia after C-section

April 23, 2018

Dear Readers,

Marie is 26 years old and had a difficult first pregnancy, resulting in a caesarean section delivery. It is now four months past the delivery and she has noticed a soft swelling along the line where they cut to remove the baby. The swelling disappears when she lies flat. She has been told that this is a hernia. Marie asks Lifeline if this means she’ll have to undergo surgery again, and why has a hernia developed.

A caesarean section (C-section) delivery refers to a procedure where a cut is made into the woman’s abdomen and uterus to reach and remove the baby from what has been its temporary home, the uterus. There are many reasons why C-section delivery is recommended or occurs as an emergency rescue of a foetus/baby. But whatever the reason for it a cut is made into the abdominal wall. It is a rare occurrence when the cut/incision line does not heal properly after being sutured, but, yes, this problem ­ hernia formation ­ can be a complication of a caesarean delivery.

What occurs here is that the abdominal lining, and sometimes even bowel, comes through this defect in the sutured, surgical incision. Women are more at risk of this occurring if:

- They are obese, which puts extra strain on the abdominal wall and on the sutured incision line.
- Their abdominal wall tissues are thin, and without good muscular support.
- They are diabetic where healing may be impaired.
- The longer the incision line the more at risk the woman is for hernia formation.
- A midline, vertical scar is more at risk for dehiscence and hernia formation than when a low abdominal wall transverse incision is made.

These hernias are called incisional wall hernias and, aside from the unattractive bulge, don’t usually cause any problems. However, sometimes they do cause some symptoms such as:
- Pain and discomfort.
- Nausea and/or constipation, as the hernia can cause the bowel loups to move out of their regular place.

SURGICAL INTERVENTION

However, they will not resolve without hernia repair, which requires surgical intervention, and they can worsen. Often, a bulge is noticed coming from or around the suture scar. As related by Marie, the hernia does not always develop immediately after C-section but can occur several months later. The hernia, like all hernias, is more noticeable when lifting an object or when coughing. Both of these activities increase the intra-abdominal pressure and tend to push out on weak areas in the abdominal wall. Abdominal wall tissues can sometimes appear lose just after delivering a baby, but your doctor should be able to examine the area and palpate the defect in the abdominal wall. A tissue ultrasound is also a good test to confirm the diagnosis.

If the problem is going to occur, it usually does so within one year of the C-section surgery, unless there are significant changes occurring in body size (e.g., developing abdominal wall obesity in later life).
There are some other conditions which can mimic a hernia, such as:

- Hematomas (blood swelling under superficial tissues)
- Abscess formation
- Abdominal wall endometriosis
- Wound infection

An ultrasound examination will confirm the diagnosis if there are any concerns, and surgical repair is usually a very successful procedure. 

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