Incisional Hernia

Overview

An incisional hernia is a bulge that pushes out through the scar left by an operation on your tummy (abdomen). After surgery, the muscles and tissue in your belly wall are stitched or held back together while they heal. Sometimes the healed area stays weak, like a worn spot in a piece of cloth. Pressure inside your tummy can then push part of your bowel or fatty tissue through that weak spot, creating a soft lump under the skin near the scar. It may be small and only show up when you cough or stand, or it may be larger and always there.

Yes. Incisional hernias are one of the most common problems after surgery through the tummy. Estimates vary, but they happen in roughly 1 in 10 to 1 in 5 people who have an operation through the abdominal wall. Some are noticed within months of surgery; others appear years later.

Anyone who has had surgery through the wall of the tummy can get one, including people who had their appendix, gallbladder, bowel, or a hernia repaired before. It is more likely in older adults, people with a higher body weight, smokers, people with diabetes, and anyone whose wound became infected or healed slowly.

Symptoms

Common symptoms

• A soft lump or bulge under or near an old surgery scar
• The bulge is more noticeable when you stand, cough, laugh, or lift something, and may flatten when you lie down
• A dull ache or pulling feeling at the scar, especially after activity
• Mild discomfort when bending, stretching, or going to the bathroom
• Sometimes a small amount of nausea or a heavy feeling in the belly

Symptoms in children

• Incisional hernias are uncommon in children, but they can happen after an operation on the tummy
• A visible bulge near the scar, sometimes only when the child cries or strains
• Young children may not say they are in pain, so watch for fussiness or pulling at the area
• Any new bulge in a child should be checked by a doctor

Symptoms in older adults

• Hernias may be larger because the tummy wall is naturally weaker with age
• Symptoms can feel mild even when the hernia is fairly big
• Other health conditions can make surgery riskier, so decisions are made case by case
• Skin over the bulge may become sore or irritated if it rubs on clothing

Causes

Main causes

• The scar from surgery leaves a spot in the tummy wall that is weaker than the surrounding muscle
• Pressure inside the tummy pushes tissue through that weak spot
• The wound did not heal as strongly as it should, for example after an infection
• The original operation cut through muscle and tissue that never fully knitted back together

Risk factors

• A wound infection or slow-healing wound after surgery
• Being overweight, which puts extra pressure on the tummy wall
• Smoking, which slows healing and weakens tissue
• Diabetes or other conditions that affect healing
• Lifting heavy things or straining soon after surgery
• A long-lasting cough, constipation, or difficulty passing urine
• Having more than one operation through the same area
• Emergency surgery, or surgery that became infected
• Long-term use of steroid medicines, which can weaken tissue
• Getting older, as tissue becomes less elastic

When to see a doctor

See a doctor urgently if:

• The lump is hard, very painful, and will not go back in
• You have vomiting or a swollen tummy along with the hernia
• The skin over the hernia changes colour or breaks down
• You have a fever with a painful lump

Book a routine appointment if:

• You notice a new bulge near an old scar
• The bulge is getting bigger or more uncomfortable over weeks or months
• The hernia is affecting your daily life, work, or exercise
• You want to talk about whether repair is right for you

Diagnosis

A doctor can usually tell by talking to you and gently feeling your tummy while you cough or sit up. They will look at the scar, check whether the lump can be pushed back in, and ask about your surgery and symptoms. Sometimes a scan is used to confirm the diagnosis or to see how big the gap in the muscle is.

Tests that may be done

• A physical exam of your tummy and scar, including checking the bulge while you cough or strain
• An ultrasound scan, which uses sound waves and is painless
• A CT scan, which gives a detailed picture of the tummy wall and is sometimes used before surgery
• Blood tests or other checks if surgery is being considered

What to expect at your appointment

The appointment is usually quick and painless. Your doctor may ask you to lie down, sit up, or cough so they can see and feel the lump. If you need a scan, it is booked for another day. You are welcome to bring a list of your past operations and any questions you want to ask.

Treatment

Treatment depends on how big the hernia is, how much it bothers you, and your general health. Small hernias that cause little trouble are often simply watched. Hernias that are uncomfortable, growing, or causing problems are usually repaired with surgery. There is no medicine that makes a hernia go away.

Self-care at home

• Keep to a healthy weight to reduce pressure on your tummy wall
• Avoid heavy lifting and straining where you can
• Treat constipation by drinking enough water and eating plenty of fibre
• Stop smoking if you smoke, as it helps healing and lowers the chance of problems
• Support the area with your hand when you cough or sneeze if it feels uncomfortable
• Ask your doctor or pharmacist before using any kind of support belt or binder
• See your doctor if the bulge becomes painful or stops going back in

Medical treatments

Doctors sometimes recommend a watch-and-wait approach, with regular check-ups to make sure nothing changes. Support garments such as a soft belt or binder can ease discomfort for some people, but they do not fix the hernia, and they should only be used after talking to a health professional. If surgery is not suitable for you, your doctor will focus on managing symptoms and keeping you comfortable, and will explain what warning signs to watch for.

When is surgery considered?

Surgery is the only way to repair an incisional hernia. It is usually offered when the hernia is painful, getting bigger, causing problems with your bowel, or affecting your daily life, and when your general health makes an operation safe. The operation can be done open, through the old scar, or keyhole, through small cuts. The surgeon closes the gap in the muscle and often strengthens it with a piece of mesh, a special patch that supports the tummy wall as it heals. Most people go home within a few days, and recovery takes a few weeks. Your surgeon will explain the benefits, the risks, and what to expect for your situation.

Living with this condition

Many people carry on with normal life with a small hernia. You may need to be a bit careful with lifting, and it helps to notice how your body responds during the day. Keep an eye on the bulge, and see your doctor if it changes, becomes painful, or stops going back in.

Lifestyle tips

• Stay active with gentle exercise such as walking and swimming
• Build up strength gradually and avoid sudden heavy lifting
• Keep your weight in a comfortable range
• Avoid straining on the toilet by eating fibre and drinking water
• If you smoke, ask for help to stop
• Wear loose, comfortable clothing over the area if it rubs

Diet and exercise

A balanced diet with plenty of vegetables, fruit, and whole grains helps prevent constipation, which strains the tummy wall. Protein supports healing if you are preparing for surgery. Gentle regular movement is good for you, but avoid heavy weights, sit-ups, and hard straining unless your doctor or physiotherapist says it is safe. If you are recovering from an operation, follow the advice you were given about how much you can lift and when.

Mental health and emotional wellbeing

It is normal to feel anxious about a bulge near an old scar, or to worry about another operation. Some people feel self-conscious about how the area looks. Talking to your doctor, a nurse, or people who have been through the same thing can help. If worry is affecting your sleep, mood, or daily life, tell your doctor. If you ever feel overwhelmed or in crisis, contact your local crisis support service or emergency services straight away.

Prevention

Not every incisional hernia can be prevented, because some of the risk comes from how a wound heals. But you can lower your chances. Follow your surgery team's advice about lifting and wound care, keep the wound clean and dry, and report any redness, discharge, or fever early. Keeping to a healthy weight, not smoking, and treating constipation and a long-lasting cough all help reduce pressure on the tummy wall.

Screening programmes

There is no routine screening test for incisional hernias. Instead, check your scar area now and then, especially in the first year after surgery, and mention any new bulge to your doctor.

Complications

If left untreated

• The hernia may slowly get bigger and become more uncomfortable
• Bowel can become trapped in the hernia, which is called strangulation and is an emergency
• Bowel can become blocked, causing vomiting, swelling, and severe pain
• The skin over a large hernia can become thin, sore, or damaged
• Everyday activities such as lifting, exercise, or work can become harder

Long-term outlook

The outlook is generally good. Many small hernias cause little trouble and can be safely watched. When repair is needed, most people recover well and get back to their normal activities within a few weeks. Knowing the warning signs means you can get help quickly if anything changes, which keeps the risk low.

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