What is Incisional Hernia: Causes, Symptoms, Diagnosis, Complications

What is Incisional Hernia?

Incisional hernia is generally observed in those individuals who undergo any abdominal surgery. Incisional hernia usually is caused when the intestines try to press their way out through the incision scar of surgery or even the tissues close to scar, which are under the process of recovery from surgery.

An individual who undergoes a surgery in belly run through the risk of incisional hernia. However, it has no time limit and it can take months or even years to develop incisional hernia after the time of surgery. Incisional hernia is usually observed in line with the vertical incision of surgery. Following is the list of the cases in which people are more prone to incisional hernia:

  • People having extra weight are at risk for incisional hernia.
  • People in their old age.
  • People who have taken steroids medicines.
  • People who develop problem in lungs as a result of surgery.
  • People who develop infection in the surgical portion.
  • People who undergo two or more surgery via same incision.

It is necessary to pay attention to incisional hernia as it can grow in size and cause lot of pain. A proper treatment for incisional hernia must be started immediately by consulting a doctor or an expert.

What is Incisional Hernia?

Causes of Incisional Hernia

There are many causes of incisional hernia but all of them are related to the surgical would infection. Any type of infection in the wound due to lack of care or even due to inappropriate surgical technique can cause incisional hernia. Even if the stitching is not done properly can lead to incisional hernia. Certain changes in body like pregnancy, obesity etc… or acts like sneezing, coughing , lifting heavy weights, overdoing workouts can all put extra pressure on the tissue around the surgical cut and force it through the wound causing incisional hernia. Hence, all such acts and movements must be strictly taken care of after surgery. There are some factors, which can increase the risk of incisional hernia like poor diet, smoking, chemical exposure, consuming alcohol, stress etc… as they make you prone to surgery. Here is the list of all the causes associated with incisional hernia:

  • Lack of proper care of wound can cause incisional hernia.
  • Obesity can also lead to incisional hernia.
  • Any Infection in the wound area can cause incisional hernia.
  • Overexertion.
  • Pregnancy.
  • Lifting weights in an improper manner.
  • Coughing or sneezing.
  • Inappropriate surgical techniques or stitching is a major cause of incisional hernia.

Other Types of Hernia Conditions Which are Related to Incisional Hernia

Hernia is of various types and can occur to individual irrespective of the gender putting both male and female at equal risk. In most of the cases the hernia would result from a mechanism which forces muscles, tissues or organs through an opening to project out and occupy outer space. Here is the list of various cases of hernia which are related to incisional hernia:

  • Hiatal Hernia: In case of hiatal hernia, the upper part of the stomach projects out through the diaphragm and invades the cavity of chest. Hiatal hernia can be further classified into following three types:
    • Esophageal hiatal hernia.
    • Paraesophageal hiatal hernia (the least probable of the three.)
    • Sliding hiatal hernia.
  • Inguinal hernia: It is caused when the intestines pushes out through the abdominal walls and occupy the groin area. It is the most common type of hernia found in men.
  • Umbilical hernia: This type of hernia is observed in the belly button portion of the human body.
  • Epigastric hernia: This is general caused in case of some opening or tearing in the abdominal region due to some weakness of tissues can allow the muscles to project out leading to hernia.
  • Femoral hernia: This is a special type of hernia, which is observed more in women as compared to men. It affects the region around the upper groin.

Signs and Symptoms of Incisional Hernia

An individual with incisional hernia shows specific symptoms. Some of the common signs and symptoms of incisional hernia are fever, swelling, pain and increased tissue pressure. The doctor can easily observe the signs of incisional hernia during the examination of the surgical wound. In general, the signs would show extension of tissues, organs or fatty contents pushing out and may cause bleeding in some cases. The better part of these signs and the symptoms is that they make it possible to detect the occurrence of incisional hernia caused after surgery.

The list of common signs and symptoms of incisional hernia is as follows:

  • Foul smelling drainage is a symptom of incisional hernia.
  • Fever.
  • Bulging lump of mass which is appeared on the scar is a symptom of incisional hernia.
  • Bowel obstruction due to strangulation of the human intestines is a symptom of incisional hernia.
  • Red streaks or redness is a sign of an infection and is a symptom of incisional hernia.
  • Pain
  • Infection
  • Visible protrusion (see internal segment poking out of surgical wound)
  • Aching
  • Swelling
  • Other symptoms can include digestive disorders & jaundice because of protrusion of the liver.

Hence, any individual showing any of the above signs and symptoms of incisional hernia must seek advice from the appropriate doctor and get suitable treatment after examination. In case the symptoms start to affect breathing, one must immediately give an emergency call on 911 and seek help.

Complications in Incisional Hernia

There can be serious complications with incisional hernia. Any type of signs or symptoms of incisional hernia must be taken care of on priority basis as any delay may cause the incisional hernia to get severe and painful. In case of incisional hernia, a portion of the intestine can be locked in the abdominal wall and cause severe pain that is associated with constipation and nausea in bowel. Any further delay allows the tissues to grow and put more pressure of the surrounding area leading to pain and swelling.

In worst cases where locked intestines cannot get proper blood circulation, there is risk of strangulation. It is a serious case of incisional hernia in which the intestinal tissue may get highly infected and can be fatal if left untreated.

Tests to Diagnose Incisional Hernia

There are few tests available to diagnose incisional hernia. The symptoms of incisional hernia are observed only after a surgery and may not be permanent. Such a special case where symptoms come and go regularly is referred as “reducible” hernia.

The symptoms of incisional hernia may not appear is some cases until the abdominal muscles are put under pressure. This can happen due to multiple reasons like heavy coughing and sneezing, heavy lifting etc… The doctor without any need of specialized tests can easily diagnose the case of incisional hernia with just a physical examination in most cases. The physical test would often require an individual to cough or bear down to make sure the presence of incisional hernia.

A simple routine test is sufficient to identify the effected part of the body by observing the bulging out muscles. However, in case of large incisional hernia, a proper testing is necessary.

After identifying the affected area based on swelling or bulging, the patient has to undergo a thorough testing procedure that involves X-ray, blood tests and CT scan for incisional hernia. The doctor would schedule the ventral hernia repair that is type of surgery involved in the process of diagnosis. Following is the list of various tests and screening procedure involved in the process of diagnosis of incisional hernia:

  • Blood tests can be done to diagnose incisional hernia.
  • Through physical examination of the surgical area in order to look for protrusion or bulge or swelling.
  • CT scan and X-ray can also help in diagnosis of incisional hernia.

The above tests and screening procedure are the perfect ways to be sure about presence of incisional hernia. A person must consult a doctor in case he feels is having some symptoms of incisional hernia.

Also Read:

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:March 30, 2018

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