24.01.2021

Postoperative hernia

If a woman does not have the possibility of delivery in a natural way, she undergoes a cesarean section. In most cases, the intervention takes place without consequences, except in situations where the incision was made longitudinally or the abdominal cavity was subjected to dissection repeatedly. As a result of this, a hernia may appear after cesarean section – its symptoms are manifested in weakening of muscle tissue in the area of ​​the incision and protrusion of the intestines and stomach outward.

In the absence of timely treatment, a hernia after cesarean can lead to complications – the part of the internal organs that began to protrude is subjected to pinching and subsequent necrotization (death). As a result, peritonitis may develop.

To prevent such an outcome, after a planned operation on the third day, a woman must be examined by a doctor. If the muscles in the incision area have lost tone and weakened, the discharge is postponed until the patient undergoes a more thorough examination and the necessary treatment.

What does a hernia look like?

The protrusion of the internal organs looks like a bump located under the suture after cesarean, constantly increasing in size. When the abdominal muscles tighten, the roughness becomes more noticeable, especially when standing. If a woman lies on her back, then the protrusion is practically not visible.

A hernia after cesarean, which was formed recently, is easily subjected to treatment, consisting in its reduction. If a lot of time has passed after the operation, it is unlikely that it will be possible to eliminate the protrusion on its own. This is considered one of the complications of a hernia requiring immediate emergency treatment.

Causes

The most at risk of a hernia after surgery is parturient women who have previously had their gall bladder or appendicitis removed.

Other reasons:

  • low-quality suture material, which was used to tighten the edges of the incision;
  • infection in the suture area;
  • frequent constipation, which causes excessive tension of the abdominal wall;
  • a hematoma formed at the seam site – the accumulation of blood leads to a divergence of muscle tissue;
  • non-observance of the diet that cesarean implies (intra-abdominal pressure increases due to digestive disorders);
  • the beginning of intimate life earlier than 7-8 weeks after the intervention; more about sex after cesarean →
  • metabolic pathologies, diabetes mellitus, endocrine diseases;
  • the next pregnancy that has suddenly come – earlier than 1.5–2 years after surgery;
  • improper connection of muscle tissue (medical error).

Parastomal hernia after cesarean surgery is not so rare. This kind of pathology is the formation of a stoma at the site of the outlet of the intestinal tube. The reasons for its appearance are in the wrong localization of the stoma, an excessive fat layer under the skin, as well as in the underdevelopment of fatty tissue in the region of the anterior abdominal wall.

You can determine a hernia after cesarean by the symptoms characteristic of this pathology. The discovery of several signs by a woman should be the reason for immediate medical attention, examination and treatment.

Symptoms of postpartum hernia

According to a number of signs characteristic of hernial protrusion, the pathology can be divided into regulated and non-regulated.

Directed hernia looks like a protrusion of a small size, not immediately noticeable visually. It is not accompanied by soreness, and discomfort can occur with a sharp tension of the abdominal muscles, for example, with intense coughing, weight lifting or excessive physical activity. When a woman takes a horizontal position, the hernia independently sets into the abdominal cavity.

An unmanaged hernia develops against a background of acute abdominal pain and an increase in protrusion in size. In the departments of the large and small intestines, stool masses gradually accumulate, which are not able to naturally exit, due to clamping of muscle tissue. As a result, the hernia grows, causing more and more discomfort and pain.

Later, constipation, increased gas, nausea, and vomiting join symptoms. Against the background of intoxication, weakness develops, a woman cannot perform elementary work and show physical activity. A hernia after cesarean becomes visually visible in the navel, which indicates the need for medical intervention.

Additional symptoms and complications:

  • Blood loss. If during natural birth the amount of blood lost does not exceed 200–250 ml, then during surgery, cesarean, this figure increases to 1000 ml.
  • Adhesive process. Adhesions are films or ropes represented by connective tissue that fuse together the abdominal organs. In addition to fusion, adhesions often undergo suppuration due to the inflammatory process. If there are a lot of adhesions, intestinal and fallopian tubes dysfunction is manifested against the background of sharp abdominal pains.
  • Endometritis. The inflammatory process in the uterus that develops when the organ comes into contact with air. Pathogenic bacteria enter the cavity, causing the appearance of weakness, fever, sleep problems, blood secretions mixed with pus.

Suspecting a hernia, manifested by at least one of the listed symptoms, a woman should not self-medicate. Only a timely visit to a doctor will help to avoid serious complications.

Which doctor treats hernia after cesarean section?

To confirm or refute suspicions of a hernial protrusion, especially at an early stage, a woman should consult a gynecologist and surgeon. Pathology data will be collected during a visual examination and based on laboratory tests, if any.

Diagnostics

To make a diagnosis, palpation is first performed in the navel. Usually this measure is enough to detect protrusion. After the diagnosis is made, additional examination measures may be necessary aimed at identifying the consequences of a hernia.

Diagnosis of complications includes:

  • Ultrasound of the abdominal cavity and pelvic organs;
  • laparoscopy (if you suspect a developed adhesive process);
  • laboratory tests of blood and urine, with a pronounced inflammatory process.

Also, radiography can be used for diagnosis. After a thorough examination, the doctor decides on the most suitable method for the treatment of hernia.

Treatment

If the protrusion was detected on time and did not entail any complications, surgery is not required. A course of treatment with antispasmodics and reduction of hernia is carried out.

At the second stage of the pathology, surgical intervention is recommended. The umbilical ring (hernioplasty) is sutured, and the gaps in the abdominal tissue are strengthened with a special mesh. Thus, the abdominal wall acquires a fixed position. The risk of relapse is reduced to zero, the body quickly recovers.

With parastomal hernia, conservative treatment does not give a positive result, therefore, surgical intervention is also required, it is carried out after reaching a large hernia.

Prevention

It is necessary to take preventive measures to prevent a hernia on the first day after surgery (early recovery period). First of all, it concerns nutrition. More on nutrition after cesarean section →

Postpartum Diet:

  • first day – it is recommended to drink a large amount of water;
  • second day – the introduction into the diet of liquid and soft consistency, which is easily absorbed;
  • the gradual start of eating solid and heavy foods.

Other preventative measures:

  • preparation for a planned operation;
  • physical activity (as far as possible) already on the first day after cesarean;
  • limitation of physical activity and tension of the abdominal muscles;
  • prevention of constipation.

The doctor can advise additional preventive measures based on the patient’s medical history, her well-being and body characteristics.

It must be remembered that the risk of developing hernial protrusion is especially great for the first few weeks after a cesarean operation. Any factor can provoke its appearance against the background of overstrain of the abdominal muscles. Therefore, a young mother should carefully monitor her health during this period and consult a doctor immediately, at the first suspicion of a hernia.

At the same time, pathology can be prevented by observing simple preventive measures and following all medical recommendations in the postoperative period.

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