HERNIAS DURING PREGNANCY: WHAT YOU SHOULD KNOW

Here's everything you should know about hernias during pregnancy...

What is a hernia?

A hernia is a medical condition that occurs when part of an internal organ (usually the bowel) or fatty tissues protrudes externally through an opening in a muscle. Hernias are caused by a weakness in the muscle wall. The most common hernias in pregnant women are umbilical hernias , where the hernia occurs near the belly button, and inguinal hernias, where the hernia occurs in one or other groin.

Why can a hernia develop during pregnancy?

Pregnant women are at greater risk of developing hernias due to the increased pressure in the abdomen caused by the growing baby, and production of the hormone relaxin (by the ovaries and placenta) that loosens ligaments, joints and muscles during pregnancy.

Are hernias common during pregnancy?

Hernias aren’t that common during pregnancy. Studies suggest around one in 1250 pregnant women are affected by umbilical hernias and one in 833 pregnant women by groin hernias.

What are the signs that I have a hernia during pregnancy?

The hernia can often be seen as a protruding lump when you’re standing. Some people experience a dull aching pain that becomes more pronounced when you’re active, bend over, sneeze, cough or laugh. However, most women don’t experience any symptoms from a hernia and may not even know that they have the condition.

Can I reduce my risk of getting a hernia?

Steps to reduce the risk of getting a hernia include not smoking (as the habit can lead to coughing triggering a hernia), lifting heavier objects in a safe way, avoiding constipation, maintaining a healthy body weight, and strengthening your core by keeping physically active and doing at least 150 minutes of moderate intensity exercise each week throughout pregnancy ( unless medically directed not to do so). 

How are hernias diagnosed?

Hernias are usually diagnosed by your GP taking a medical history and examining the area. If there remains doubt as to whether a hernia is present your doctor may order an ultrasound scan to image the affected area. Ultrasound is considered the best diagnostic method for pregnant women as it avoids exposing your baby to radiation.

How are hernias treated in pregnancy?

Surgery is the only way to repair hernias, unfortunately they do not get better on their own. The timing of surgery depends on the symptoms you’re experiencing and the stage of your pregnancy. 

If the hernia is reducible ( you can easily press it back into place when lying down) and not giving rise to pain your doctor may decide to keep a close eye on it -known as ‘watchful waiting’-and delay surgery until after you‘ve had your baby.

Ideally, if the hernia isn’t too troublesome, doctors like to delay surgery until you’ve completed your family. This is because pregnancy following a repaired hernia increases the risk of recurrence. You shouldn’t feel unduly concerned about waiting since although hernias won’t get better without surgery, they’re also unlikely to get any worse.

If the hernia is causing increasing pain and appears at risk of complications it’s possible to have surgery during pregnancy. Ideally, surgery is carried out in the second trimester (4-6 months).  This is because elective surgery increases the chance of miscarriage during the first trimester (1 to 3 months), and premature birth during the third trimester (7-9 months).Uncommonly, a hernia can require emergency surgery during pregnancy- see below.

What types of surgery are used to treat hernias?

The different types of surgery used to repair hernias include open surgery (where a cut is made into the body at the location of the hernia) and keyhole surgery (where instead of a cut tiny incisions are made to allow for insertion of surgical instruments). Key hole surgery is considered the preferred approach since it results in less postoperative pain and numbness.

What happens if I already have a hernia and plan to get pregnant?

If you’re planning to start a family and your hernia is considered to be at low-risk of complications surgery can be postponed until after you’ve had your baby.

As mentioned previously, it can be a good idea to delay the operation until you’ve completed your family as pregnancy following hernia repair is associated with a higher chance of recurrence. If the hernia is giving you pain or is at risk of complications developing you may be advised to have a hernia repair operation then wait one or two years before getting pregnant. The delay is to give your body time to recover to be in optimum condition for pregnancy.

When should you seek emergency medical help?

There are two instances when hernias require urgent medical treatment. Obstruction (also known as incarceration) occurs when the hernia becomes trapped with the result it can’t return to its usual position in the body. Strangulation occurs when the intestine becomes trapped in a way that cuts of its blood supply.

Both can be life threatening, but are readily treatable with surgery. You should go to your nearest A&E if you experience any of the following symptoms: sudden severe pain in the hernia that quickly intensifies, vomiting, difficulty moving your bowels or passing wind, a hernia bulge that turns red, purple or dark, and a hernia that becomes firm or tender and can’t be pushed back in.