Frequently Asked Questions
A hernia is an opening in the abdominal wall. Hernias commonly occur in the abdomen between the chest and hips as well as in the groins. When pressure increases in the abdomen with coughing, sneezing, lifting or straining to pass stool or urine, different tissues or organs from inside the abdomen get pushed out through this hole, creating a bulge. Because a hernia is a physical opening, it will not get better on its own and is likely going to require surgical repair.
A hernia can be present from birth or develop over time through natural weaknesses in the abdominal wall. Activities and medical problems that increase pressure on the abdominal wall can cause these weak areas to open into a hernia. These include:
- Obesity
- Heavy lifting
- Straining to pass stool or urine
- Pregnancy
- Poor nutrition
- Lung disease and Smoking (straining from coughing)
- Inguinal hernias (groin hernias) occur when fat or intestines from abdomen bulge through the groin. This type of hernia is ten times more common in men than women.
- Umbilical hernias are associated with a natural weakness in the belly button.
- Ventral hernias occur most commonly in the middle of the abdominal wall.
- Incisional hernias occur at the site of a surgical incision. These incisions may also be areas of weakness in your abdominal wall. Your risk of developing an incisional hernia is higher if you had a wound infection as a complication of your surgery. Up to 50% of patients who have had prior open abdominal operations can develop an incisional hernia.
Yes, watchful waiting is an option. However, remember that hernias do not get better on their own. They often get bigger and may become more symptomatic. The majority of patients with a hernia will eventually go on to have surgery, most likely because of pain. Rarely, hernias can cause complications that are life threatening known as acute incarceration or strangulation. This is when a piece of bowel gets stuck in the hernia and can’t be pushed back. As a result, the bowel and its blood supply are compressed. This situation requires emergent surgery to restore the circulation to the bowel and fix the hernia. In some cases, the bowel is injured and must be removed. The risk of this happening is approximately 1% per year.
Surgical options depend on individual patient health status and the location of the hernia.
- Open surgical repair closes the hernia with sutures, mesh or both. This procedure can be done under many types of anesthesia, including local anesthesia and sedation.
- Laparoscopic/robotic (minimally invasive surgical techniques) repair closes hernias from inside the abdomen with mesh reinforcement. These procedures use several small incisions made in the abdomen and requires a general anesthetic. Laparoscopy is commonly used to repair recurrent hernias, as it allows the surgeon to avoid scar tissue from a previous hernia repair. Minimally invasive surgery may also be offered for bilateral inguinal hernias as these techniques allow access to both sides at the same time through these small incisions with a single recovery period.
Mesh Advisory
Is Mesh Safe?
Surgical mesh is loosely woven sheet made of various types of synthetic material. Mesh reinforces the hernia repair and acts as a scaffold for surrounding tissues to incorporate and strengthen the repair. Mesh is frequently used in hernia repairs and has been shown to reduce the risk of a hernia coming back. It has been proven that a mesh repair has a lower risk of recurrence than a non-mesh repair. Mesh is also used in a variety of non-hernia operations.
Despite what you may have heard or read in the media, the majority of patients who undergo hernia repair with mesh heal well and are able to resume normal daily activities without limitation. There is a small risk of complications with mesh, similar to any surgically placed foreign body (prosthetic joints, vascular stents, heart valves). These complications include mesh infection, migration, erosion into other tissues and chronic pain. However, it is important to know that complications such as wound infection and chronic pain are also seen in hernia surgeries that do not use mesh. It is important to know that complications of mesh reported for non-hernia operations do not necessarily apply to hernia surgery.
Preparing for Surgery
Surgery is a huge stress to the body, so it is essential to optimize your health and physical fitness.
- Physical activity pre-operatively, including light weights and walking/running, has been shown to improve surgical outcomes.
- Weight loss. Obesity is major risk factor for post-operative complications and hernia recurrence.
- Diabetes management and strict blood sugar control is essential to prevent wound infections.
- Quitting smoking is highly recommended if not mandatory prior to having a hernia surgery. Smoking negatively affects wound healing in several ways.
By quitting smoking, being physically active, and controlling your diabetes, you improve your chance of a good surgical outcome.
Hernia Specific Post-Operative Care
Arrange for someone to take you home from the hospital.
Pain
- You will have some discomfort over your incision(s).
- Men may have a swollen, bruised or tender scrotum.
- Oral pain medication and ice packs will help.
Diet
- There are no dietary restrictions.
- It is essential to avoid weight gain to prevent hernia recurrence.
Activity
- We recommend no heavy lifting for 2 weeks following surgery to prevent hernia recurrence.
- We do encourage immediate low impact activities such as walking, jogging and climbing stairs.
- You will be sore for a week or so. Take it easy and let pain be your guide.
- Following these 2 weeks, there are no physical restrictions on activity.
Seroma
- You may have an on-going bulge at site of your hernia repair right after surgery.
- Don't worry – this is a normal feeling and appearance.
- The hernia repair did not fail – the hernia bulge can sometimes fill up with fluid – this fluid is a normal result of surgery and will usually be absorbed by the body in several weeks.
How to manage your hernia if your surgery has been delayed due to the COVID-19 pandemic.
Why was your surgery delayed?
In response to the COVID-19 pandemic all elective surgery was suspended based on recommendations from the Royal College of Surgeons. This is being done to prevent in-hospital COVID-19 transmission and conserve resources, such as personal protective equipment that would be used in the operating room. It is understandably frustrating that your surgery has been postponed, however there are a variety of ways your continue to optimize yourself for your surgery.
Recommended treatment until surgical intervention
While awaiting your surgery, you should:
- Continue to lose weight. The more weight loss, the less likely your hernia is to recur.
- Ensure all your other medical issues remain well controlled.
- You may wear a hernia belt or TRUS, which can relieve symptoms.
- Try to avoid excessive heavy lifting.
Indications for them to recontact the surgeon
It is unlikely that your hernia will require emergency surgery while awaiting your operation. If your hernia becomes more swollen, tender, firm or the overlying skin turns red, you should present to the nearest emergency department. You may have a piece of bowel stuck in your hernia which might require emergency surgery. This is a rare occurrence.