How to Treat a Post-pregnancy Hernia as part of an abdominoplasty
Abdominoplasty surgeries reshape your tummy and your waist after giving birth. But they are also useful in treating hernias that may have occurred during your pregnancy.
In the days after giving birth, women have to come to terms with their changed bodies. Carrying a baby in your belly for nine months leads to serious physiological divergences. Some changes seen after pregnancy can include weight gain, separated abdominal muscles (called diastasis recti), and hernias. Reverting to pre-pregnancy bodies can pose a challenge for many women, especially in the case of hernias or diastasis recti. Surgical intervention is often needed to recover fully for those suffering from these conditions.
In this article, we will examine how post-pregnancy hernias are caused and how they can be repaired during a Tummy tuck by a specialist surgeon.
Post-pregnancy Hernia Repair During tummy tuck surgery
Umbilical hernia
Before learning how pregnant women can contract a hernia, we should also learn a little about hernias. Some might be surprised to learn that hernias are a common affliction among women after pregnancy. When most people think of hernias, they imagine a scrotal hernia, which only affects men. Think of Joey suffering a hernia after lifting weights in that F.R.I.E.N.D.S. episode.
But childbirth involves considerably more effort than anything Joey could muster while working out. Any activity that strains your groin and abdominal muscles can cause a hernia, and they don’t come more strenuous than giving birth to a screaming newborn. For this reason, many specialist general surgeons also perform hernia repair surgery when performing abdominoplasties on new mothers.
In the simplest terms, a hernia is formed when the intestines or internal organs start poking through the retaining abdominal wall of the muscles and connective tissue. Between the constant pressure on the inner abdominal wall during pregnancy and the exhausting effect labour has on a woman’s muscles, it’s unsurprising that some develop hernias in the aftermath.
A 2020 study titled “How to Treat Hernias in Pregnant Women?” published in the medical journal Cureus found that about 20 million operations are performed for hernias globally each year. It also estimated frequency rates of 0.08% for umbilical hernias and 0.12% for groin hernias among pregnant women.
Those might seem like small percentages, but for women affected, hernias can eventually take away from their quality of life. And the worst part about hernias is that they do not heal by themselves. It will take a medical intervention, sometimes non-surgical but more commonly involving surgery, to treat the hernia.
What Causes a Hernia?
While hernias during pregnancy are uncommon, they still afflict a few women. Some factors during your pregnancy that might increase your chances of developing a hernia are:
- Having multiple pregnancies or a complicated pregnancy
- Prolonged labour during childbirth
- Being overweight or obese during the term
- Having a pre-existing umbilical hernia before getting pregnant
Of course, hernias aren’t exclusive to pregnant women. Anybody, regardless of age or gender, could develop a hernia based on several factors. Also, there is more than one type of hernia. Different kinds of hernias can occur in the groin, abdomen, and intra-abdominal area, all with their inciting causes.
Common Causes of Hernias
- Congenital birth defects
- Chronic Obstructive Pulmonary Disorder (COPD)
- Excessive coughing
- Overworking the muscles during exercise
- Straining the abdominal muscles
- Ascites, a condition when fluids build up in the liver
- Injuries or complications from an earlier surgery
- Old age
- Being overweight
- Premature birth
- Cystic Fibrosis
- Lifestyle choices like smoking and drinking
- Family history of hernias
Sometimes, small hernias can escape notice. Their symptoms are also hard to detect until a few months have passed. But eventually, even a small hernia will grow large enough to attract attention and need treatment.
Types of Hernias
While hernias may not necessarily be life-threatening, they do require medical attention. Left untreated, hernias could lead to health complications down the line. There are various kinds of hernias, which are categorised according to the site of their occurrence. A few of the most common types of hernias are listed below.
Abdominal wall hernias
Abdominal wall hernias
Abdominal wall hernias occur when there is a weakness or defect in the abdominal wall, which allows an internal organ, such as the intestine, to protrude through. Abdominal wall hernias can be caused by surgical incisions, childbirth, certain activities or lifting heavy objects, and even genetics. Common types of abdominal hernias include inguinal (groin hernias), umbilical, and incisional hernias. Abdominal wall hernias can cause a variety of symptoms, including abdominal pain in the area near the hernia, swelling or bulge in the abdomen, and difficulty moving or lifting objects.
Incisional Hernia
Incisional hernia
This type of hernia occurs in many patients who have undergone surgery in the past. When the surgeon makes an incision in the abdominal cavity, complications in the healing process could lead to a weakness in the muscles at the incision site. This allows fat, intestines, or organs to push through the muscles, forming an incisional hernia.
Inguinal Hernia
These are the most commonly seen hernias. Inguinal hernias affect men more often than women. It gets its name from the inguinal canal, an opening within the groin through which male testicles descend after birth. In cases where the inguinal canal fails to close properly after the testicles have passed through, a hernia could push through the opening in the groin. These hernias are usually brought about due to lifting heavy weights.
Femoral Hernia
Following the path of the femoral artery, femoral hernias are located at the juncture of loose skin between the upper thigh and groin. It is formed when tissue or part of the small intestine protrudes outside the abdominal wall. Femoral hernias are commonly observed in older women patients.
Umbilical Hernia
Umbilical hernia
Umbilical hernias are seen in young children as well as older patients. Umbilical hernias appear as a slight bulge near the belly button or umbilicus.
Unlike other types of hernias, umbilical hernias can heal over time as the child’s abdominal muscles strengthen. Most children with umbilical hernias recover on their own by the time they reach two years of age. However, adults can also develop umbilical hernias due to obesity, abdominal fluid collection, and pregnancy. Hernia repair surgery is usually required to resolve these hernias.
Ventral Hernia
A ventral hernia is a term given to hernias where the tissue pushes through the abdominal wall muscles. It can appear as a bulge in the abdomen that reduces in size when the patient lies down. Like the other types of hernias, ventral hernias are brought on by strenuous activity, pregnancy, or weight gain.
Spigelian Hernia
The Spigelian hernia is one of the rarest types of hernia. They make up only about 2% of all hernia cases. It is seen when fatty tissue or organs push through the internal obliques and transversus abdominis muscles.
Epigastric Hernia
When a hernia develops above the belly button but below the sternum, it is referred to as an epigastric hernia. Like all the other types of hernias, epigastric hernias can also be treated with surgery. In fact, due to their location on the stomach, epigastric hernias are commonly repaired during tummy tuck surgery.
Hiatal Hernia
Hiatus hernia
These hernias can be some of the most challenging types to live with. Hiatal hernias are caused by a part of the stomach protruding through the diaphragm and into the chest cavity. This protrusion perforates the diaphragm, separating the chest and abdomen cavities. It leads to symptoms of gastroesophageal reflux disease (GERD), where the stomach acids wash back into the oesophagus, causing a burning sensation in the throat.
These hernias can occur as people age or result from a congenital birth defect in children.
Classification of hernias
Categorising hernias according to their site of occurrence is a reliable system. However, there is another way of looking at hernias according to their nature instead of their location. Under this classification system, hernias fall under three main types. These are:
Reducible Hernia: Cases where the hernia can be pushed or manipulated back into position through the opening it is coming through.
Irreducible Hernia or Incarcerated Hernia: When the tissue or organs have completely filled up the hernia sac, it can no longer be manipulated back. These cases are referred to as irreducible hernias.
Strangulated Hernia: When the organs or tissue causing the hernia experience torsion (twisting), they can become cut off from the blood supply. This is known as a strangulated hernia and can lead to serious health complications, including tissue death.
Strangulated hernia
Regardless of the type of hernia, correcting it will require some medical intervention. While dietary and exercise restrictions, along with over-the-counter medications, can help manage the symptoms of hernias, most cases require surgery to fix.
Surgical Treatments For Hernias
Hernias have been afflicting humans for as long as we’ve been doing strenuous physical activities- essentially all recorded history. The condition is even noted in the ancient Egyptian Ebers Papyrus, a scroll describing ailments and their treatment options thought to date to approximately 1,500 B.C. In modern medicine, surgical treatment is considered the best fix for hernias.
There are several surgical approaches to treating hernias. The two main approaches differ in their treatment method, as we will see below.
- Herniorraphy: A herniorraphy is the oldest surgical solution for hernias and is still in use today. Surgeons make a cut over the hernia. They open up the hernia sac and trim it, returning displaced organs to their original positions. The hernia sac is surgically removed. Finally, the surgeon stitches shut the hole in the muscles through which the hernia protruded. While herniorraphy is a time-tested method for fixing hernias, the drawback is that this method has a high chance of the hernia reappearing.
- Hernioplasty using mesh: A newer approach to fixing hernias is the hernioplasty, sometimes called “tension-free hernia repair.” In this procedure, instead of stitching the muscle opening closed after removing the hernia sac, surgeons cover it with a patch of mesh. This mesh is made of sterilised or organic materials, like polypropylene (medical grade plastics) or animal tissue. The mesh supports the damaged tissues surrounding the hernia, allowing them to heal stronger. Hernioplasties have a better recovery rate with fewer chances of hernias recurring than herniorraphies.
Ventral hernia surgery repair
These two hernia repair operations can also be distinguished further based on the medical equipment used by the surgeon. The two commonly seen styles of surgery to get the hernia repaired are:
- Open Repair: This is the traditional method. The surgeon makes an incision over the hernia. The hernia is then exposed and repaired.
- Laparoscopic Repair or Laparoscopic Surgery: This method sees a tube camera inserted into the patient’s body through a tiny incision. The surgeon uses miniature tools to access the hernia through a second small cut. Laparoscopic hernia surgery is less invasive than the traditional surgical repair method but may not be suitable for every patient’s hernia.
Other newer methods of hernia repair or hernia treatments include the use of robotics. Along with traditional hernia repair operations, you can also treat hernias with plastic surgery.
Plastic Surgery & Hernia Repair
Patients with hernias can have them removed while getting a tummy tuck. The abdominoplasty procedure gives the surgeon access to the patient’s abdominal wall. While restructuring and suturing the abdominal muscles, the surgeon can also perform a herniorraphy to remove the abdominal hernia. Epigastric, inguinal, and umbilical hernias, which appear in the same region operated on during an abdominoplasty, can be treated during this procedure.
Women who have just given birth are sometimes concerned about the changes pregnancy brings to their bodies. An abdominoplasty surgery not only addresses their cosmetic concerns but also provides medical benefits.
Torn abdominal muscles and hernias need not trouble women after pregnancy. After careful consultation with a Specialist surgeon, it’s possible to repair post-pregnancy hernias with an abdominoplasty.
