Pregnant women have an increased risk of hernias because of the increased pressure pregnancy puts on the abdomen. Most hernias in pregnant women are external, meaning that they affect the abdominal wall and may be seen or felt as a bulge under the skin. This most commonly happens in the lower abdomen or groin area. (1) Most hernias in both the general population and pregnant women affect the groin, in either what’s known as an inguinal or a femoral hernia. But pregnant women are at increased risk for an umbilical hernia, which affects the area around your navel (belly button). (2,3) If a hernia is causing discomfort during your pregnancy, it can usually be repaired in a surgical procedure with little risk to you or your pregnancy. And if your hernia develops a serious complication, emergency surgery will be necessary. But if your hernia isn’t causing any unpleasant symptoms, you may decide to wait until after giving birth to have it repaired. (2) According to the Mayo Clinic, certain factors make it more likely that you’ll develop a hernia when you’re pregnant:
Being overweight or obeseMultiple pregnancies (twins, triplets, and more)Previous abdominal surgery, including hernia repairOlder ageFamily history of herniasLifting heavy objectsChronic sneezing or coughingChronic constipation (3,4)
You may only find out that you have a hernia when your doctor does a physical exam or imaging tests related to your pregnancy care. But in many women, a hernia shows up as a bulge or lump that appears when you lie down or press on a nearby area. You may only be able to feel this bulge, or it may be visible. A hernia may also cause pain, which is typically dull but may become sharper when you exert yourself by walking quickly, bending over, sneezing or coughing, lifting heavy objects, or laughing intensely. Your symptoms may become more intense as your pregnancy progresses and your body weight increases. (1) You should be able to push your hernia back into your body when you’re lying down. If you have trouble doing this, applying an ice pack to the area may help. If you can’t push your hernia back into your body under these conditions, this may indicate that your hernia is trapped (incarcerated). If you suspect that this is the case, see your doctor immediately to help avoid the serious complication of a strangulated hernia, in which the blood supply to the trapped tissue is cut off. Symptoms of a strangulated hernia may include:
NauseaVomitingSudden pain that gets worseHernia bulge turning red, purple, or darkInability to pass stool or gas (3)
If your hernia is small and isn’t causing any unpleasant symptoms, you and your doctor may decide to wait until after you give birth to repair it. But if your hernia is causing you discomfort, most doctors will recommend repairing it while you’re still pregnant. And if your hernia develops a complication, like becoming trapped or strangulated, emergency surgery will be necessary. (2) In the absence of an emergency, the following options may be available to treat or manage your hernia during pregnancy:
Elective Repair During Pregnancy
Your doctor may propose surgically repairing your hernia while you’re still pregnant if it’s causing you symptoms, or if it’s large enough to risk developing complications. The exact timing of your surgery isn’t likely to follow any specific rules. Some doctors recommend it during the first or second trimester, while others believe that the second trimester is the optimal time to operate. If your hernia is repaired using only sutures — without using steel mesh to support the area of weakened muscle — then the risk of your hernia coming back during your pregnancy is high. But using mesh in the operation can limit the flexibility of your abdominal wall and cause pain, both during your current pregnancy and in any future one. Hernia repair surgery during pregnancy is considered to be a safe procedure. As outlined in the Frontiers in Surgery report, in one study of umbilical hernia repair in 126 pregnant women, few side effects and no pregnancy losses were reported within 30 days of the surgery. (2)
Hernia Repair During a C-Section
If you don’t have a particularly severe hernia and plan to give birth by Caesarian section (C-section), you may be able to have your hernia repaired at the same time. The Frontiers in Surgery article notes that combining a hernia repair with a C-section seems to result in a longer overall procedure to repair the inguinal hernias, but not for umbilical hernias — meaning that it takes no longer than a regular C-section. Just as with elective repair during pregnancy, using only sutures to perform a repair during a C-section appears to carry a greater risk of hernia recurrence than using steel mesh. (2)
Hernia Repair After Childbirth
For mild hernias, you and your doctor may decide not to repair your hernia during a C-section for a number of reasons, including if you’re planning another pregnancy. Hernia repair can be done as a separate procedure as soon as five to eight weeks after you give birth, or it can be delayed for a year or longer to allow your body to recover more fully from your pregnancy. In this situation, delaying a hernia repair for up to five years appears to be safe as long as you continue to look out for hernia enlargement and complications, according to the Frontiers in Surgery article. (2)
