What is an incisional hernia?
An incisional hernia is a type of hernia that occurs at or near the site of a previous surgical incision in the abdominal wall. During surgery, the abdominal muscles and other tissues are cut and then sewn back together. In some cases, this repair can weaken over time, allowing the contents of the abdomen, such as the intestines, to push through the weak spot. While they can appear months or even years after the initial operation, they do not resolve on their own.
The initial progression of an untreated incisional hernia
Initially, a person with an incisional hernia may only notice a soft bulge near their scar, which might be more visible when standing, coughing, or straining. The hernia may be 'reducible,' meaning the bulge can be pushed back into the abdomen with gentle pressure. However, over time, the hernia will continue to grow and the opening in the abdominal wall will become larger. As it grows, the symptoms, which may include a pulling sensation or general discomfort, are likely to become more pronounced.
Increased risk of incarceration
As an incisional hernia enlarges, the risk of it becoming incarcerated increases significantly. This occurs when a portion of the bowel or other abdominal tissue becomes trapped in the hernia sac and cannot be pushed back inside. This condition is more serious than a reducible hernia because it can lead to a bowel obstruction. A bowel obstruction is a blockage of the intestine, which can prevent the passage of stool and gas, causing severe pain, nausea, vomiting, and a swollen abdomen.
The life-threatening danger of strangulation
Perhaps the most severe and life-threatening complication of an untreated incisional hernia is strangulation. This happens when an incarcerated hernia becomes so tightly trapped that its blood supply is cut off. Without a proper blood supply, the trapped tissue will begin to die (necrosis), releasing toxins into the bloodstream. Strangulation is a medical emergency that requires immediate surgical intervention. Symptoms of a strangulated hernia include:
- Sudden, severe pain at the hernia site
- A bulge that becomes red, purple, or dark-colored
- Fever
- Nausea and vomiting
- An inability to pass gas or have a bowel movement
- Rapid heart rate
How chronic pain develops
Even without progressing to incarceration or strangulation, an untreated incisional hernia can cause a great deal of chronic discomfort. The persistent pressure on the abdominal muscles and surrounding nerves can lead to chronic pain that interferes with daily activities. The constant strain can also make the hernia's symptoms more noticeable during physical exertion, limiting a person's ability to exercise or perform other routine tasks. Over time, this can significantly impact an individual's quality of life.
Impact on future surgical options
Delaying the repair of an incisional hernia can make future surgical procedures more complex and difficult. Larger hernias require more extensive surgery to repair. Additionally, operating on older, neglected hernias can be challenging, as the surrounding tissues may have been thinned or compromised. This can lead to a more complicated recovery and potentially a higher risk of recurrence.
Comparison of Untreated vs. Treated Incisional Hernia Outcomes
| Feature | Untreated Incisional Hernia | Treated Incisional Hernia (via surgery) |
|---|---|---|
| Progression | Will inevitably grow larger and more symptomatic over time. | Repaired, preventing further growth and progression. |
| Complications | High risk of incarceration, bowel obstruction, and life-threatening strangulation. | Minimal risk of acute complications; some risk of recurrence depending on the repair method. |
| Symptoms | Worsening pain, discomfort, pressure, and potential digestive issues. | Immediate post-operative pain managed with medication; symptoms resolve long-term. |
| Emergency Status | Can develop into a medical emergency requiring immediate, and more complex, surgery. | Elective, planned procedure allows for better preparation and safer conditions. |
| Recovery | No recovery, only worsening of the condition over time. | Defined recovery period, often with a return to normal activity within weeks. |
For more information on the various types of hernia repair and patient resources, refer to the UCLA Health Hernia Care FAQs.
Conclusion
While a small incisional hernia may seem like a minor annoyance, leaving it untreated is a dangerous gamble with your health. The potential for the hernia to grow, become incarcerated, or turn into a life-threatening strangulation is a risk that should not be taken lightly. Seeking prompt medical evaluation and discussing treatment options with a healthcare provider is the safest and most effective way to address the condition, prevent serious complications, and restore your quality of life.
