Incisional Hernia

An incisional hernia is a bulge that develops at or near a weakened area of the abdominal wall where an earlier surgery was performed. Fat, intestine, or other abdominal tissue can push through the weak spot, often near a surgical scar. An incisional hernia can happen after many types of abdominal operations, including open surgery and minimally invasive procedures. It may appear soon after surgery or months or years later.

After an abdominal operation, the healing tissue at the incision may remain weaker than the surrounding muscle and connective tissue. When pressure rises inside the abdomen, fat or part of the intestine can push through this weak area and create a hernia. Coughing, straining, lifting, or other activities can increase pressure, although the weakness usually relates to the healing process itself.

An incisional hernia can follow open or minimally invasive abdominal surgery, including a cesarean delivery or gallbladder surgery. For this reason, an after C-section hernia or a hernia following gallbladder surgery may not become noticeable until months or years after the operation.

Factors linked to medical history and healing

Sometimes tissue becomes trapped in the hernia and cannot move back into the abdomen; this is called incarceration. If the blood supply to the trapped tissue is reduced or blocked, the condition is called strangulation. These complications can cause a bowel obstruction, tissue damage, and the need for urgent surgery, although not every incisional hernia becomes an emergency.

Diagnosis usually begins with a medical history and physical examination. A clinician may examine the scar and bulge while you are standing, coughing, or straining, and may assess whether the bulge can be gently pushed back into the abdomen. The examination also helps determine whether the scar is involved and whether the hernia may be causing symptoms.

When imaging may be needed

Ultrasound or CT imaging may be used when the hernia is subtle, large, recurrent, painful, or potentially complicated. Imaging can show the size and contents of the hernia and help the surgeon plan an incisional hernia repair. Urgent symptoms may require immediate evaluation rather than waiting for routine imaging.

Small hernias with few or no symptoms may sometimes be monitored with guidance from a clinician. An incisional hernia generally does not permanently close on its own, so a medical evaluation can help determine whether monitoring or repair is appropriate. While awaiting evaluation, avoid activities that cause pain or heavy straining, and address constipation with advice from a healthcare professional.

Surgical repair options

A surgeon may reinforce the abdominal wall with stitches, mesh, or both; in selected situations, a tissue-only repair may be considered. The approach depends on the hernia’s size and location, previous operations, overall health, and risk of recurrence. After surgery, follow activity restrictions and attend follow-up visits. Discuss possible recurrence, infection, chronic pain, or bowel injury with the surgical team.

An incisional hernia may remain stable, gradually enlarge, become painful, or develop complications. Definitive repair often improves symptoms, but recurrence remains possible, especially with larger or more complex hernias. The outlook depends on the hernia’s size and location, symptoms, overall health, and treatment plan.

Recovery after incisional hernia repair usually involves a gradual return to activity and follow-up with the surgical team. Persistent bulging, pain, swelling, or an abdomen that appears larger after hernia surgery should be discussed with a clinician. Follow-up helps identify recurrence or other concerns early.

Arrange a clinician visit for any new bulge near an abdominal surgical scar, an increase in size, pain, discomfort with activity, or concern about a possible recurrence. A healthcare professional can examine the area and discuss monitoring, abdominal hernia treatment, or repair options.