Hernia and pregnancy by Dr. Iraniha
Hernia is a weakness or defect in the abdominal wall musculature which could be congenital or acquired. Any condition, such as pregnancy that increases the intraabdominal pressure repeatedly or constantly could cause or aggravate an abdominal wall hernia. The development of a hernia during pregnancy is not uncommon. Hernia and pregnancy is associated with gradual increase in the intraabdominal pressure due to growing fetus which distend the abdominal cavity by stretching the musculature and therefore could create or worsen an abdominal wall defect. On the other hand, in the course of hernia and pregnancy, the abdominal wall musculature tend to get thinner, weaker and stretch which make the pregnant women more susceptible to develop hernias. If the pregnant woman already has a hernia, it could get bigger and/or more symptomatic during the late stages of hernia and pregnancy. Due to potential risk of any elective surgery in the course of pregnancy, it is advisable to fix the hernia few months after the delivery unless there is a true hernia emergency such as incarceration of the bowel into the hernia defect. Some women will regain their abdominal muscle shape and strength few months after the delivery, however there are others who end up with diastasis (separation) of rectus muscle with or without peri-umbilical (around the belly bottom) abdominal wall hernia. Diastasis of rectus muscles is the separation of the two midline vertical abdominal muscles (usually called six-pack muscles) from each other in the center of the abdomen. This condition presents with a bulge in the middle of the abdomen with or without discomfort during exercise and straining activity or creates an esthetically undesirable condition so called pot belly in the standing position.
Hernia and pregnancy abdominal wall hernia
These problems are seen and become more noticeable especially in women with thinner and smaller body frame and they never improve spontaneously even with diet and daily core exercises. In fact the diastasis of rectus muscle and/or hernia could potentially get worse or become more noticeable after heavy exercise and/or excessive weight loss. Women after pregnancy not only have the potential of developing abdominal wall weakness with diastasis of rectus muscle and/or abdominal wall hernia, but also could experience other esthetically undesirable conditions such as excessive skin laxity, stretch marks and excessive fat deposit around the abdomen and flank regions. These issues can take a big toll on the women`s self-image and self-confidence and could be extremely stressful if not addressed. Fortunately there are many surgical options like Laparoscopy hernia repair to address these problems. However, the surgical management of the women after the pregnancy is challenging and extremely individual and requires multidisciplinary approach by an expert in the field of hernia repair and body contouring to address all or most of these undesirable conditions. For example, some women are good candidates for concurrent full abdominoplasty and hernia repair, with or without liposuction to repair their hernia and diastasis of rectus muscle and remove the extra loose skin and fat. However some women are not suitable for full abdominoplasty due to lack of excessive skin and may require mini-abdominoplasty with repair of hernia and diastasis with or without liposuction. There are also women with athletic body who just suffer diastasis of rectus muscle and hernia without any skin laxity or excessive fat deposit and just require tightening of their muscle and repairing their hernia. These patients could be a great candidate for robotic surgery. Therefore a thorough assessment of the patient by an expert in the field of hernia repair and body contouring is essential to identify all the esthetically undesirable conditions and patient`s expectations and create an individual comprehensive plan to address the problems and achieve the best aesthetic and functional results.