Types of Hernias to Watch Out for During Pregnancy

Types of hernias during pregnancy include umbilical, inguinal, and incisional forms. These conditions may emerge due to increased abdominal pressure. Recognizing early symptoms such as localized swelling and discomfort ensures timely medical evaluation and safe management.

Umbilical hernia in pregnancy often appears as a bulge near the navel. Though usually harmless, close monitoring is necessary to prevent complications. Proper prenatal care and physician guidance help distinguish normal changes from clinically relevant hernias.

Inguinal hernia may cause groin discomfort and noticeable protrusion. Hormonal changes and uterine growth increase susceptibility. Early detection allows for conservative management, often postponing surgical intervention until after childbirth unless complications arise.

Incisional hernia may occur in women with prior abdominal surgeries. Pregnancy places additional strain on scar tissue, leading to bulging or pain. Preventive measures, medical supervision, and tailored activity restrictions reduce the risks associated with such hernias.

What is a hernia, and why is it more common during pregnancy?

A hernia, in its simplest definition, is when an internal organ or tissue bulges outward through a weak spot in the muscle or connective tissue that normally holds it in place. The abdomen and groin are the most common locations for hernias. This weakness can be congenital or may develop over time.

So, why does pregnancy facilitate the development of a hernia or make an existing hernia more visible? The underlying reason lies in the natural changes that pregnancy brings to your body. Your growing uterus increases intra-abdominal pressure and slightly shifts the position of internal organs. This increased pressure places additional load on the weak points in the abdominal wall. At the same time, abdominal muscles stretch, thin out, and may weaken during pregnancy. Hormones also play an important role; especially hormones like relaxin can loosen connective tissues and create a predisposition for hernia formation. When all these factors combine, pregnancy creates a suitable environment for hernia development or for a silent hernia to become noticeable.

What are the common types of hernias to be aware of during pregnancy?

Different types of hernias may be encountered during pregnancy. Each has its own specific characteristics and management strategies. Let’s take a closer look at these types of hernias and their features.

What is umbilical hernia to be aware of during pregnancy, and how is it managed?

Umbilical hernia is the protrusion of intestine or fatty tissue through a weak area at or around the navel. Although it is not very common during pregnancy, it is somewhat more frequent in women than in men.

• Causes: The main causes during pregnancy are the increased intra-abdominal pressure caused by the growing uterus and the stretching of abdominal muscles. The area where the umbilical cord is located may be slightly weak congenitally.
• Symptoms: It usually manifests as a swelling or bulge around the navel that becomes more prominent when coughing or straining. The size can vary. There may be a feeling of pressure, dull pain, or tenderness, especially with movement. Symptoms usually appear in the second or third trimester. However, many umbilical hernias may remain silent.
• Diagnosis: A doctor’s examination is usually sufficient for diagnosis. If necessary, ultrasound can clarify the size and contents of the hernia.
• Management: In hernias that do not cause symptoms or have mild symptoms, “watchful waiting” and monitoring are usually sufficient, as many resolve or cease to be a problem after birth. Avoiding heavy lifting and straining is important. Supportive clothing like an abdominal binder can provide temporary relief. Surgery is generally avoided during pregnancy; however, emergency situations such as strangulation (loss of blood flow) or incarceration may require surgery. If surgery is unavoidable, the second trimester is usually preferred. Definitive repair of the hernia is typically postponed until after delivery, usually a few months after birth. Whether to repair it during a cesarean section is evaluated according to the situation.

What is inguinal hernia to be aware of during pregnancy, and how is it differentiated from round ligament varices?

An inguinal hernia is when tissues (usually part of the intestine) protrude through a weak spot in the abdominal muscles in the groin area. It is rare in pregnant women.

• Causes: As the uterus grows, the pressure on the inguinal canal increases. An existing weakness in the connective tissue or muscles also plays a role.
• Symptoms: The most typical symptom is a soft swelling or protrusion in the groin. This may be accompanied by dull pain in the groin area, which typically worsens with movement, coughing, or sneezing.
• Diagnosis: Physical examination is important. However, there is a condition that can mimic and is often confused with inguinal hernia during pregnancy: round ligament varices (RLV). The round ligament is a structure that connects the uterus to the groin area, and the veins in this ligament can dilate during pregnancy. Its symptoms are very similar to those of an inguinal hernia. Color Doppler ultrasound is critical in differential diagnosis. Ultrasound shows blood flow in varices, whereas a hernia will appear differently. This distinction is important, as round ligament varices usually resolve on their own after childbirth and are managed without surgery, while a complicated inguinal hernia may require surgical intervention.
• Management: Since surgery is generally not recommended during pregnancy, a “wait and see” approach is common. Supportive garments may provide relief. Surgery is usually postponed until after delivery unless complications develop. However, severe pain, persistent protrusion, nausea, or vomiting may indicate hernia strangulation, and immediate medical attention should be sought.

What is femoral hernia to be aware of during pregnancy, and why does it pose a particular risk?

A femoral hernia is a swelling that occurs near the crease where the leg joins the trunk, in the groin area. It is rarer than inguinal hernias. The most important feature of femoral hernias is their high risk of strangulation. The femoral canal, where the hernia emerges, is a narrow and rigid structure. Therefore, even a small hernia has a high risk of trapping tissue and disrupting blood flow. This makes the “watchful waiting” approach generally inappropriate for femoral hernias.

• Symptoms: It presents as a painful swelling in the leg/groin crease or inner upper thigh. An irreducible, tender swelling is a medical emergency.
• Management: Due to the high risk of strangulation, surgical repair is recommended for all femoral hernias if the patient is suitable. Emergencies require immediate surgical intervention.

What is hiatal hernia to be aware of during pregnancy, and what are its symptoms?

A hiatal hernia is when the upper part of the stomach moves upward through the opening in the diaphragm for the esophagus into the chest cavity. Pregnancy, with its increased intra-abdominal pressure, can trigger this condition.

Symptoms: It is often asymptomatic. When symptoms do occur, they may overlap significantly with common pregnancy discomforts (heartburn, acid reflux, belching, chest pain, indigestion, nausea). Therefore, it can be difficult to distinguish whether symptoms are “just from pregnancy” or are caused by an underlying hiatal hernia.

• Diagnosis: It is diagnosed using methods such as endoscopy.
• Management: Treatment primarily aims to alleviate symptoms. Lifestyle changes and medications (antacids, PPIs) prescribed by a doctor may be recommended. Surgery is rarely necessary during pregnancy.

Lifestyle changes include:

• Eating smaller, more frequent meals
• Avoiding fatty, acidic, and spicy foods
• Staying away from alcohol, chocolate, caffeine, and mint
• Not smoking
• Not lying down immediately after eating
• Stopping eating 3–4 hours before bedtime
• Elevating the head of the bed

What is incisional hernia to be aware of during pregnancy, especially after a cesarean section?

An incisional hernia is the protrusion of internal organs or tissues through a weakened area of the abdominal muscle or fascia at the site of a previous surgical incision. The risk may increase especially after cesarean section due to increased pressure on the incision as the uterus grows.

• Causes and Risk Factors: Excessive physical activity in the early postoperative period, significant weight gain, a new pregnancy, and conditions that increase intra-abdominal pressure before the wound has fully healed all increase the risk.
• Symptoms: Swelling or a bulge on or near the surgical scar, pain, or discomfort in this area may occur.
• Diagnosis: Medical history and physical examination are generally sufficient.
• Management: If there are no symptoms, conservative methods such as an abdominal binder can be tried. Definitive treatment is surgical repair. The timing of surgery depends on the situation; in uncomplicated cases, repair is usually postponed until after delivery or planned together with a cesarean section.

What is epigastric hernia to be aware of during pregnancy, and how is it treated?

An epigastric hernia is usually the protrusion of fatty tissue in the upper midline of the abdomen, between the lower end of the breastbone and the navel. It is rare during pregnancy.

• Causes: The main cause is the pressure of increased intra-abdominal pressure on the abdominal wall during pregnancy.
• Symptoms: Swelling, localized pain, or tenderness in the upper abdomen, which becomes more apparent with coughing, laughing, or lifting objects. Sometimes it may be asymptomatic.
• Diagnosis: Physical examination is usually sufficient. Ultrasound can confirm the diagnosis.
• Management: Non-surgical methods are preferred unless there are complications. Lifestyle adjustments, supportive garments, and ice packs for pain can provide relief. Surgery is generally postponed until after delivery.

Why are internal hernias especially important during pregnancy, and why are they difficult to diagnose?

An internal hernia is when an organ protrudes through a normal or abnormal opening within the abdominal cavity boundaries. Because they are not visible from the outside, they are difficult to diagnose and thus can be dangerous. They should be particularly considered in pregnant women who have previously undergone bariatric surgery.

Why Are They Important?

• Difficulty in Diagnosis: Symptoms (abdominal pain, nausea, vomiting) can mimic normal pregnancy symptoms.
• High Risk: Delayed diagnosis and surgery can lead to serious consequences (bowel obstruction, strangulation).
• Symptoms: Usually intermittent or persistent cramp-like abdominal pain, bloating, nausea, and vomiting.
• Diagnosis Challenges: A high index of suspicion is necessary. Imaging methods such as ultrasound, CT, or MRI are used. However, even if imaging is normal, further investigations may be required if clinical suspicion persists.
• Management: Definitive diagnosis and treatment are usually possible with prompt surgical intervention (laparotomy or laparoscopy).

What are the warning signs and symptoms of hernias to be aware of during pregnancy, and when should a doctor be consulted?

Knowing the signs of hernia and possible complications during pregnancy is vital for timely intervention.

General symptoms of hernia during pregnancy include:

• Lump or swelling in the abdomen or groin
• Dull, aching pain that worsens with movement
• A feeling of pressure or heaviness in the hernia area
• Tenderness around the hernia

However, some situations require emergency medical attention. If any of the following “red flag” symptoms occur, you should immediately consult a healthcare facility:

• Sudden, severe, or increasing pain in the hernia area that does not improve with rest
• The hernia bulge becoming hard, tender, irreducible by hand, and painful
• Redness, bruising, or dark discoloration of the skin over the hernia
• Nausea and vomiting with a painful, tender hernia bulge
• Fever
• Inability to pass gas or stool (signs of bowel obstruction)
• Rapid heartbeat

Any new pain or swelling around the navel or groin area, in particular, should always be evaluated by a doctor.

What are the diagnostic approaches for hernias to be aware of during pregnancy?

Accurate diagnosis is the first step toward proper treatment.

• Physical Examination: Usually the first step and may be sufficient for many superficial hernias.

Imaging Methods:

• Ultrasound (US): A safe and effective method during pregnancy. It shows the location, size, and contents of the hernia. The Doppler feature is very valuable in distinguishing inguinal hernias from round ligament varices.
• Magnetic Resonance Imaging (MRI): Does not involve ionizing radiation and is safe during pregnancy. It provides detailed information in complex cases or when ultrasound is insufficient.
• Computed Tomography (CT) Scan: Can be used in emergencies or when MRI is not possible, after a risk-benefit assessment. Due to radiation exposure, its use is limited during pregnancy.

What are comprehensive management strategies for hernias to be aware of during pregnancy?

Management of hernias during pregnancy requires a personalized approach. The mother’s health is always the priority.

What are conservative management methods?

For most uncomplicated hernias, non-surgical (conservative) management is preferred. These methods include:

• “Watchful Waiting”: Regular medical follow-up for asymptomatic or mild hernias.
• Avoiding heavy lifting and strenuous activities
• Maintaining healthy weight control
• Adhering to special dietary recommendations for hiatal hernia (small, frequent meals, avoiding foods that trigger reflux)
• Consuming fiber-rich foods and adequate fluids to avoid straining
• Providing temporary relief with supportive garments (abdominal binders, hernia belts)
• Physiotherapy (strengthening core muscles, correct breathing and movement techniques)

When and how is surgical intervention performed?

Surgery during pregnancy is reserved for emergencies such as hernia strangulation, incarceration, bowel obstruction, or severe pain unresponsive to conservative treatment. Emergency surgeries are performed regardless of gestational week. For non-urgent but necessary surgeries during pregnancy, the second trimester (weeks 14–26) is generally preferred. Most elective hernia repairs are postponed until after delivery. Surgery can be performed using open or laparoscopic (minimally invasive) techniques.

What should be known about the use of mesh and anesthesia?

The use of mesh is a common method to reduce recurrence in hernia repairs. However, for women of childbearing age or those planning future pregnancies, the decision to use mesh is made more carefully. This is because a pregnancy after mesh placement can increase the risk of hernia recurrence, and mesh can affect the flexibility of the abdominal wall, causing pain. If possible, definitive mesh repair is recommended after completing childbearing. Anesthesia is planned with special attention to the condition of the pregnant patient and baby. Most anesthetic drugs are safe during pregnancy.

What are the effects of hernias during pregnancy on delivery, labor, and the postpartum period?

There are some important points regarding the mode of delivery, the labor process, and the postpartum period for a hernia during pregnancy.

• Effect on Mode of Delivery: Most women with hernias (especially umbilical or inguinal hernias) can have a normal vaginal delivery. Hernia is usually not a reason for cesarean section. However, if the hernia is very large or there are other medical necessities, a cesarean may be considered.
• Management During Labor: Labor usually proceeds normally. Straining may affect the hernia to some extent.

Postpartum Hernia Repair:

• Timing: Elective repair is usually postponed until after delivery. This may be a few weeks to a few months after birth. Sometimes a longer wait is recommended for complete tissue healing.
• Breastfeeding Mothers: Even if surgery is necessary, breastfeeding can usually continue. Most medications are safe for breastfeeding mothers. However, support for baby care should be planned during the postoperative recovery period, as lifting restrictions will be in place for a while.
• Risk of Recurrence in Future Pregnancies: A new pregnancy after hernia repair can increase the risk of recurrence. Therefore, it is important to be aware of this risk if repair was done before family planning was complete.

Remember, most hernias encountered during pregnancy can be managed safely. The important thing is to recognize symptoms, seek medical advice promptly in worrisome situations, and follow your doctor’s recommendations. In this way, both your health and your baby’s health will be protected.

Dr. Ahmet Bekin

Op. Dr. Ahmet Bekin was born in Istanbul in 1983. He graduated from the Faculty of Medicine at Kocaeli University in 2006 and completed his specialty training in the Department of General Surgery at Istanbul University Çapa Faculty of Medicine in 2011. After his specialization, he worked in the fields of hernia surgery, reflux surgery, obesity surgery, advanced laparoscopic surgery, and robotic surgery. In addition, he received training in endocrine surgery, oncological surgery, and minimally invasive surgery. He is currently accepting patients from Turkey as well as from countries such as Germany and France at his private clinic located in Istanbul.