An incisional hernia forms when tissue or an organ protrudes through a weakened area in the abdominal wall at the site of a previous surgical incision. While often associated with abdominal discomfort, an incisional hernia can also contribute to back pain.
Understanding Incisional Hernia
An incisional hernia develops following abdominal surgery when the wound does not heal as strongly as the surrounding abdominal wall. This creates a gap through which internal tissues or organs, such as intestines, can push outwards. These hernias can appear weeks, months, or even years after an operation, affecting up to 20% of people who undergo open abdominal surgery.
Factors increasing the likelihood of an incisional hernia include conditions that impair wound healing, such as obesity, diabetes, or immunosuppressant medication use. Activities that strain the abdominal wall, like heavy lifting or chronic coughing, especially soon after surgery, also contribute. Surgical site infections can further compromise wound integrity.
The Connection to Back Pain
An incisional hernia can contribute to back pain through several mechanisms, impacting the body’s biomechanics and potentially affecting nearby nerves. The integrity of the abdominal wall is important for core stability and support for the spine. When an incisional hernia compromises this wall, it can alter the body’s natural alignment and distribute strain unevenly.
The weakened abdominal muscles may lead to other muscle groups, particularly those in the back, overcompensating to maintain stability. This increased workload on the back muscles can result in chronic tension, muscle strain, and spasms. Studies indicate that individuals with incisional hernias show a significant reduction in abdominal strength, sometimes by as much as 20%, which can directly impact spinal support.
An incisional hernia can also directly irritate or compress nerves in the abdominal wall, leading to pain felt in the back. If these nerves become entrapped or damaged by the hernia, pain can radiate to the lower abdomen, groin, or upper thigh, and manifest as back pain. This is known as referred pain, where discomfort is perceived in an area different from its source due to shared nerve pathways.
Recognizing Associated Symptoms
While back pain can be a symptom, an incisional hernia typically presents with other common signs. The most apparent is often a visible bulge or lump at or near the site of a previous surgical incision. This protrusion may become more noticeable when standing, coughing, or straining, and might recede when lying down.
Discomfort, aching, or localized pain directly at the incision site is common and tends to worsen with activity. A feeling of pressure or heaviness in the abdomen is also commonly reported. If the hernia involves bowel loops, digestive issues such as constipation, bloating, or a feeling of fullness can occur. Any sudden severe pain, redness, or fever in the area could indicate a complication like strangulation, which requires immediate medical attention.
Diagnosis and Treatment Approaches
Diagnosing an incisional hernia typically begins with a thorough physical examination. The provider will often inspect and palpate the abdominal area, asking the individual to cough or strain to make the bulge more apparent. For smaller or less obvious hernias, imaging tests like ultrasound, CT scans, or MRI may be used to confirm the diagnosis and assess characteristics.
Treatment depends on the hernia’s size, symptoms, and potential for complications. For very small hernias causing no discomfort, watchful waiting might be recommended. Lifestyle adjustments are often advised, such as managing weight, avoiding heavy lifting, and addressing chronic cough or constipation to prevent worsening.
Surgical repair is frequently the definitive treatment, especially if the hernia is causing pain, growing larger, or leading to complications. Common surgical techniques include open repair, where an incision is made to push the tissue back and close the opening. Laparoscopic or robotic-assisted repair involves smaller incisions and specialized instruments. A surgical mesh is often used to strengthen the weakened abdominal wall and reduce recurrence. Successful repair can resolve associated back pain by restoring abdominal wall integrity and alleviating pressure on nerves and muscles.