A hernia occurs when an organ or tissue pushes through a weak spot in the muscle or connective tissue, creating a visible bulge. For women planning a family, common types include umbilical (around the navel), inguinal (in the groin), and incisional (at a prior surgical scar). Deciding whether to repair an existing hernia before conception is complex and hinges on its symptoms and characteristics. The recommended course of action depends entirely on the hernia’s specific characteristics, such as its size and the symptoms it causes.
How Pregnancy Affects Existing Hernias
Pregnancy initiates physiological changes that affect an existing hernia. The primary cause of increased symptoms is the gradual rise in intra-abdominal pressure as the uterus expands. This continuous pressure pushes against the weakened abdominal wall, causing the hernia sac to become more prominent and noticeable.
Hormonal shifts, such as increased relaxin production, soften connective tissues throughout the body. This softening further weakens the abdominal wall and fascia, potentially leading to hernia enlargement. As the hernia enlarges and muscles stretch, women often experience increased localized pain, discomfort, and pressure. These symptoms impact comfort and quality of life throughout the pregnancy.
Acute Risks of Hernias During Gestation
The primary concern with an unrepaired hernia during pregnancy is the risk of an acute, dangerous complication requiring emergency surgery. The most serious risks are incarceration and strangulation, which occur when the protruding tissue becomes trapped. Incarceration means the tissue cannot be pushed back into the abdominal cavity, often causing severe pain and potential bowel obstruction.
If the trapped tissue’s blood supply is cut off, the condition progresses to strangulation. This is a life-threatening medical emergency that can cause tissue death (necrosis), leading to perforation and sepsis, posing a high risk to both mother and fetus. Many umbilical hernia repairs performed during pregnancy address these acute complications, highlighting the risk of watchful waiting.
Emergency surgery during pregnancy carries increased risks, including complications from anesthesia and the possibility of inducing premature labor. Although necessary to save the mother’s life, the urgency makes the procedure less controlled and more hazardous than an elective repair. This potential for a sudden, high-risk scenario supports considering pre-pregnancy elective repair, especially for hernias deemed high risk.
Planning and Recovery for Pre-Pregnancy Repair
If an elective repair is chosen before conception, careful planning is necessary to ensure the best outcome. Repair can be performed using open surgery (a single incision) or a minimally invasive laparoscopic approach. Surgical mesh is often utilized to reinforce the weakened muscle layer, as it offers a lower rate of recurrence compared to using only sutures, especially given the stress of pregnancy.
A mandatory recovery period must be completed before attempting pregnancy. Surgeons typically advise waiting at least three to six months between the procedure and conception. This waiting period allows the surgical site to heal completely, the mesh to fully integrate, and the abdominal wall to regain strength.
Some experts recommend waiting up to a full year to allow for hormonal stabilization and for the patient to return to a baseline body weight, maximizing the repair’s durability. Attempting pregnancy too soon, particularly if mesh was used, may increase the risk of recurrence as the abdomen stretches. Even with mesh, the repaired area may cause pain or discomfort during the final months of pregnancy due to the restricted flexibility of the reinforced abdominal wall.
Making the Decision Based on Hernia Type and Severity
The decision to fix a hernia before pregnancy requires consultation with both a surgeon and an obstetrician-gynecologist. Large hernias or those causing significant pain and discomfort are strong candidates for pre-pregnancy repair, even if they have not yet incarcerated. Any hernia with a prior history of becoming incarcerated should be repaired electively beforehand to mitigate the risk of severe recurrence during gestation.
Conversely, small, asymptomatic umbilical hernias may be safely monitored throughout pregnancy. In these cases, a “watchful waiting” approach is common, with repair postponed until after delivery or after the woman has completed her family. A symptomatic hernia that significantly affects a woman’s daily life should be repaired before conception.