Have you damaged your hernia repair?

Have you damaged your hernia mesh repair

A hernia occurs when the body’s natural containment of a structure fails, allowing the structure to bulge through the containment barrier. It’s typically associated with pain due to pressure on the failed/damaged section of the barrier.

Two of the most common sites for a hernia are Inguinal and Umbilical, both involving the abdominal wall.

And that’s where our surgical team comes to the rescue! The most common procedure for hernia repair involves inserting a mesh to reinforce the damaged area in the wall and strengthen the resistance to internal pressure.


POST-OP RECOVERY AND WHAT TO EXPECT

The surgery is fairly quick but the recovery can take longer than expected. You’ll need to tread carefully during the early weeks, when pain and aching will let you know you’ve pushed too hard, too soon.

For 95% of patients undergoing a hernia mesh repair you’re almost at full capacity again and ready to return to pre-surgical function after 6-12 weeks of gradual increases in loading. The remaining 5% is the expected complication rate for this surgery and will take longer to make a full recovery.

So far so good. But then, after the surgery is a distant memory, you start to feel that dreaded soreness again, especially on lifting or abdominal contraction. Have you damaged the surgery? Is it another hernia? What’s gone wrong?


MY HERNIA MESH AREA HURTS, WHAT HAVE I DONE?

Firstly, don’t panic. Serious complications, including damaging the old surgery, is still a rarity.

We need to consider a number of factors when assessing your risk of damage. So let’s go through the “have I damaged my hernia repair?” checklist.

THE CHECKLIST†

  1. How long ago did you have the surgery?
    • After the first six months, your risk of fresh structural damage is still elevated but the risk has reduced compared to your pre-op odds
    • After two years, it’s much harder to bother the surgical site and cause a tear
  2. Did it suddenly become painful during a high load task?
    • This isn’t about it getting sore after a day of lifting. This is picking up something or stretching the area and, BAM! You felt a sudden stabbing pain. It’ll often make you drop what you’re holding
    • Sudden acute pain during a task with abdominal loading may indicate a fresh tear, although it’s very unlikely to lead to another hernia
  3. Does it hurt to perform daily tasks?
    • Simple tasks like walking or climbing into a car become painful with damage to the surrounding soft tissue
    • If you’ve irritated the area without any damage, it’s a lot harder to bother and requires more extreme tasks like twisting into the back seat of the car
  4. Is there a sore spot to push on at the site of the repair?
    • There will usually be a localised soreness to touch if you’ve bothered the repaired area
    • Vice versa, no painful area on prodding may clear you of any irritation or damage to the surgical area
  5. What does the pain feel like?
    • If it’s a constant nasty pain, you may have torn something in the area
    • Pain that settles with rest but is easily stirred up and then stays sore for a long time could indicate either a tear or fresh herniation, although the latter is very rare after a mesh repair
    • An ache that flares up on loading, such as lifting or twisting, but settles to its resting level of soreness quickly is often a strain of the scar tissue that forms around the mesh

WHAT’S THE BEST TREATMENT APPROACH FOR A PAINFUL OR DAMAGED HERNIA REPAIR?

Now let’s look at the rehab options to get you moving again.

  1. The first step is about whether to get it checked out by your doctor
    • If you had a sudden onset with loading, if it’s within 6 months of surgery, if the pain is severe or it’s constant for more than 3-4 days, get it assessed properly to identify any potential damage
  2. Then we need to unload the area
    • This means avoiding any stretching, like overhead or twisting movements
    • Avoid lifting anything to substantial. Depending on the severity of the aggravation, you’ll need to reduce your lifting loads
    • This also includes straining on the toilet, so keep your hydration and fiber intake up
    • Simple rule – if it hurts, don’t do it!
  3. Avoid anti-inflammatory medication
    • This includes meds like Advil, Nurofen and Voltaren as they can mask the pain and worsen any bleed from a fresh tear

HOW DO I RELOAD THE AREA AFTER THE SYMPTOMS BEGIN TO EASE?

As it settles, you can begin to gradually reload the area. You’ll still need to reduce or avoid any stretching through the area. Start with slow movements and low resistance around neutral positions. You can steadily increase the loading in this sequence if it’s not causing any symptoms:

  1. Increase resistance (increased weight on bar or firmness of resistance band)
  2. Increase loading outside centre of mass (holding weight away from body)
  3. Add more range of motion (lifting through range or towards end range)
  4. Add speed (this is deliberately left until last as it generates huge amounts of intra-abdominal pressure)

HOW LONG WILL THE PAIN TAKE TO SETTLE?

Symptoms that persists at the same level, or the improvement is both minor and slow, discuss this with your treating health professional and consider seeing your doctor for scans after ~4 weeks.

If the pain isn’t improving and worsens with the return to mild loading, head to your doctor for a scan after two weeks.

Pain is severe and constant, or it affects your organ function (eg. Frequency of going to the toilet, etc), see your doctor immediately for scans.


THE TAKE HOME MESSAGE

Take home message: if you suspect your hernia mesh repair has been compromised, reduce your activities back to a level that didn’t cause pain and monitor it closely for improvement.


Special thanks to Kate N for inspiring this article by getting random injuries.

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