Can an incisional hernia develop months or years after surgery?

Incisional hernias can appear weeks after surgery or develop months to years later as the fascial repair progressively weakens under repeated intra-abdominal pressure. The risk of incisional hernia formation is highest in the first year after surgery but hernias can appear at any point after an abdominal operation.

Can an incisional hernia go away on its own?

No incisional hernias do not heal spontaneously. The fascial defect that allows abdominal contents to push through does not close without surgical repair. Without treatment, the hernia typically enlarges over time.

Can an incisional hernia get bigger over time?

Incisional hernias almost always enlarge progressively as the fascial defect widens under repeated mechanical stress from intra-abdominal pressure. Activities that raise intra-abdominal pressure (heavy lifting, chronic coughing, constipation) accelerate this enlargement. Delaying repair allows the hernia to grow, making eventual surgery more technically complex and increasing the risk of complications.

Is it safe to exercise with an incisional hernia?

Light activity such as walking is generally safe and does not worsen most incisional hernias. Heavy lifting, sit-ups and exercises that significantly increase intra-abdominal pressure should be avoided, as they can enlarge the hernia and increase the risk of incarceration.

Can coughing or sneezing make an incisional hernia worse?

Yes coughing and sneezing cause sudden, sharp rises in intra-abdominal pressure that push the hernia contents through the fascial defect. Repeated coughing, particularly from a chronic respiratory condition, is associated with hernia enlargement.

Can an incisional hernia come back after surgery?

Yes hernia recurrence after repair is a recognised complication. Recurrence rates are lowest with mesh-based repairs and higher with non-mesh primary repairs and higher still in patients with persistent risk factors such as obesity, uncontrolled diabetes, or ongoing smoking.

How long does it take to recover from incisional hernia repair?

Recovery depends on the type of repair. After open mesh repair, most patients return to light activity within two to three weeks and normal activity within four to six weeks. After laparoscopic repair, recovery is typically faster, with return to light activity within one to two weeks. Heavy lifting and strenuous activity should be avoided for at least six weeks after open repair and four weeks after laparoscopic repair.

Can I live normally with an incisional hernia without surgery?

Many patients with small, reducible and minimally symptomatic incisional hernias do live with them for extended periods without surgery, particularly if they are elderly or have medical conditions that make surgery high risk.

What activities should I avoid if I have an incisional hernia?

Avoid heavy lifting (anything heavier than five to ten kilograms), straining at stool (address constipation with dietary fibre and hydration), vigorous exercises that raise intra-abdominal pressure (such as sit-ups, crunches, and heavy weight training) and activities that cause pain or visible enlargement of the hernia. Lying flat and resting usually reduces the hernia temporarily, confirming it is reducible.

How can I reduce the risk of an incisional hernia after surgery?

Before planned surgery: lose weight if obese, control blood sugar if diabetic, stop smoking for at least four weeks. After surgery: avoid heavy lifting and straining for the full period advised by your surgeon (typically four to six weeks), prevent and treat constipation, follow wound care instructions carefully and report any signs of wound infection (redness, swelling, discharge, fever) to your surgical team immediately so that treatment can begin before wound breakdown occurs.

Incisional Hernia: Symptoms, Causes, Treatment and Prevention

Medically Reviewed By Dr. Bharat Sangal, FIAGES, MCH- Surgical Gastroenterology, DNB- General Surgery, MBBS, Consultant - Gastrosciences

Updated on: Sep 18, 2026
Published on: Sep 18, 2026

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An incisional hernia is one of the most common complications of abdominal surgery. A bulge near a surgical scar that appears weeks, months or even years after an operation is the hallmark of this condition. It arises because the abdominal wall at the site of the incision has failed to heal fully or has weakened over time. Understanding the symptoms, risk factors, complications of leaving one untreated and treatment options.

What Is an Incisional Hernia

A hernia occurs when an internal organ or tissue pushes through a weakness or gap in the muscle wall that normally contains it. An incisional hernia specifically occurs at the site of a previous surgical incision in the abdominal wall.

If the abdominal wall repair does not heal fully or weakens over time, a gap develops in the fascial layer. Abdominal contents, most commonly a loop of intestine or fatty tissue (omentum), then push through this gap, creating a visible bulge just beneath the skin.

Incisional hernias are a subtype of ventral hernia. They can occur after any abdominal or pelvic surgery, whether the original incision was large (open surgery) or small (laparoscopic surgery, where hernias at port sites are called trocar site hernias).

Symptoms of an Incisional Hernia

Common symptoms are:

Visible bulge near the surgical scar: Typically soft, rounded and located directly at or adjacent to the surgical scar
Aching or dragging discomfort: A dull ache or heaviness at the hernia site particularly after prolonged standing or physical activity
Intermittent pain: Some patients experience sharper pain at the hernia site when a loop of intestine is temporarily trapped
Nausea, vomiting or inability to pass gas or stools: These occur when a loop of intestine is trapped inside the hernia sac and its blood supply or passage is compromised
Skin changes over the hernia: In large or long-standing hernias, the overlying skin may become stretched, thin and shiny. Redness, warmth, or tenderness in a previously comfortable hernia may indicate strangulation and requires urgent evaluation.

Why It Happens After Surgery: Causes & Risk Factors

An incisional hernia forms when the abdominal wall fails to heal fully after surgery. Several factors can contribute to this.

Wound infection: Surgical site infection is one of the strongest risk factors for incisional hernia formation, disrupting the healing process and significantly weakening the fascial repair.
Increased intra-abdominal pressure: Persistent coughing, constipation, heavy lifting, obesity and pregnancy place repeated mechanical stress on the fascial repair before it has fully healed.
Suture-related factors: The suture material, technique and surgeon experience in closing the abdominal wall all influence fascial repair strength. The small-bite continuous suture technique produces lower rates of incisional hernia than other closure methods.
Patient nutritional status: Patients who are malnourished, anaemic or have low serum albumin at the time of surgery have impaired wound healing. I

Who Is at Higher Risk

Certain groups of people have a higher risk of incisional hernia. They are:

Obese individuals: Excess abdominal fat increases intra-abdominal pressure, places higher mechanical tension on the fascial repair, and is associated with increased rates of wound infection and poor wound healing.
Patients with diabetes: Diabetic patients have significantly higher rates of both wound infection and incisional hernia.
Patients who had post-operative wound complications: Any wound complication after the original surgery including haematoma, seroma, wound infection or dehiscence, substantially increases the risk of subsequent incisional hernia.
Patients undergoing emergency abdominal surgery: Emergency operations, often with a contaminated surgical field, carry a higher risk of wound complications and subsequent hernia than elective (planned) operations.

Reducible vs Irreducible Hernias

A reducible hernia is one whose contents can be pushed back into the abdomen when lying flat or with gentle pressure. Reducible hernias cause discomfort and a visible bulge but are not immediately dangerous, though they carry the risk of becoming irreducible as the hernia enlarges.

An irreducible (incarcerated) hernia is one whose contents cannot be pushed back into the abdomen. When the blood supply to the trapped intestinal loop is cut off, the hernia is strangulated. Strangulation is a surgical emergency.

Complications If Left Untreated

If left untreated an incisional hernia carries some complications. They are:

Progressive enlargement that increases the risk of strangulation
Pain may worsen during coughing, lifting or prolonged standing
Bowel obstruction causing severe abdominal pain, vomiting, bloating and constipation
Large incisional hernias cause chronic pain, physical limitation and inability to perform physical work.

Diagnosis: How Doctors Confirm an Incisional Hernia

An incisional hernia can usually be diagnosed clinically by a surgeon through history and physical examination. The surgeon examines the patient both lying and standing and asks the patient to cough or strain to make the hernia more visible. They also assess size of the fascial defect, the hernia sac and whether the hernia is reducible. Investigations are:

Ultrasound: It confirms the hernia, identifies the fascial defect and determines whether abdominal contents are present within the hernia sac
CT scan of the abdomen: For large or complex incisional hernias a CT scan provides precise mapping of the hernia's size, the fascial defect and any loss of domain.

Treatment and Repair Options

Surgery is the only definitive treatment for an incisional hernia. The goal is to repair the fascial defect and restore abdominal wall integrity. Non-operative management with an abdominal binder is used only as a temporary measure in patients who are not fit for surgery.

Open mesh repair: The most commonly performed incisional hernia repair in India. The hernia sac is opened, the herniated contents are returned to the abdomen and a synthetic mesh is placed to reinforce the fascial repair.
Laparoscopic (keyhole) mesh repair: Performed through small incisions using a camera and instruments, with the mesh placed inside the abdomen against the abdominal wall. Laparoscopic repair is associated with lower wound complication rates and faster recovery than open repair.

Conclusion: Recovery and Prevention Tips

After surgical repair, most patients recover well. Avoiding heavy lifting and strenuous activity for four to six weeks after open repair (two to four weeks after laparoscopic repair) allows the mesh and fascial repair to consolidate.

Prevention involves: optimal control of diabetes and blood pressure before planned surgery, weight loss in obese patients before elective operations, smoking cessation for at least four weeks before surgery, use of the small-bite closure technique by the surgical team, prevention and prompt treatment of wound infections, and avoiding heavy lifting during the post-operative healing period. Patients should report any new bulge near a surgical scar to their surgeon promptly rather than waiting to see whether it resolves.

FAQs

Can an incisional hernia develop months or years after surgery?
Incisional hernias can appear weeks after surgery or develop months to years later as the fascial repair progressively weakens under repeated intra-abdominal pressure. The risk of incisional hernia formation is highest in the first year after surgery but hernias can appear at any point after an abdominal operation.
Can an incisional hernia go away on its own?
No incisional hernias do not heal spontaneously. The fascial defect that allows abdominal contents to push through does not close without surgical repair. Without treatment, the hernia typically enlarges over time.
Can an incisional hernia get bigger over time?
Incisional hernias almost always enlarge progressively as the fascial defect widens under repeated mechanical stress from intra-abdominal pressure. Activities that raise intra-abdominal pressure (heavy lifting, chronic coughing, constipation) accelerate this enlargement. Delaying repair allows the hernia to grow, making eventual surgery more technically complex and increasing the risk of complications.
Is it safe to exercise with an incisional hernia?
Light activity such as walking is generally safe and does not worsen most incisional hernias. Heavy lifting, sit-ups and exercises that significantly increase intra-abdominal pressure should be avoided, as they can enlarge the hernia and increase the risk of incarceration.
Can coughing or sneezing make an incisional hernia worse?
Yes coughing and sneezing cause sudden, sharp rises in intra-abdominal pressure that push the hernia contents through the fascial defect. Repeated coughing, particularly from a chronic respiratory condition, is associated with hernia enlargement.
Can an incisional hernia come back after surgery?
Yes hernia recurrence after repair is a recognised complication. Recurrence rates are lowest with mesh-based repairs and higher with non-mesh primary repairs and higher still in patients with persistent risk factors such as obesity, uncontrolled diabetes, or ongoing smoking.
How long does it take to recover from incisional hernia repair?
Recovery depends on the type of repair. After open mesh repair, most patients return to light activity within two to three weeks and normal activity within four to six weeks. After laparoscopic repair, recovery is typically faster, with return to light activity within one to two weeks. Heavy lifting and strenuous activity should be avoided for at least six weeks after open repair and four weeks after laparoscopic repair.
Can I live normally with an incisional hernia without surgery?
Many patients with small, reducible and minimally symptomatic incisional hernias do live with them for extended periods without surgery, particularly if they are elderly or have medical conditions that make surgery high risk.
What activities should I avoid if I have an incisional hernia?
Avoid heavy lifting (anything heavier than five to ten kilograms), straining at stool (address constipation with dietary fibre and hydration), vigorous exercises that raise intra-abdominal pressure (such as sit-ups, crunches, and heavy weight training) and activities that cause pain or visible enlargement of the hernia. Lying flat and resting usually reduces the hernia temporarily, confirming it is reducible.
How can I reduce the risk of an incisional hernia after surgery?
Before planned surgery: lose weight if obese, control blood sugar if diabetic, stop smoking for at least four weeks.
After surgery: avoid heavy lifting and straining for the full period advised by your surgeon (typically four to six weeks), prevent and treat constipation, follow wound care instructions carefully and report any signs of wound infection (redness, swelling, discharge, fever) to your surgical team immediately so that treatment can begin before wound breakdown occurs.

References

1. Bosanquet DC, Ansell J, Abdelbar S, et al. Systematic review and meta-regression of factors affecting midline incisional hernia rates: analysis of 14,618 patients. PLoS One. 2015;10(9):e0138745. https://doi.org/10.1371/journal.pone.0138745

2. Muysoms FE, Antoniou SA, Bury K, et al. European Hernia Society guidelines on the closure of abdominal wall incisions. Hernia. 2015;19(1):1–24. https://doi.org/10.1007/s10029-014-1342-5

3. Liang MK, Holihan JL, Itani K, et al. Ventral hernia management: expert consensus guided by systematic review. Ann Surg. 2017;265(1):80–9. https://doi.org/10.1097/SLA.0000000000001701

4. Poulose BK, Shelton J, Phillips S, et al. Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia. 2012;16(2):179–83. https://doi.org/10.1007/s10029-011-0879-9

5. Deerenberg EB, Harlaar JJ, Steyerberg EW, et al. Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised controlled trial. Lancet. 2015;386(10000):1254–60. https://doi.org/10.1016/S0140-6736(15)60459-7