Hernias in Women

Hernias can affect both men and women, but there are some differences in terms of anatomy and potential considerations for women, particularly in relation to pregnancy.

Anatomic Differences

While women and mens bodies are mostly similar there are some key differences. Inguinal hernias are the most common types of hernia overall, and they are greatly more common in men (8x). This is most likely due to the weakness due to the spermatic cord and its origin in men, which is absent in women. During development the testicle actually starts higher up in the abdomen and descends down through the inguinal canal. If this path does not totally close off, a hernia can develop. This does not happen in women. Women are more likely to get femoral hernias instead, likely due to the wide shape of their pelvis.

Rectus Diastasis

Women are also prone to getting abdominal wall and umbilical hernias later in life since pregnancy greatly increases intra-abdominal pressure, leading to hernia formation. During pregnancy the abdominal wall also softens from hormonal changes, allowing for the belly to expand to carry a child. This typically resolves and the abdominal wall goes back to normal after 6 months, however a rectus diastasis, or separation of the rectus muscles (6-pack muscles or abs), may still be present.

Rectus diastasis and associated hernias in women can cause a number of symptoms including:

  • Pain and discomfort

  • Abdominal bulging

  • Back pain

  • Abdominal and core weakness

  • Bloating, indigestion

Types of Hernias in Women

Women can have several different types of abdominal wall and groin hernias.

  1. Inguinal Hernia

  2. Femoral Hernia (More common in women)

  3. Umbilical Hernia (More common in pregnancy)

  4. Epigastric Hernia (More common in thin women)

  5. Pelvic, Obturator and Perineal Hernias (Common after pregnancy, due to weakness in pelvic floor muscles)

Symptoms of Hernias in Women

Most often hernias do not have symptoms and present as a bulge. Other symptoms to watch out for include:

  • Pain, discomfort or a burning sensation in the area of the hernia, groin or pelvis (Sometimes pelvic pain without an obvious source may indicate a hernia)

  • Indigestion

  • Swelling

  • Muscle weakness

  • Back pain (can be a sign of an abdominal wall hernia or diastasis)

Difficulties in Women

There are many difficulties in both diagnosis and treatment of hernias and diastasis in women.

Due to the fact that gynecologic problems occur in the area of the most common hernias, hernias are often misdiagnosed in women. There are several other problems that can cause pain in the pelvis including:

  • Endometriosis

  • Ovarian Cysts

  • Organ prolapse

Some of the more rare hernias such as femoral and obturator hernias are more common in women and due to the fact that the contents can get stuck more easily, should be fixed expeditiously.

The timing of surgeries in women is also hotly contested. Abdominal wall hernias (hernias not in the groin or pelvis) should ideally be repaired after childbearing to avoid any mesh interaction with a growing uterus. However for larger hernias, it is beneficial to fix prior to getting pregnant as large hernias may complicate pregnancy.

Hernias in Women FAQ

Below are some of the most common questions we get in regards to hernias in females

Do I need mesh for my hernia repair?

  • Smaller umbilical hernias, epigastric hernias and inguinal hernias may be repaired without mesh. For larger hernias, or any hernia repair involving reconstruction of the abdominal muscles, mesh may be needed to support the repair and prevent recurrence.

When should I get hernia surgery?

  • If you have a small umbilical or epigastric hernia, or even a mild diastasis, you can get get surgery at any time. Otherwise more major hernias, if having minimal symptoms, should ideally be on hold until you are done having children. If you just recently had a child, it is recommended to try and wait at least 6 months to fix a hernia, as the abdominal wall should go back to its normal contour and elasticity by then.

Will fixing a hernia hurt my chances of having a kid in the future?

  • Having a hernia fixed should not hurt your chances of having a child in the future, however we recommend saving more elective surgeries involving mesh for after child-bearing, due to the theoretical restriction it may have.

If I have rectus diastasis and a small hernia, what are my options to fix it?

  • You have several options to fix these. The first option is to try physical therapy to close the diastasis and then have the hernia fixed. The next option is to fix both through an incision near your belly button. The last option is the traditional abdominoplasty, “tummy tuck” or “mommy makeover”. This entails a longer incision near your bikini line and involves fixing the diastasis, the hernia and removing any excess skin. This option is the most extensive, most painful, however may offer more cosmetic results in patients with excess skin.

Should I get any tests to diagnose a hernia?

  • For the most part, for small hernias, a good physical exam by a hernia surgeon is all you need

I just had a kid and my stomach is huge. I think I have rectus diastasis. Should I get it fixed?

  • Unless you are having symptoms such as core weakness, abdominal or back pain, or have severe limit to your mobility, you can safely leave the diastasis alone. Most commonly it presents as just a cosmetic problem. However, physical therapy at a pelvic floor or rectus diastasis specialist may help.