Q: I am a 34 years old woman who had a second c-section one and a half years ago similar to the earlier one (belly button to pubic bone). I had intermittent abnormal bleeding for 13 weeks with passage of large lemon size clots every time. The doctor said it was due to hormones and put me on pill, which did not stop it. I consulted another doctor who admitted me to the hospital and gave me medication, which finally resolved it. Shortly after that my stomach started to distend. I consulted my family doctor and he informed me I had a hernia. So I consulted a surgeon and he told me that my entire incision was open from inside and my hernia was the length of the incision. During surgery he found so much damaged tissue that he didn’t know if the correction would hold after removal of so much tissue. He gave me a 50/50 chance that it would hold and told me that it might be difficult to have any other surgery in that area for fear that they might not have enough tissue to close. What would have caused this? I am not an obese person, my weight is 155 pounds and height is 5.7 feet. I was very careful after my c-section due to the bleeding not to exert myself at all. I am still having trouble with this like ripping and burning sensations even a year after the correction. Please suggest.

A:Incisional hernias are relatively common after caesarean sections. The reason is that the lower half of the abdominal wall, below the umbilicus, is inherently weaker than the upper: one layer of tissue is missing. Surgeries performed in the lower abdomen more often progress to hernia. Surgery for an incisional hernia is usually carried out by placing a mesh to cover the hernia hole. The mesh is made of polypropylene. The recurrence rate is about 5% or less if a mesh is used, and is about 40% if no mesh is used. Your surgeon would probably have used a mesh. Your symptoms are likely to subside in a few more months. The dissection during surgery for incisional hernia is rather large, therefore pain-like symptoms continue for a long time.