Stephanie Kewin has always been a serious athlete: She played competitive basketball through her teenage years and into university; she’s run too many races to count; and as an adult, she’s competed in weight-lifting and CrossFit competitions.
But after the birth of her first son, Van, in 2014, an uncomfortable umbilical hernia—part of intestine popping through the abdominal wall— forced some physical restrictions on the then 30-year-old.
“Not long after Van was born, I started to notice a bulge above my belly button. I had already been diagnosed with pretty severe diastasis recti, which is the separation of the abdominal muscles caused by childbirth, and this bulge—which wasn’t really painful as much as it felt super weird—got caught between my ab muscles all the time. I’d have to shift around to pop it back where it belonged,” says Kewin. Believe it or not, this frightening anatomical oddity isn’t an unusual condition, especially during pregnancy.
Because a woman’s muscles and tendons become more elastic and are required to stretch, the pressure of the growing baby can lead to a hernia. (Other, non-gestational causes include heavy lifting, fluid or increased pressure in the abdomen, excess weight, coughing or sneezing or straining while using the bathroom.)
“Umbilical hernias don’t often cause much of an issue,” says Magali Robert, a urogynecologist in Calgary with the Foothills Medical Centre, Alberta Health Services. In fact, not many umbilical hernias even need to be repaired; they are considered a relatively common part of pregnancy, according to Robert, and are only a problem if they are severe or cause pain. Robert even explained that when a woman’s belly button pops out during gestation, that’s actually considered a hernia; it’s usually an unsightly but non-dangerous, self-resolving situation, post-delivery.
Robert says there is a higher risk factor of umbilical hernias when looking at pregnancy of multiples, obesity, prior pregnancy with long labour and previously repaired hernias.
But some pregnancy-related hernias, like inguinal hernias, aren’t as normal. An inguinal hernia is also characterized by a bulge—a protrusion of the intestine through a weak spot in the abdominal wall—but it occurs in the area of the pubic bone; they are often accompanied by aching, pressure or a dragging sensation in the groin. Inguinal hernias can also be pushed back into place, as Kewin did with her umbilical hernia, but there is a higher likelihood that an inguinal hernia will cause symptoms.
“The strange thing is, the bigger the hernia, the safer it is,” says Robert. “Bigger hernias slide in and out, and while they can be uncomfortable, they aren’t dangerous, per se.” But if patients experience nausea, vomiting, fever, intense or sudden pain, a discolouration of the bulge, immobility of the bulge, or an inability to pass gas or move their bowels, it should be treated as an emergency situation. These are symptoms of an incarcerated hernia, which means a piece of the intestine is trapped and has lost its blood supply, and can be life-threatening.
Unfortunately, there’s very little that can be done to prevent umbilical or inguinal hernias. “Extra external support during pushing might help,” says Robert. (There are maternity band products on the market for this purpose, for use during pregnancy, delivery and in the postpartum weeks, designed to support the mama-to-be’s abdominal wall and muscles. There are also trainers who specialize in pre- and post-natal exercise, and pelvic floor physiotherapists, who may help with building core strength while your baby’s still cooking and in the postpartum recovery period.) Ultimately, though, it’s difficult to pinpoint the area of weakness in the abdomen, which means it would be nearly impossible to prevent.
But Robert says that’s no reason to worry. If you notice a hernia during your pregnancy or after delivery, make your doctor aware. “The physician will determine whether treatment is necessary based on how much it bothers the woman, and whether the woman is planning to have more children.” (The fix—which involves closing up the layers of the abdominal wall, sometimes with surgical mesh—can be affected by another pregnancy, and a second repair is unlikely to be as effective.)
For Kewin, her hernia meant being wary of activities that would exacerbate the issue—especially heavy lifting in her exercise routine—which is the recommended course of action for any woman diagnosed with a prenatal or postpartum hernia. “I still worked out, but I had to be careful with my routines. I knew if the hernia ever got caught and couldn’t be popped back into place, it could be a serious problem.”
But after Kewin and husband Darren welcomed their second son, Gunnar, she had emergency surgery to repair another, unrelated, genetic hernia, and doctors were able to repair her umbilical hernia at the same time: “I saw it as the silver lining,” she says, with a laugh.
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