Instructions After Hernia Surgery

Your Incision(s)

You may notice pain, swelling, and/or bruising at your incision (where the surgeon cut your skin to perform surgery) and/or at the spot where your hernia used to be. The swelling and bruising may begin 1-4 days after surgery, and will typically go away within 2 weeks after surgery. Ice for the first 48 hours after surgery can help to reduce this.

Below are more detailed instructions, based on the type of surgery you underwent:

After Open (not Laparoscopic) Inguinal (Groin) Hernia Repair

You may have dark purple bruises at your groin, penis, scrotum, and/or upper thigh. Do not be alarmed. This is just body fluid resulting from your hernia repair that is being pulled down by gravity toward these organs. The dark color is usually noticeable 3-5 days after surgery and goes away within 2 weeks. No treatment is necessary.

You may have swelling of your groin or scrotum. At your incision in the groin, you may notice a “healing ridge”, which is a line of firm scar tissue under your incision. This is normal and will take over 6 weeks to soften. The scrotum may feel heavy and full of fluid. This is usually seen if you had a large noticeable hernia prior to surgery. This swelling is fluid that is now filling the empty space that your hernia used to take up. It will go away within 2 weeks. Wearing support underwear such as briefs, as opposed to boxers, may help. Bicycle shorts may also be helpful. When sitting, you can also try propping up the scrotum with a small towel. Lifting the scrotum encourages the fluid to drain back toward your heart.

The bruising and swelling does not affect sexual function.

You may have dark reddish-purple “bruises” at your groin and labia, toward your vagina. Do not be alarmed. This is just body fluid resulting from your hernia repair that is pulled down by gravity toward these organs. The dark color is usually noticeable 3-5 days after surgery and goes away within 2 weeks. No treatment is necessary. At your incision in the groin, you may notice a “healing ridge”, which is a line of firm scar tissue under your incision. This is normal and will take over 6 weeks to soften. Your groin area will then resume normal sensation.

After Laparoscopic Inguinal (Groin) Hernia Repair

Most pain is at the belly button (umbilicus), at the site of an incision through the tissues.

You may have dark purple “bruises” at your groin, penis, scrotum. Do not be alarmed. This is just body fluid from your hernia repair that is being pulled down by gravity toward these organs. The dark color is usually noticeable 3-5 days after surgery and goes away within 2 weeks. No treatment is necessary.

You may have swelling of your groin or scrotum. The scrotum may feel heavy and full of fluid. This is usually seen if you had a large noticeable hernia prior to surgery. This swelling is fluid that is now filling the empty space that your hernia used to take up. It will go away within 2 weeks. Wearing support underwear such as briefs, as opposed to boxers, may help. Bicycle shorts may also be helpful. When sitting, you can also try propping up the scrotum with a small towel. Lifting the scrotum encourages the fluid to drain back toward your heart.

The bruising and swelling does not affect sexual function.

Most pain is at the belly button (umbilicus) where you had a cut through the tissues.

You may have dark reddish-purple “bruises” at your groin and labia, toward your vagina. Do not be alarmed. This is just body fluid from your hernia repair that is pulled down by gravity toward these organs. The dark color is usually noticeable 3-5 days after surgery and goes away within 2 weeks. No treatment is necessary.

After Umbilical, Epigastric, Abdominal Hernia Repair

You may have bruising and/or swelling at the area(s) of your incision. This is expected and usually resolves on its own.

There may be blood staining of your dressing or wound strips. This is blood left over from the surgery. No treatment is necessary.

Incisional pain is expected after surgery. Every patient may experience a different level of pain sensation. In general, most patients have acute pain that requires pain control for 1-3 days after surgery. Some require pain control for 1-2 weeks after surgery. Normal recovery involves a daily improvement in pain.

Ice is the best form of first-line pain control. Use ice packs directly on your incision, or in the area of your original hernia, starting immediately after surgery. Place the ice on for 20 minutes, and off for 40 minutes, while awake. The greatest benefit is in the first 48 hours after surgery.

If you require pain control in addition to ice, the following over-the-counter medications may be taken as second-line therapy, in addition to the ice:

  • Naproxen (Aleve, Naprosyn). Over-the-counter pills are 200 to 220mg each. Take 2 pills no more than every 6 hours as needed for pain. Take with food and/or antacids to prevent stomach irritation. You may get a prescription for naproxen 500mg. Take only 1 pill up to 3 times a day. For some patients, Naproxen may not be recommended due to its side effects.
  • Acetaminophen (Tylenol). Over-the-counter pills are 325 to 500mg each. Take 1 to 2 pills no more than every 8 hours as needed for pain. These may be taken in combination with the naproxen.
  • Homeopathic anti-inflammatories. We like to start these before surgery in order to reduce pain, swelling, and bruising. The regimen will be provided during your consultation visit.

You may also be given a prescription-strength pain medication by your surgeon. This medication should be used sparingly and only if your pain is not adequately controlled with ice and naproxen (Aleve, Naprosyn). Follow the instructions on the prescription for dosage.

The best therapy is combining the prescription medication with naproxen (Aleve, Naprosyn), as outlined above. Do NOT take the prescription medication together with acetaminophen (Tylenol).

For the first 48 hours after surgery

  • Keep the wound dry.
  • After 48 hours, remove the clear dressing and gauze from your wound and allow your skin to be open to air. Keep the thin strip of tape (Steri-strip) on your incision, as your wound will heal and look better with this in place. The strip typically peels off on its own within 2 weeks.
  • You may shower after taking off the dressing.
  • You may begin driving after 48 hours and whenever your are no longer taking a prescription medication for pain control.

For the first 2 weeks after surgery

  • Be active. Walking, non-extreme exercises, and normal daily activities are highly encouraged. These may include shopping, stairs, treadmill, sexual activity, and house work. This will speed up the healing process, decrease the chance of lung problems and prevent complications such as blood clots in the legs.

After the first 2 weeks after surgery

  • You may resume all activities, without restriction.
  • For gym-type exercises, make sure you work your core muscles (stomach, mid-to-lower back, and hips).
  • If your job involves routine heavy lifting, ask your surgeon for further instruction. You may be encouraged to delay lifting heavy objects until 6 weeks after surgery.
  • If you had inguinal (groin) hernia surgery, begin hip extension stretching exercises for 1 month. This will help reduce scarring and improve the range of motion in the hip area.
  • If you are provided with an abdominal binder to wear (usually for larger abdominal hernia repairs only), please wear it for 2 months when out of bed. This helps reduce tension on the hernia repair, reduce pain, reduce swelling, and make your incision look better. In some instances, you may be instructed to wear the binder for a longer period of time.
  • You can return to work when you feel comfortable that you can perform your job safely and at the level you and your employer expect. Please discuss this with your surgeon prior to surgery and during your office visit after surgery.

These are general common instructions we use. Follow what Dr. Towfigh says, which may vary depending on your individual situati0n.

Resume your usual diet. We generally recommend a high fiber diet to prevent constipation and high protein diet to promote healing. You should also increase your fluid intake to 8 glasses a day.

Constipation is the most common problem after hernia surgery. It is also a major cause of hernia occurrence, because straining to have a bowel movement can place tension on the abdominal muscles as well as on the hernia repair.

We encourage very aggressive prevention of constipation for all patients. The following is a list of regimens, all over-the-counter, which may be combined as needed to prevent constipation and straining after hernia surgery:

  • Drinking 8 glasses of fluid per day
  • High fiber diet (high fiber cereals, vegetables, beans, fruits). For a list of high fiber foods, go to www.about.com.
  • Fiber supplementation (Miralax, Senokot, Metamucil, Benefiber, fiber tablets, fiber powders, fiber crackers). Take these 1 to 3 times a day.
  • Milk of magnesia. Take a tablespoon 3 times a day.
  • Mineral oil. Take a tablespoon 2-3 times a day.
  • Magnesium malate. Take a tablespoon 1 to 3 times a day.
  • Stool softeners (Colace, Dulcolax, docusate, sorbitol) do not usually work. Take as directed on bottle.

If you had a urinary catheter (tube inserted into your bladder to allow urine to drain) in you during surgery, you may experience burning after your first urination. This should go away after the first couple of times urinating.

If you have prostate problems, it is possible that you may have difficulty urinating after surgery, especially after an inguinal (groin) procedure. It is important that you urinate within 6 hours of your surgery end time. If you do not empty your bladder normally or feel extra stretching of your bladder, you must seek emergency medical attention. This may involve placement of a urinary catheter to empty your bladder.

When to call after surgery

  • Pain that is not relieved by medication.
  • Nausea for longer than 1 hour
  • Vomiting
  • Fever greater than 101°F
  • Redness, warmth, and worsening pain at the incisions
  • Purulent (pus) drainage from any incision
  • Difficulty urinating or burning when you urinate
  • Watery diarrhea, more than 3 times a day

To speak to the On-Call Physician, please call: (310) 358-5020