A new bulge underneath or beside an abdominal scar can be a sign of an incisional hernia. This occurs when the deeper layers of a previous surgical wound do not remain fully closed and tissue pushes through the weakened area. The change may appear months or years after surgery and can range from a small, soft swelling to a larger bulge that affects comfort, movement and abdominal shape.
Common symptoms
The bulge may become more prominent when you stand, cough, lift or strain and may flatten when you lie down. Some incisional hernias cause aching, pulling, pressure or tenderness around the scar. Others are painless and noticed only through a change in contour. A large hernia may affect core function or make clothing uncomfortable. Symptoms alone cannot show the size or complexity of the underlying defect.
Why can this happen after surgery?
Any abdominal incision creates a temporary weakness while it heals. Wound infection, fluid collections, smoking, diabetes, obesity, poor nutrition and long-term steroid treatment can impair healing. Repeated pressure from coughing, constipation or heavy strain may also contribute. An incisional hernia can still develop without an obvious complication or risk factor.
Assessment and imaging
Your surgeon will review the original operation, wound-healing history and current symptoms. Examination helps determine whether the bulge is reducible and whether muscle separation is also present. CT imaging is often useful for larger, recurrent or complex problems because it maps the defect, abdominal muscles, scar tissue and any previous mesh. Ultrasound may be appropriate for a smaller or uncertain lump.
When is it urgent?
Seek urgent help for sudden severe pain, vomiting, abdominal swelling, fever or a firm lump that will not reduce. These may be signs of bowel obstruction or strangulation. A slowly enlarging or increasingly uncomfortable bulge should also be assessed, although it may not require emergency treatment.
What happens next?
Not every incisional hernia requires immediate surgery. Treatment depends on symptoms, size, progression and general health. When repair is appropriate, it may involve abdominal wall reconstruction and mesh reinforcement. Health factors may be optimised before surgery to reduce wound complications and recurrence.
Frequently asked questions
Can scar tissue itself cause a lump? Yes, but a new bulge that changes with coughing or standing should be assessed for an incisional hernia.
Can an incisional hernia appear years later? Yes. It may become noticeable long after the original operation.
Will a support garment repair the weakness? A garment may improve comfort but does not close the underlying defect.