Recovery post hernia surgery
We highly recommend to our patients to download our post hernia surgery leaflet. Read this thoroughly to get the best results from your surgery. Patients can expect to feel alert and well within an hour of surgery, and to be walking out of hospital within 2 hours of their surgery. The side effects of local anaesthetic, compared with general, are minimal.
Following a general anaesthetic, with its mix of drugs, surgery trauma and opioid pain relief, patients often experience difficulty passing urine; a few will need catheterisation.
This is yet to happen using our local anaesthetic & sedation technique.
With no opioid or anaesthetic drugs, a local anaesthetic starts working before surgery begins and not only prevents pain but also alters the body’s physiological response to surgery.
Therefore, recovery is more comfortable, even after the local has worn off. It’s also typically the case that after a local, rather than a general, patients take fewer opioid painkillers, if any, thereby avoiding unpleasant side effects associated with opioids: headache, nausea, poor appetite, constipation and stomach pains.
Bruising post hernia surgery
Local anaesthetic repairs have a quick recovery time. The length of time you will need to take simple pain relief is influenced by the amount of bruising. Hernia surgery can cause a lot of superficial bruising and sometimes swelling too that often affects the scrotum and penis.
It looks alarming but don’t be alarmed. It will get better within 2 weeks. No matter how large the bruise, some simple pain relief and waiting up to a few weeks will fix it. Bruising is complicated.
There are a lot of factors that influence the extent of bruising, including: size and complexity of the hernia, how the hernia is repaired – open or keyhole, being overweight, medical conditions that affect bone marrow and tissue healing, regular blood-thinning medication, age and general frailty.
Wound closure
The skin edges are closed with a suture that is invisible under the skin, so there are no sutures to see – if you can feel an end it will disappear in a few weeks.
A surgical incision is a cut and it repairs like any other cut to your skin which you may have had in the past from either illness or accidents. Soon after surgery, they can feel sore, look a little red and raised at the edges (but dry) and itch. Later the skin edges can become a little dry and scabby as well as itchy.
This is normal and you should just follow the advice given here for wound care.
Wound dressings post surgery
You will have three layers of dressing. We advise to leave the wound alone and wait for it to heal by itself over time. It takes approximately 12 days for the skin edges to join securely.
Bottom layer:
The bottom layer (layer one) of butterfly sutures needs to stay on for 12 days.
Middle layer:
The middle layer (layer two) is a flat waterproof dressing. You can shower with it on and then pat it dry. It may last 12 days but you might need to change it once or twice. The fewer times it is changed the better as it reduces the risk of a minor wound infection.
Top layer:
The top layer (layer three) is a pair of hernia supports. We use these as a pressure dressing. They should apply firm pressure to the area around the wound to reduce bruising and swelling. Hernia supports are used as the best method of applying pressure to the wound. We recommend that you wear the hernia supports for a minimum of 48 hours.
The suture takes about 3 weeks to breakdown but the knot takes longer. Some notice the suture end pokes out around week 3, If that happens pulling it out will solve this and the wound will already be healed.
Removing dressings
At 12 days, you can remove all the dressings including small steri-strips and the wound should be healed: dry and clean. Simply washing it with a wet flannel at this stage will remove any lasting old clot. An alcohol wipe can remove any sticky residue from the dressing adhesive.
To help the scar heal as neatly as possible, start to apply a moisturizer (any that you would happily put on your face is fine) twice day. Rub firmly. After a few more days, rub to the point that it is slightly uncomfortable.
You may feel a lump in your scar
Post surgery there are varying amounts of inflammation and swelling. This can depend on the patient. In many, there is a period when the skin or tissue beneath the skin feels like a raised lump that is cigar or finger shaped. This is a normal variant of healing and flattens by 3 months.
It is not an indicator that anything is wrong and is not a recurrent hernia. The lump lasts up to 3 months and flattens. The area then feels firmer than the other side for further 6-9 months.
Please see our page on wound healing for further explanation of the stages of wound healing.
Improve Your Post Hernia Surgery Results
Below we provide advice on the importance of hernia supports, early mobility and returning to activity for better post-surgery results.
Returning to Activity and Wound Healing
Our patients help us by completing a clinical outcome survey. This helps us to continue to understand in detail what patients feel able to do during their recovery. Most of our patients reported* that they can go on a short walk within 1 week post surgery. They can drive and go for a longer walk within 2 weeks*. By 4 weeks* they are back to their normal activities and 8 weeks* able to lift a medium weight.
Research shows wounds have no strength in the first 2 weeks and have 50% strength at 4 weeks. It takes 6-8 weeks to get to about 80% of wound strength. The final wound does not get much stronger than this. The shape and colour of the wound alter as wound healing progresses through 4 phases lasting over 12 months.
What does this tell us about returning to activity?
It says be careful in the first 6-8 weeks as you can disrupt the wound healing by lifting too much. However, wounds also need movement and mechanical force to encourage deposition of collagen and to ‘show’ the body what direction the collagen fibres need to be laid down to provide a strong wound.
Wounds heal by laying down scar tissue and then remodelling that scar tissue between months 3-12 post surgery. The better organised the scar tissue, the more comfortable it becomes. Scars can attach to neighbouring planes of tissue making a scar look puckered and feel ‘caught’ when these planes are tethered by a scar.
Stretching and getting back to activity as quickly as comfort and wound strength permits is key to creating a comfortable and compliant wound.
So do not become still or scared of causing damage. Listen to your body. If it hurts do not do it yet. We also know that healing wounds need more oxygen and so tire more quickly. They will need rest as well as activity. The less they are worked hard, the longer they will last. Using the hernia supports we recommend provides support, so the operated area tires less quickly, allowing you to do more and be more active during your recovery. Taking part in our post operation rehab programme and returning to your normal activity as recommended is your chance to influence your outcome.
Read more details about “wound healing“.
Improve Results With: Hernia Supports
99% of our patients have said they would recommend hernia supports to those undergoing a hernia repair.*
After a minimum of 48 hours you can stop using the pressure supports at home. Many choose to wear these for longer as they can make mobilisation more comfortable in the first few days. In fact, 92% of our patients have said the hernia supports helped relieve discomfort.* We ask you wear them for 48 hours, but you can use them for longer if you choose to. This will leave the two dressing layers still in place.
For an inguinal hernia repair we always recommend you purchase a pair of firmly well-fitted hernia support briefs such as those produced by www.orthotix.co.uk.
For those having an inguinal hernia repair we ask that you bring these with you for your operation. This will be more comfortable and allow you to shower from the day of surgery. Wear them for a minimum of 48 hours.
Some patients report finding them more comfortable to move around in during the early recovery phase. You can wear them as long a time (min 48 hours) as you find them helpful.
Hernia supports also help to control hernia symptoms if you wear them while waiting for your operation. They come in a range of shapes. Each shape suits a different body shape.
To find out more about why hernia supports are helpful, Click Here!
Our rehab exercise programme
After day 2 increase your movement using our rehabilitation exercises guide videos and handout.
After your surgery, you will be given access to these. There are no limitations on returning to activity as long as you follow this rule: If it hurts (more than just being a bit uncomfortable) stop doing it and try again tomorrow.
For those wanting a more structured return to activity please do the above remembering to include some stretching exercises. Consider joining a yoga or pilates class to aid return to old levels of flexibility and core strength. The older you are the more this applies to you.
Your hernia supports can help with both this programme, and generally returning to activity. Over 93% of our patients have said that wearing their hernia support helped them feel more confident returning to activity.*
*Patients surveyed in our 2023/2024 Clinical Outcomes Survey
Improve Results With: Mobility and Returning to Day-to-day Activity Post Hernia Surgery
The other significant factor involved in recovery is mobility. For the first 48 hours just move around gently as clots stabilise during this time and are important to tissue healing, minimal bruising and scarring which is what makes the hernia repair successful.
Then early mobilisation after surgery is key – particularly with the older generation. Being still will only worsen stiffness and soreness making your recovery longer and more painful. Most people can walk a mile and carry a small bag of shopping within a week.
Returning to sport
Sport enthusiasts should return to exercise carefully 14 days after surgery. Read Mr Kirkby-Bott’s details about “wound healing” to help explain what how the body is repairing. It is best to try aerobic exercise, such as running, swimming and exercise classes first and for a smaller distance or duration than you usually managed. Build it up again as comfort allows.
Returning to cycling
Cycling can be uncomfortable for several weeks so it is not encouraged until it feels comfortable.
When can I fly post surgery?
Please see CAA guidelines here:
www.caa.co.uk/passengers-and-public/before-you-fly/am-i-fit-to-fly/health-information-for-passengers/passenger-health-faqs-am-i-fit-to-fly/
Returning to weight-lifting
Expect it to take between 4-6 weeks to lift weights in the gym. If lifting weights start with light weights that are comfortable and increase the number of repetitions before lifting heavy weights at a low repetition. At all times stay well hydrated to avoid any constipation.
DO NOT lift heavy objects for a minimum of 6-8 weeks post surgery as this can cause the hernia to return. Lift small objects initially building up the weight so you are never uncomfortable lifting.
Driving
For driving the DVLA states that you must be able to do an emergency stop. It is illegal to drive a car if you cannot do this. Some insurers have time limits in the small print of their contracts so it can be worth calling them to make sure you are covered to drive again. On average after hernia surgery expect not to drive for 10 days.
Washing
You can shower or wash at a basin from day one. To have a bath or swim the wound needs to be healed and dry (typically after 12 days).
In short, try and use common sense and follow the first rule stated above: If it hurts (more than just being a bit uncomfortable) stop doing it and try again tomorrow.
For more details about wound healing click to page “Wound healing” and read our detailed “Post Hernia Surgery Patient Advice Leaflet”
The best way to manage pain relief is to:
Take the simple pain medicines prescribed before any pain develops or becomes present enough to reduce your mobility or makes you feel unwell.
If you don’t actively try to control the pain, hernia surgery can be painful. If you do actively manage it then recovery from hernia surgery should be reasonably straightforward.
To maximise your post surgery comfort and recovery, we advise that before the anaesthetic wears off you start taking the paracetamol and ibuprofen prescribed to you on your discharge before leaving hospital.
Paracetamol
- Take two paracetamol capsules regularly four times a day.
- This medicine has few/no side effects and is safe in nearly everyone.
- Please discuss with us if you have been recommended in past not to use this drug.
Ibuprofen
- Take two ibuprofen capsules, regularly to start with, three times a day.
- Always take them with food.
- Some patients can experience problems with this medicine as it can cause stomach irritation and affect kidney function. However, taking it for 72 hours with food should be safe and it is a very effective painkiller, especially when taken with paracetamol.
Dihydrocodeine
- This is a powerful opioid painkiller with a long list of side effects. Only take it if needed.
- You can take it up to four times a day with the paracetamol and ibuprofen as instructed above.
- It can cause constipation, nausea, poor appetite, headaches, drowsiness and affect concentration.
- You should not operate machinery while taking this and you may need a laxative with it. We will send you home with one.
Altered Sensation
It is common with any open hernia surgery to feel a numb patch or area of altered sensation around the wound. This is due to disrupting the skin nerves with bruising or surgical damage.
As the wound heals and bruise resolves this area will naturally fill in over the first 2-3 months (nerves heal slowly).
In a small proportion of patients a numb patch about the size of a 50p piece around the middle and bottom area of the scar can occur. This can take up to six months to disappear and for a few this sensation can be permanent.
Risks Post Hernia Surgery
Hernia surgery is low risk
As with all surgery there are potential issues. These risks include:
Risk: Bruising
We view minimal bruising as an indicator of success, and aim to limit it by using hernia supports worn for a minimum of 48 hours post surgery.
Age, obesity, blood thinning medications and general frailty often leads to worse bruising. The ‘luck of the draw’ is also important.
Risk: Wound infection
This is uncommon, and we use a waterproof dressing, beneath the pressure dressing, that can be worn while showering.
We recommend patients leave the waterproof dressing intact for 12 days as it was put on while the wound area was clean and sterile.
Risk: Hernia recurrence
This happens rarely, and carries the same risk regardless of how the operation is carried out.
Because, under local anaesthetic, we can test the repair during surgery, the risk of early technical failure is low.
The main risks for recurrence are smoking and being overweight. Alter these factors and the risk will reduce to become very small.
Risk: Altered skin sensation
It’s common (with any open hernia surgery) to feel a numb patch or area of altered sensation around the region of the scar (to about the size of 50p piece),
Patients can expect this to fade slowly overtime. It can be permanent in a small number.
Risk: Testicle injury
Damage to the testicle’s blood supply
This is a rare complication of groin hernia surgery in men. The hernia sac is attached to the tubes running to and from the testicle. We will need to dissect the hernia sac off these tubes to repair the hernia. It is rare, but if having to dissect one structure from another there is going to be a risk of damaging either of them.
In the case of these tubes, damaging a part of them alters the blood supply of the testicle. This WILL NOT alter function and would not be expected to reduce testosterone levels significantly. It can make the testicle change in size, so it gets smaller and aches whilst it does so.
This ache then resolves after 4-6 months. In the worst-case scenario, you may require testosterone replacement either as a gel rubbed into the skin or as an injection 2-4 times a year. There is an extremely low risk of this happening (approx. 0.4%).
Hydrocele
Unrelated to damaging testicle blood supply is a small risk of fluid filling a sac around the testicle causing enlargement of the scrotum. This is called a hydrocele. They occur naturally in 1 in 70 men (1.4%) and overtime we have seen 2 occurring within a few months of hernia surgery. This seems to be due to irritation of this lining of the testicle by bruise or inflammation. We see bruise/inflammation routinely in the scrotum and in much less than 0.3% of people, this has developed into a hydrocele.
It is uncertain whether this is a true complication or coincidence (i.e. that a hydrocele may have developed anyway as our incidence figures suggest). Timing suggests there may be a rare linking of the 2 events. If it is uncomfortable, it may require further surgery to correct it. In these rare cases it would need assessment and surgery by one of our urology colleagues.
Risk: Persistent pain
An inflamed pubic tubercle may cause discomfort which becomes chronic (pain for 6 months or more), but this is very rare and broadly speaking of equal risk from either hernia repair technique.
If you have any questions post surgery before your follow up consultation, please get in touch with Hernia Clinic Hampshire with your questions.
We will contact you to arrange a follow up consultation approximately 4-6 weeks post-surgery.