Monday, October 29, 2007

Ridge Lines



In no way is it false modesty to say that physicians are not healers. At best, what we do is to grease the way, to make conditions as favorable as possible for the body to heal itself. For without the body's amazing powers of defense and repair, nothing we do -- especially we surgeons -- would be lasting at all. The most immediate and palpable reminder of this is the process of sewing someone up, and watching what happens.

Wound healing is a wonderfully complex process, and it would be folly for me to attempt explanation in detail; mainly, because I've forgotten the pathways, the kinins and the prostaglandins involved. I'm not going to look it up again, but you can if you like. Anyone who's had an operation, from minor to a big deal, has had the opportunity to witness it. Maybe you were too sore to be in awe. But I always liked to point out the easy evidence to my patients.

I've gotten calls about red incisions (despite trying to explain it in advance.) Of course, it's necessary to separate the natural from the infected (digital photography and email have been known to save an office visit, for the technologically inclined); but all incisions get red for at least a few millimeters out from the cut. An inflammatory response, it's the process of bringing the building materials into the work site: capillaries dilate and proliferate, blood flow increases. That, and much more, goes on under the surface as well. Attracted by "injury chemicals," various cell types arrive and unload their cargo, set up lattice work, induce structural changes. The result of the influx is a gradual thickening and hardening of the area for an inch wide or more, and which carries the unofficial-official name "healing ridge." When the ridge isn't there, you know there's trouble ahead. In the very ill, in people on high-dose steroids, in the malnourished, a soft and non-pink incision is an unwelcome and unhappy harbinger.

As much as feeling the healing ridge can alarm the unexpecting, it's a sign of health, the indication that help is on the way, that work is going on to effect healing. I'd warn people. To hernia patients, I'd say, "In a few days it's going to feel like a sausage under there. You might think the hernia is back." Or, after removing a lump of some kind from some place, "In three weeks, you'll think I didn't remove it at all." It takes many weeks for the ridge to melt away. The zone of redness dims, but the incision itself gets increasingly red, and doesn't simmer down for a year or more. (It also fades after the application of vitamin E, of ear wax, and of snake-oil, singly or in combination.) It's a living monitor of how long healing is active. Given an explanation of what's going on, surgipatients get a ridge-id ringside seat from which to watch the body do its work. (A corollary is the tiredness that most everyone feels after surgery. There's lots of work going on, I'd tell them. While you're lying around feeling lazy, your body is doing the equivalent of walking around all day. Give yourself a break.)

125 comments:

rlbates said...

I love to watch all the changes (like seasons) along the "ridge-line". It never ceases to fascinate me. (guess I'm just easily amused)

Onehealthpro said...

Thank you for sharing this lovely post. I'll never forget that ridge lines are a good thing.
Onehealthpro

mark a said...

As someone who studies a similar process occurring in the lungs I too am fascinated with wound healing and marvel at the seemingly simplistic nature of it yet marvel at the underlying complexity.

Lynn Price said...

Good point about insisting that patients take it easy and allow their bodies to heal. With our busy lives, we tend to get out of bed while still sick or go back to work before we've fully healed. And, boy, do we ever pay the price.

Doggerelle said...

so true - I knew I was in big trouble when there was no ridge after my second C section. Sure enough it opened up a few days later.

Embrace those ridges!

Sid Schwab said...

patrick: thanks for the links. I'll check them out. Maybe a future post might come of it. And thanks for the Dawkins links, too. A soft voice of reason, I think.

surg resident said...

Ha! I thought that picture was the Bridger mountains. That brings me back to college. Nice visual, Dr. Schwab!

Anonymous said...

In a couple days I will have a total hip replacement. Yesterday, I sat through 3 hours of total hip education. Not once was the subject of letting your body heal mentioned. No, it was, "we get you up and dressed and on the next day" and ship you out in three days. Have they been talking to the insurance companies too much? Speedy discharges are all well and good, but for God sakes tell the patient it is OK to rest and heal. In the last two years, I've had five major operations, including four belly procedures. I wish I had read your article at the outset.

Dreaming again said...

WOW!! I've just learned a bit.

I've got myasthenia, lupus and take steroids in doses I'd prefer not to.

I also have an eating disorder and have been known to not be the highest nurourished person on the planet.

I've had 15 surgeries ...

I have had some where the incision looks wicked, and the surgeon says "hey! Looks good"
and others, where I think it looks great .... and they make me come back twice as often!!
You just explained it!

Now ...off to do some 'self care'

oceansmiles said...

Useful information! I just had surgery last week for a small primary ventral hernia, and was certain that the doctor created a bigger problem when I awoke yesterday to find a cucumber-like bulge in my abdomen! After some internet research, I realise this is normal. Why, oh why, did my physician never mention it?! I'll try to stop pushing it in now...!!! Thank you for the blog!

jay said...

I had hernia surgery 2 weeks ago. My doctor mentioned a healing ridge. Now it feels like a sausage under there--like my hernia came back. I was happy to see your blog telling me that this is a good sign.

Sid Schwab said...

jay: glad to have been of help.

Fulmer Fam said...

I just had my thyroid removed and this was not mentioned to me before hand, luckily my surgeon had given me her e-mail so it eased my worries somewhat when she said it was normal and called a ridge line, but this post really eased my mind even more since in the back of my mind I was thinking "are you sure" :)

Anonymous said...

Great post, very reassuring as I look at my poor sore 'ridge' from hernia surgery. I need to accept that rest is what I need :)

American Consumer said...

I also had a hernia operation 4 weeks ago, and that healing ridge doesnt seem to be going away... But this is helpful.

Thanks for the post!

Anonymous said...

I had hernia surgery two weeks ago and just got back from my followup visit with the surgeon. He took one look at the "healing ridge" and pronounced that I had superior genes! I had worried for several days that something had not gone right and a second surgery would be necessary. Now my fears are twice unfounded. He did say the ridge would go away slowly... over the next 3-6 months. Until then I will just remember Mae West's line... "is that a gun in your pocket, or are you just glad to see me." :)

Sid Schwab said...

Well, with that in mind, maybe they should call it a "himnia" instead of a "hernia."

Anonymous said...

Thank you so much for the useful information! We just called our doctor with concerns about our son's hernia site and they said it was the "healing ridge" but gave no further information. I found this blog and am so relieved.

Sid Schwab said...

Thank YOU!! I love hearing that I've been of help.

Jon said...

Thanks so much...I had my cyst removed from my face three weeks ago and wondered why I still felt the lump there...It saves me many worrying hours

Jen said...

My son (2.5 years old) had an injury to his face 9 months ago (May 2008) which required 5 stitches in the emergency room by the ER Dr (no plastic surgeon was available to stitch him up). He still has a hard lump under the scar but a bit off to the side more that under it. It feels like a "ropey bean" to describe the texture & shape of it & it sticks out of his face. I am hoping it is the healing ridge & will go away on it's own so he doesn't need to have the scar revised. 9 months seems like a long time & it hasn't softened at all over this time, but our plastic surgeon has said children take longer to heal than adults & he says it's just scar tissue underneath that has formed. He has never used the term "healing ridge".

Is the term "healing ridge" a common term in the medical world? Neither my family Dr or plastic surgeon have ever used this term, they just say it's scar tissue. The plastic surgeon said if it isn't gone by the time 18 months have gone by then we can consider revision to remove it.

Sid Schwab said...

It's a common term but has a pretty specific meaning, namely the general thickening of tissues immediately below an incision in the early phase of healing. It's mostly gone within several weeks, so what you describe doesn't really fit the definition, from what I infer.

Jen said...

Thanks for your reply. Well hope it goes away on it's own then whatever has formed in there. I have talked to other people with c-sections & other surgeries that said it took 2 years to disappear.

CW said...

What a great informative post. Thank you so much. I am a week out of inguinal hernia repair and having periods of great pain. I was convinced the operation was a botch. But I am a pretty lean and fit person and in this case the surgeon said that it was working against me. I don't have a lot of fat down there to cushion the healing ridge, so I guess the nerves are getting irritated. I found your explanation to very much ease my worries.

Sid Schwab said...

CW: thanks for the comment. Happy healing.

Anonymous said...

Thank you for this information!!! My surgeon for hernia repair did not tell me about this and I have been worrying!

AJ said...

I just recently had sentinel lymph nodes removed to check for any metastatizing of DCIS and there is this large lump to the front of my underarm which greatly aggrevated and somewhat alarmed me. Only when I spoke of it to my surgeon post-op did the phrase "healing ridge" come up, no forewarning was given. Your blog is the only info. that appeared under Google's "I Feel Lucky" and boy do I ever. Thank you for this helpful information. Now I can watch in true awe instead of worrying that another surgical procedure would be necessary to remove it.

Sid Schwab said...

Thanks, AJ. I love getting comments like that.

Ivan, RN, paramedic said...

I am nurse practitioner student 9 days post op from an open inguinal hernia repair. My laptop is sort of propped up on my "healing ridge" as we speak. I showed my wife your article and now she occasionly asks, "How is your sausage?" to which I answer, "We are fine, thanks for asking."
My surgeon was great. A nice person, who didn't seemed too rushed to answer questions, but we never discussed the "healing ridge". This information should be on the print outs they give you when you leave recovery. Thanks the info, sir, it is greatly appreciated!

EmpressD said...

Howdy, and thanks for a most useful explanation, quite calming to the nerves somewhat frayed by an unexpected adbomenal procedure! Best with from the Pacific Northwest

Sid Schwab said...

Glad to help. The Pacific NW is, of course, the best of the best.

Anonymous said...

Thanks for this info. 10 weeks post hernia op....healing ridge still there. Is it normal to still feel discomfort/heavyness and some times dull pain at the incision site when sitting down?

Sid Schwab said...

anonymous: I'd say it's normal, especially if you think it's improving. But without being able to see it, I'd also have to say it's best to direct specific questions to your surgeon.

Anonymous said...

Thanks for your opinion. Not in the mood for another follow-up visit. All the way from South Africa...isn't technology just great!!

Anonymous said...

Thanks Surgeon for the post. I've had a hernia operation just over a week ago. I've been sitting here worried about infection and that the hernia has become 'undone'. But from your post it seems the redness is natural so I can ditch the anti-biotics and it looks like the healing ridge is on the rise. Got to say, some of the pain from the operation due to swelling in the scrotum, etc, has been truly awful. Fingers crossed for a full recovery. Tim.

Sid Schwab said...

Tim: for the record, redness is a matter of degree, and so is swelling. Whereas a certain amount of redness can be normal, and swelling of the type associated with a healing ridge certainly is, at a week out from surgery there could be other issues as well. I don't know why you're on antibiotics, but I wouldn't ditch them (assuming they were prescribed) without checking with your doctor. In fact, you should check with him/her anyway, regarding your symptoms.

SJO said...

I'm almost a month past having half of my thyroid removed, and I have a lovely healing ridge on my throat. My surgeon (an AMAZING man...I've endured three abdominal surgeries under his care, including a urachal cyst that had ruptured my colon and bladder and I was suffering from peritonitis when he cut me open) recommended kneading/massaging the incision line to help soften the healing tissue (and keep vigorous bloodflow to the area, too, I suspect, which also helps healing). What are your thoughts on massaging a healing ridge? (Rather than investing in "snake oil.")

Sid Schwab said...

I'm not aware of studies that show massage affects the healing process one way or the other. My guess is that it, and snake oil, achieve about the same results; namely, resolution over time. On the other hand, I doubt there's harm; and your surgeon might well know something I don't.

Anonymous said...

I don't think that I can add much to what others have posted except to say "thank you" for this very useful and reassuring information.I am one week post-op of an ambilical hernia. I too thought that I'd done something to cause the hernia to come back. At my post-op appt the nurse practitioner did mention the healing ridge, but didn't even give a basic explanation of what that is. It seems like such a simple thing to tell a patient in advance so they know what to expect. Again, thank you!

acecard said...

Ten days post inguinal hernia repair and was getting incresingly concerned about the hard lump under the incision which felt very similar to the hardness of the hernia itself, the difference being that the hernia disappeared when lying down but this lump is always there. I really thought it was a botched job and am so relieved to find your site. Why the surgeon never discussed this apparently common after effect astonishes me.
Thank you so much.
Paul from the UK

Sid Schwab said...

You're welcome! On the other hand, be aware that self- or online diagnosis is risky to a certain extent. So it never hurts to keep your surgeon apprised of the situation, too.

Anonymous said...

Thank you for taking the time to put this info. on the internet. I had to send an email to my surgeon to voice my concerns about this big walnut under my incision after gallbladder removal. I was told it probably was a healing ridge. I've had three adom. surgeries over the years and don't ever remember anybody ever telling me about this process. Well, now I know.

Sid Schwab said...

Happy to help.

mommijock said...

AMEN! Thank you for explaining this. I had hernia surgery almost 2 weeks ago and I thought - and my surgeon thought I did something to mess up the surgery. Geeze. You 'd think my surgeon would know what that hardness was. He is a wiz at laparoscopic surgery but the open -makes me wonder. My neighbor who is an RN came over and said it looks good - looks nasty to me but she said the incision looks great. Ok - ha! God Bless you for explaining the healing ridge! I wish the doctors would explain this because it freaks us out. Thanks again -
Marcia

Anonymous said...

I had hernia repair done 8 months ago. The last two weeks I have experienced dull pain and discomfort in my groin. The back of my leg and bum is sore...burning sensation. I am also experiencing discomfort in my hip...almost like something is pulling in the area. No buldge....Is the Hernia back?

Sid Schwab said...

Turn your head and cough...

In other words, I can't make any sort of diagnosis without an exam. You should contact the surgeon who did your operation.

Whiplash said...

Wow...I am SO happy I found this blog entry.

I have been freaking out for about a week now (I am 12 days post op) due to the increasing bulge near my old inguinal hernia. 2-3 days after the surgery I hit the peak of swelling and it has been subsiding ever since. The more swelling goes down the bigger the healing ridge looks to me...which is normal.

I found that the healing ridge is highest and widest near the old hernia site. I rationale this by saying "it's where the most work was done during surgery...so probably where the most healing needs to take place". Does this make any sense?

Freaking out about recurring hernias is no fun. I am quite confident about the surgeon/facility where the surgery was done but because I am from out of town I can't really go back for a post-op assessment. :(

Sid Schwab said...

What you say make sense, whiplash; but, as you'd expect, I'd add that I can't really say without looking at it. It's always best, when you have questions, to check with your surgeon or someone who can look and poke around.

It's also true that if a hernia were to recur and to be thick and unyielding, it'd suggest incarceration or strangulation which would likely make you pretty sick. So, yeah, it's nearly certainly a normal healing ridge. But, covering my rear, I can't say with certainty.

Chantell said...

thanks so much! I am 8 days post op hernia surgery. open incision with mes for an inguinal and a femoral. I was so worried about the sausage feeling under my incision. I am glad to know it's a good thing!!! Thanks a lot!

Anonymous said...

I am just over two weeks post hernia op and have a pretty impressive cucumber which seems to have reduced a little in size over the past few days. My doctor today said that there is still some blood built up (which he saw on an ultrasound) and tried to draw it out (after giving me a local anaesthetic) but could only get a few drops. He said that it may be necessary to operate again just to get the blood out and only for cosmetic reasons so that I am not left with a bulge on one side. From your blog on the Healing Ridge (which I was greatly relieved to find) I would have thought that I just need to wait and time will bring the bulge down. Now I am bit confused. I have known my doctor for man years and have great confidence in him but he has not said anything about my "cucumber" being a normal part of the healing process.

Sid Schwab said...

Not knowing what it looks/feels like, I can't say why this might or might not be part of normal healing. I assume by your "doctor" you mean the surgeon who did the operation... It could be that he thinks it's a collection of blood instead of the normal healing ridge. Usually removing a blood collection with a needle doesn't work in this time frame: it takes a lot longer for the clot to liquefy to the point of being able to drain it.

Anonymous said...

Many thanks for your reply. I have another appointment in 10 days and will see what it is like then. I have no pain, feel really good and am itching to do some gentle jogging soon. The symptons from before, ie why I had the surgery in the first place, have gone.
Yes, he is my surgeon (sorry if I get the terminology wrong). I am in Germany and he is both a general doctor (in his specialist area) and a surgeon for operations in the same area.

Nathaniel said...

Thanks for posting on the post-surgical ridge. I have learned a little about this through two consecutive open mesh repairs of an inguinal hernia. The first was done about 1 year ago. After the initial swelling went down, the ridge was still apparent but never seemed to go away. 8 months post-op, my (1st) surgeon confirmed that it was a recurrence--pretty rare with a mesh repair. Went to a different surgeon to get it "re-repaired." In my first post-op visit with the new surgeon, he said the initial mesh was loose and ballooning. He tightened the existing mesh and put additional mesh near the site to reinforce a larger area. He drew me some nice pen and ink pictures of what he did, which was actually very helpful. Anyway, I'm 5 weeks post-op from this second repair and I still have a pretty stubborn ridge/buldge, and it balloons a bit when I put my hand on it and cough--makes me nervous. I do hope the ridge subsides, the surgeon made it sound like it should be about gone by now, (my last visit was 3 weeks ago) so I'm starting to get a bit nervous that I may have pulled the darn thing loose again. Might be time for another visit, although he didn't seem very concerned about it three weeks ago.

Anonymous said...

This is a wonderfully written blog entry on the subject of ridge lines, and by far the best I could find online.

It is two weeks after hernia surgery, and my line is sore and the size of cucumber.

This blog entry saved me days of panic before I could see my surgeon today.

Seeing a massive, swollen line was disconcerting to say the least! :)

Thank you!

Sid Schwab said...

You are most welcome! Thanks for writing.

Jeff said...

Like many of the posts on here, I had a hernia repair and was concerned something had gone wrong. I am relieved to see that the healing ridge and sausage are good signs. Thank you so much!

Milla said...

I had an open abdominal myomectomy five weeks ago and I have a 'ridge' or swollen 'shelf' or 'sausage shape' all along the five & a half inch incision. Underneath the incision feels hard & the incision is still a little tender. Below the incision is swollen too, but I'm more alarmed at the swollen shelf that looms over the incision. I am on the small side (107lbs) so the ridge/shelf looks rather strange on my body, as I didn't have excess fat to get trapped in the incision, which could be causing the bulge.
My surgeon/consultant hasn't shed much light on it and I'm concerned it won't go away without further surgery.
I'm also a little unsure of what you mean by 'healing ridge'. Do you mean hardening underneath the incision, or swelling (in a sausage shape) above it?
I'd be grateful for your thoughts on this matter.

Sid Schwab said...

Milla: Unable to examine it, I can't say specifically what's going on with you. But your description sounds like what I was discussing: the healing ridge. It can take much longer than five weeks to go away. Absent other factors, like redness, fever, pain, etc, I'd think the odds are that's what it is and that it will eventually go away.

But any opinion based only on a blog comment isn't to be considered accurate; you need to stay in contact with your surgeon.

Milla said...

Thank you for your reply & for providing some insight on this issue. I will be seeing my consultant again in two weeks time, although so far, he hasn't explained what has caused the ridge. In the meantime, I was wondering if you could explain, in general terms, what causes a ridge to form & visibly bulge over an incision? Is it because the area underneath the incision has internally hardened? And do 'healing ridges' gradually disappear, as the internal hardening softens over time?

Sid Schwab said...

You should re-read the post, because I think your questions were addressed in the original article.

Anonymous said...

I had my gallbladder remove and my surgeon also repair an umbilical and supraumbilical hernias. He did not used any mesh to repair. He just close the hernias. He did this through my belly button only. It has been almost 3 weeks since my surgery and I on top of my belly button I have a big hard ball. Do you think that what I have is the healing ridge that you described on your blog? I have no real pain. Some times I feel a little burning sensation when I have been doing too much activity, so I stopped what I am doing an rest and I feel better. My doctor says to give it time, that it will go away. What do you think?

Sid Schwab said...

I think the doctor who did the operation and who has examined the lump has a much better idea of what it is than I possibly could.

All I can say is what I said in the post: I told my patients that in two or three weeks you might worry the hernia is back because of the lump that will form there; in three weeks you might think I didn't remove it at all. It's three weeks, and you're worried that the hernia is back.

Anonymous said...

Thank you very much for your blog. I was worried the doctor did something wrong. I will wait a couple of months to see if my hard lump goes away.

Daniel L said...

Thank you for putting me at ease with your insightful post. I am an orthopaedic surgeon who just got a hernia repair 10 days ago. I thought perhaps the mesh was folded up when I felt the healing ridge! Instead of trying to protect ourselves by dwelling so much on the unlikely worst-case scenarios, perhaps we may better serve our patients by giving them a good idea of what to expect. Being under the knife myself has given me an invaluable perspective.

Sid Schwab said...

Well-said, Daniel L. Thanks.

Dlinthe said...

Hi! I would just like to say that I came across this article this evening while looking up information on my healing ridge. I didn't truly understand why my surgeon wanted me out of work another week. I didn't argue, I had pre-surgery hernia pain, and I've got some good post-surgery pain going on a week and a half after and figured it was solely the pain levels and my functionality because I'm not walking too well just yet. She did, however, encourage me to go to a social event today so long as I didn't overdo it and took it easy. That wasn't a problem. What shocked me was how entirely exhausted, physically and mentally (though the second was partly from the meds) I was after just a few hours of some standing, mostly sitting. I wondered at this even as I got home, sat on the couch, and began drifting in and out of consciousness.

However, the last part of your article here makes a lot of sense - that even while I'm doing nothing, my body is doing a full day's work and then some. It's something we forget about the healing process. I'll keep that in mind over this next week as I am beginning to get back to physical activity and working on walking decently again. Thanks - I really needed that reminder!

Tim said...

I recently had open surgery for an inguinal hernia and just found out about the healing ridge and the scar is right on my beltline. Is there an average healing time for this because this is really uncomfortable. Besides the fact that I wasn't told about it prior to the surgery or I would have chosen laproscopic surgery.

Sid Schwab said...

For it to disappear completely usually takes several weeks.

Mark O'Donoghue said...

Thank you for this information. My surgeon did not mention this either and I've been worried that something is wrong. I feel a lot better after reading this.....

Sid Schwab said...

And thank you for taking the time to comment. Makes me feel good that my stuff is still useful.

Anonymous said...

Thank you so much. I can stop worrying about something that is apparently normal and healthy. I am 13 days out from inguinal hernia repair. The "healing ridge" has just made it's presence known and I thought the worst. Following up with my surgeon next week, for good measure. Thanks again Doc.

Dave Dauster said...

I too had become apprehensive about the ridge that had formed on the left half of the incision three weeks after my inguinal hernia repair. Had the mesh unattached and rolled up? Thanks, Doctor, for easing my mind.

Anonymous said...

Hi! True to what you wrote, 3 weeks post op a laparoscopic ventral hernia repair w/ mesh, I thought my hernia had come back, or I had a seroma. My surgeon said it was the hernia sack and could take months to dissolve, his nurse mentioned a healing ridge, which I had not heard of. I came home,googled and found this blog. :) I noticed after reading many of the posts, they mention healing ridge and open repairs of hernias. Does/can a healing ridge form after laparoscopic hernia repair with mesh? Thank you so much for your help and insight.

Anonymous said...

I was told post - surgery (April 6) that I had an INDIRECT (ie Congenital) Hernia.... This was on my left side.... Since the body is generally symmetrical, I was wondering of this means I am likely to have the same defect on my right side as well -- and am likely to develop a hernia there as well? There is no protrusion there at present -- but I had none on the left side for the first 44 years of life despite the defect. Thank you.

Sid Schwab said...

Good question, and, interestingly, it turns out that, since hernias are more common on the right, when a person has one on the left the chances of getting one on the right are higher than the other way around.

On the other hand, only around 15% of people who have one get another on the other side, % for left sided) so it's not something to worry about much. And, as you suggest, if it took 44 years, you might be okay, vis a vis the right side.

Incidentally, it's nice that you're aware of the more-or-less true fact that indirect herniƦ are congenital and direct ones are more considered due to straining, etc.

Anonymous said...

From your 05/19 post: On the other hand, only around 15% of people who have one get another on the other side, % for left sided) so it's not something to worry about much. And, as you suggest, if it took 44 years, you might be okay, vis a vis the right side.

Me (anon - Steve) I missed the % for those who have their first [only - I hope] hernia.... I always like to know the percentages. Also, absent a protrusion -- can a physical exam by a doctor see if the congenital defect is present -- whether or not a hernia manifests itself [ie can they feel the opening] or is the exam only capable of confirming a hernia once it is present. Thank you very much.... Aside, my healing ridge is smoothing out V E R Y slowly... I'll be at 7 weeks post op on Friday (May 25th)... Most lit says 4 to 6 weeks... I'm going on 7 and at the present rate it won't fully flatten until 3 months or more. I know its normal,necessary, even good - a sign of healing - but my own experience is outside of that 6 week window I see as I peruse the net.

Sid Schwab said...

Resolution of the healing ridge can take three months, give or take.

I don't have a lot of use for statistics, in that whatever happens to the individual is 100%. I think it's possible feel a somewhat lax internal ring, ie the hole through which a hernia protrudes.

But absent an actual hernia, it doesn't mean much. I don't know of any surgeon who'd operate to tighten a relaxed ring when there's no hernia, no symptoms. Of course the fact that I don't know of any doesn't mean there are none. But I wouldn't.

Anonymous said...

three weeks post a bilat open inguinal hernia repair, no problem except feeling stretching sensation on sitting or standing for more than 1hour or so,feels like lying down, on lying feels as if something trying to come up,better after few minutes,is mesh related edema the cause,how long it may take to resolve?

Sid Schwab said...

By some measures, three weeks is when tissues are at the most abnormal postoperatively. So I wouldn't be worried about tightness at this point, unless there are other signs, like redness, heat, fever, etc.

It's hard to say how long it might take; anywhere from another month or two to a few more than that. As always, it's best to raise your concerns with your surgeon, who'll know more about what exactly was done.

Bhuvana said...

Hello,
I had my hernia surgery 3 weeks ago (mine became an open surgery as my bladder was accidentally punctured during the laproscopic surgery and the bladder was fixed along with the old-fashioned fix of the hernia (inguinal on the right side). I am a female and was told that this happened because of the presence of scar tissues as a result of previous c-sections.

I was perfectly fine till yesterday - I do not work and was doing moderate work (such as climbing up and down, sitting, standing, cooking some dinner but not any heavy lifting etc). Yesterday was the first time I tried my hands on driving and ever since I have developed a sharp pain on my hernia site. It is bad especially when I am sitting, sleeping or putting pressure on the abdomen area.

Is this normal ? Is this the result of scar tissue acting up ? Can I resume my normal activities or should I wait some more ? Will the pain go away ? I also have some bulge in the area as I was worried about the recurrence. Could this be a healing ridge also ?

Thanks
Bhuvana

Sid Schwab said...

It's impossible for me to say whether all of this is part of the normal healing process (likely) or something else, without being able to examine the area. You should be in touch with your surgeon.

anna said...

This is indeed very helpful - explains the 'sausage', the tiredness, the scar. i have question though about pain around the site. 3.5 weeks after an open mesh femoral hernia repair, i have stitch -like pain in my stomach muscles up that side, and also pain around the pubic bone. The tummy muscles also feel rather ridged and lumpy. i'm a slim female so its easy to see/feel. is there an obvious reason for this? thanks if you get time to answer this.

Sid Schwab said...

Sometimes, depending on the repair, a stitch could be place in or very near the pubic bone. As to the rest, it's hard to say: effect of "favoring" one side when there's pain, maybe, causing stress on other muscles.

But for specifics it's best to ask the surgeon, since I really can't know from this far away.

Andy in ALA said...

Your blog on the healing ridge is remarkable! I am a hospital coder and read charts all day and I have NEVER heard of a healing ridge...I also worked in a wound care clinic and never seen the surgeon mention 'healing ridge'. Now that I am 12 days postop of an open ventral hernia repair w/ mesh, I have developed the 'healing ridge' as the nurse told me via phone call today. Surgeon nor hospital staff forewarned me about this... I knew I had a seroma 3 days postop I was leaking serous red/brown fluid from the op site. After 7 days of Bactrim no more leaking fluid from site however I still had the 'KNOT' anterior to the wound. Until I read your blog I was mentally preparing myself for a potential 'postop complication seroma surgery'. I can't thank you enough for your insight and experience from the operating theater. I remain

Yours truly,
Andrea in Alabama

Sid Schwab said...

It's very satisfying to know the blog still is helpful to people. Thanks for writing!

Anonymous said...

I had an umbilical hernia repair done exactly two weeks ago. It was a small hernia (dime to nickel sized) so my surgeon used sutures rather than mesh. I have a hard lump under my belly button, making it appear to stick out (even more than before and now I really have an outie). The lump is hard, not like the squishy hernia. Is this the healing ridge? On average, how long does it take it to go away?

Sid Schwab said...

I really can't make a specific diagnosis without an exam; if you're concerned you should have your surgeon evaluate it. As I said in the post, though, the healing ridge is generally firm, and I used to warn people that for a while they might think their hernia has returned. I'd tell them the ridge, the firmness, can take several weeks to resolve.

Anonymous said...

I am sooo glad I found this post! I went to see a surgeon for a hernia that needed repair and it turns out during the post op follow up, I realized he repaired a hernia I didn't even know I had!! My first operation was on Oct 25 and done lapriscopic. Well needless to say I just got the hernia that was giving me trouble repaired exactly a week ago. It was done open and no mesh was used. Yesterday I noticed a hard lump around both operation sites. It was also pretty sore and tender to the touch. Needless to say I was pretty frantic thinking my surgeon had once again let me down. After reading this, I am totally hopeful the surgery was a success and I will rest easy until I have my post op checkup Monday. This post has been most helpful:)

Sid Schwab said...

Hmm... Are you saying he "repaired" the wrong site the first time around?

Anonymous said...

Yes I am. I went to him due to pain I was experiencing stemming from a ventral hernia right above my belly button... When he operated, he repaired an umbilical hernia I didn't even know existed! To my dismay, once the bandage came off I realized I now had an innie belly button but the painful bulge above it was still there... When I went for my post op appt. I showed him the area I was referring to as painful. It was at that point that he said that he would have to do another surgery to repair the ventral hernia because he had not caught it the first time around. Basically I had the operations a month apart. This is why when I felt the bulge this time I was super worried...

Sid Schwab said...

Hmm...

Anonymous said...

Sid are u saying I have a malpractice case? Lol

Joseph said...

I am eight days out from an open repair of a right inguinal hernia, using mesh. I was completely unprepared for the amount of pain for the first five days. And just today I found myself in tears having discovered the hardened lump underneath the incision site. I was absolutely convinced that my surgeon was an idiot. Thank you SO very much for your incredibly insightful post regarding the healing ridge. I agree with so many other commenters that physicians could save their patients much worry and mental anguish by preparing us to expect the hardening of the healing ridge. It is quite easy to understand and would only take a couple minutes of their time. Your post has convinced me that I need to not rush my recovery but learn to rest and let my body work its magic. And you've given me peace of mind that my healing process is very much on a positive track. I will sleep easier tonight, having run across this fantastic post. THANK YOU for what I consider an excellent and compassionate piece of helpful information.

Joseph

Sid Schwab said...

And thank you, Joseph, for the day-brightening words!

Sid Schwab said...

No, anonymous. I'm saying "hmm."

Mr Camper Man said...

Just found this today and you have saved me a trip to the hospital A&E dept, I had my inguinal hernia repair just under 3 weeks ago & yesterday discovered this healing ridge and to be honest sh*t myself as I thought the hernia had recurred or something drastic had gone wrong as I had NO explanations at all about what would happen to my body after surgery abd have had to rely entirely on the internet to get me through the 3 weeks so far, Thanks for putting my mind at rest also the surgeon mentioned that it was a new process using NO stiches to hold the mesh in ?? which has not helped my worrying about the slightest little thing.

Sid Schwab said...

Glad to have been helpful, and thanks for taking the time!

Matt Altland said...

I had umbilical surgery two weeks ago to the day and it looks like the hernia is back the swelling is in the same place the original hernia was to the left of the belly button. I did not have any swelling at all and then all the sudden this happened at 2 weeks. It feels a little tight when getting up out of chair have been doing alot of walking. I know you can not see what I am talking about but will this healing process make it look just like the hernia again it is a little hard under it. Surgeon look at it last week and said it looks great. Never mentioned this healing ridge it looks like the hernia is back. Any thoughts??

Sid Schwab said...

My only thought can be that you should get back in touch with your surgeon. It could be healing ridge, it could be recurrence; impossible to say without seeing it.

Jules said...

What an interesting and well written blog. 11 days ago, I had my gallbladder removed. The surgery was a breeze and my recovery has been swift. As a very active triathlete-in-training, I was thrilled to even resume running just 6 days post-op!

It was a bit disconcerting, however, to feel those lumpy, bumpy spots underneath my 4 incisions. Your post helped me understand what is happening just below the surface, with cells "bringing materials to the work site" to heal the body. What an ineresting process.

My surgeon assures me they will diminish or disappear completely over time.
Thanks again for writing an article everyone can understand.

Sid Schwab said...

Thank you for writing. And, looking at your blog, congrats on your new-found health and hard work!

Anonymous said...

I had umbilical surgery five weeks ago. My hernia was very large (cue ball size) and was laparoscopic with a large mesh. My incisions healed nicely but my belly button is now a smaller hard lump (but flat) and still a bit sore. I called my surgeon and she said not to worry its normal with out any further explanation. I am so glad I found this page, you rock! Given the large size of my hernia how much longer should I expect it to take for the ridge to go soften and go down?

Sid Schwab said...

In general such things can take several weeks; up to three months or even a little longer.

Anonymous said...

I am grateful to come across this. I was just a bit concerned about my incisions for my appendectomy as there is a "hard" ridge especially on the top incision, and it's still tender. Surgery done on May 25. I am also grateful that you mention rest as I get on myself for "napping" after work since this surgery. Thank you.

Andy in ALA said...

I had open incisional hernia repair with mesh Nov 15.2012, with hx of lap cholecystectomy in May 2012. I have lost 40 lbs since the November surgery and it is July 1 2013. My knot "healing ridge" has decrased from a small softball to the size between a baseball and a golfball. I know you mentioned it would take around a year to dissolve however, I am concerned about the 'what if' factor. As I had to move (by myself) in April 2013. How would I know if I have a recurrent hernia or if it is the healing ridge? I look like I am pregnant...ok well at least a baby bump..which it not flattering when someone comes up to rub the 'baby'. LOL. What symptoms should I look for if it is a recurrent hernia? Also, with the weight loss I am concerned about the mesh tension...do you think that would be an issue. I have not done situps or crunches so I do not know. Thanks in advance,
By the way love your book Cutting REMARKS

Sid Schwab said...

Andy, the only way to know for sure what's going on is to have a surgeon (your surgeon) have a look. Whatever it is, it doesn't sound at all like a healing ridge.

I guess it depends on how the hernia was repaired. If it was large, and a large mesh was placed, it's possible that it's just protrusion outward of the mesh but not a true hernia. Or, it could be recurrence.

Andy in ALA said...

Thank you, by the way I am a female... I use my nickname a lot. The surgeon said I had a large size mesh placed under the fascia to 'prevent' recurrence but even I know better about recurrent hernia's. So if I the tension is loose and if I had a recurrent hernia... how can I get a plastic surgeon to 'tag team' with general surgeon to perform a panniculectomy. I have lost over all 100lbs in 2 years...all gained immediately after giving birth to son -post partum depression, OSA...put the pounds on me. Apologies...I am thinking if I can meet med nec on the panniculectomy and repair of the knot...what is the risk if I urge for both surgeries in same operative setting. Too risky? I am thinking I will need the panni done anyway so why not do both? Your opinion please?

Sid Schwab said...

It's not unusual to do such things simultaneously. I can't say one way or the other whether it makes sense in your case, not knowing the extent of either operation.

I'd say the thing to do is see a plastic surgeon, and then have him/her discuss the possibility of "co-surgery" with the one who'd be doing your hernia surgery -- assuming it's decided it needs doing.

Joey Reb said...

Having inguinal surgery 5 weeks ago and experiencing that lump underneath the incisional site led me to your well written article.
My question...the skin above the ridges are purple in color and raised along the entire top incisional line and partially below the incisional line 1/4 to 1/2 wide. Purple????

Thank you in advance.

Sid Schwab said...

Hard to know without seeing it. During healing, incisions, and the nearby skin, go through various normal color changes.

Another possibility is that it could be forming a keloid, which is a thickened scar. They can be permanent, and unattractive, but not significant. If injected with steroid while forming, the growth can be diminished.

Whenever there's a postoperative concern, the best thing is to check with your surgeon.

Anonymous said...

Sid, remarkably valuable post of yours which clearly identifies a widespread omission in postoperative advice. I have added it to my customer service questionnaire after my tag and prolapse repair (along with 1) immediate post operative pain relief via suppositories should be default mode NOT tablets for abdominal surgery- I lay in agony for hours before an empathetic nurse came on duty....2) a tightly rolled and taped towel is invaluable for support of your wound during movement, coughing,retching etc)

Anonymous said...

Im really glad to see this. I had a inguinal hernia since i was 14. Im not 27 and finally got it done but for a moment i was thinking my dr. didnt fix it. Thank u sooooo much for posting this. Im seeing my surgeon today so he can remove the staples and im pretty sure he is gonna say the same thing. It's been 2 weeks since my surgery but having this "bridge" it's quite uncomfortable. Any suggestions on what to do with this feeling?

Sid Schwab said...

I can't make specific suggestions without knowing the details; best advice, as usual, is to be in touch with your surgeon if there are things going on that concern you.

Tommy said...

Thank you Dr. Schwab, your article left me feeling much better about this hard lump that feels like my old hernia. I really feel that unnecessary worrying can increase stress and slow the body's natural healing ability. So thank you very much for helping me to relax and in doing so helping me to heal faster.
What a great Doctor=)

Jack said...

I have a question. I suffered an injury a few weeks ago and had to get two very tiny stitches. The cut was not that deep and the doctor originally was not even going to put two sutures in but he couldn't get it to stop bleeding and decided to. The stitches came out fine and it is filling in well but there is the bump line (the ridge) still there. I know it will be a while before that heals. He claims there probably will not be a noticable scar or any real visible scar at all because the cut was not deep. Is this possible, does that sound right? What does a tiny ridge on the fact look like?

Sid Schwab said...

Jack, if a cut doesn't go all the way through the dermis, i.e. the skin, there's a good chance it'll heal without a visible scar; or that it'd be very hard to see.

I don't know how to answer your last question. I assume you meant "face" instead of "fact," but even so, a healing ridge tends to go away completely; what's left will depend on various factors, including the size and depth of the cut as well as its relation to natural skin lines.

Sid Schwab said...

Nice!!

Indigolocs said...

Thanks for posting. I had an abdominal myomectomy 3.5 weeks ago and my ridge is quite hard. I wasn't too alarmed as my doctor warned me of it, but it's good to know that it's normal and a sign of healthy healing.

Amanda said...

o,

I just had a quick question. I know this is fairly old but I had a c section four weeks ago and it has healed nice... The incision is great but right above the whole incision is a ridge like over hang.. I am not a big person and do not have excess fat like that.. It is soar to the touch and feels bruised I have been putting pressure and massage to make it go back down to no avail. Is this normal will this go away? Can you email me asaft@live.ca? I am very curious. I can forward picture of this mass of skin if need be.. But will this go away and is this normal

Sid Schwab said...

Amanda: first, it's always best, when you're concerned about your incision, to have it looked at by your surgeon. I can't specifically diagnose what's going on.

As a general comment, which may or may not apply to you, I can repeat what I said in this post: it's normal to have a firm ridge in the area of an incision that can be quite prominent, and which may take three months or more to go away.

Amanda said...

Thank you,

I have saw the surgeon and she states that by massaging this ridge above the s section scar it may improve the appearance. But she did not state whether or not this would dissipate. It goes the whole length of the section scar directly above. Do you believe cold compress or warm Compress with massage would bring down this type of due or am I stuck with this

Sid Schwab said...

Assuming it's the usual healing ridge, it'll go down with more time whether you massage or not, whether you use heat or cold or nothing at all. It's a process that happens internally and which proceeds at its own pace.

On the other hand, none of those measures will harm anything; so if you want to do any of them, have at it!!

Anonymous said...

Thank you. It's almost poetry to see such a full and precise description of the healing ridge (I've recently had an iguinal hernia operation) and very reassuring. Also spared my Dr another query and I'm sure she'd be grateful too.

Anonymous said...


thanks for the helpful info. i had a testicle removed last week and was worried about hard lump that suddenly developed under the incision. how long do you recommend patients stay out of swimming pools and hot tubs after hernia surgery, etc. to avoid infection?

Sid Schwab said...

Best to check with your surgeon about timing of such things. It depends a little on how the incision was closed. And if you ask ten surgeons you'd probably get at least five answers, mostly based on not much.