An incisional hernia looks like a bulge or protrusion in your abdomen at or near the site of a previous surgical scar. It can range from a small, barely noticeable lump to a large, obvious swelling that distorts the shape of your belly. The bulge appears because abdominal tissue or a loop of intestine has pushed through a weak spot in the muscle wall where it was cut during surgery.
Where the Bulge Appears
The hernia always forms along or very close to a surgical incision line. If you had a vertical midline incision for abdominal surgery, the bulge typically shows up somewhere along that scar, from just below the breastbone to below the navel. Hernias from horizontal incisions, like those from a cesarean section, follow that same path across the lower abdomen. The bulge may be centered on the scar itself or slightly off to one side where the muscle repair was weakest.
Small incisional hernias can look like a soft, rounded lump the size of a golf ball sitting just beneath the skin. Larger ones can grow to the size of a grapefruit or even bigger, creating an obvious asymmetry in the abdomen that’s visible through clothing. Some people describe the appearance as a “pooch” or dome shape that wasn’t there before, while others notice their scar itself seems to push outward rather than lying flat.
How It Changes With Movement
One of the most distinctive visual features of an incisional hernia is that it comes and goes. The bulge becomes more noticeable when you stand up, cough, sneeze, or strain your abdominal muscles. When you lie down and relax, it often flattens out or disappears entirely. This is why doctors will ask you to stand up, then sit down, or cough during an exam: they’re watching to see if the bulge appears and then retreats.
This behavior happens because standing and straining increase the pressure inside your abdomen, pushing tissue outward through the weak spot. When you’re relaxed and lying flat, that pressure drops and the tissue slides back inside. If you notice a lump near your scar that seems to inflate when you bear down and deflate when you rest, that pattern is a strong visual clue that you’re looking at an incisional hernia.
What It Feels Like to Touch
A hernia that can be pushed back in (called a reducible hernia) typically feels soft and squishy, almost like pressing on a balloon beneath the skin. You may be able to gently push the bulge flat with your hand while lying down. Some people can feel movement or a gurgling sensation under the skin, especially if a section of intestine is involved.
A hernia that has become stuck and can no longer be pushed back in feels firmer and more tender. The bulge stays present regardless of your position. It may feel tight or hard to the touch, and pressing on it can cause discomfort or sharp pain. This firmness signals that the tissue has become trapped in the opening, which is a more urgent situation.
Skin Changes Over the Hernia
In most cases, the skin covering an incisional hernia looks normal. It matches the surrounding skin in color and texture, just stretched slightly over the bulge. If the hernia is large or has been present for a long time, the skin may appear thinner and more taut. In some cases, you can actually see the outline of intestinal loops or movement beneath the skin when the hernia is particularly large and the overlying tissue is thin.
The scar itself may widen or appear raised compared to how it looked before the hernia developed. Some people notice the scar tissue takes on a shinier, smoother appearance as the bulge stretches it.
Warning Signs That Need Urgent Attention
Most incisional hernias are not emergencies, but certain visual changes signal that the hernia has become strangulated, meaning the blood supply to the trapped tissue is being cut off. The skin around the bulge may turn reddish at first, then progress to a darker, purplish, or dusky color. This color change is a red flag. A strangulated hernia is also typically very firm, painful to touch, and cannot be pushed back in.
Other visual and physical warning signs include sudden swelling that’s larger than usual, skin that feels warm or hot over the bulge, and redness that spreads outward from the hernia site. These changes, especially combined with nausea, vomiting, or severe pain, indicate a surgical emergency.
When They Develop After Surgery
Incisional hernias don’t always show up right away. Up to 75% develop within the first two years after surgery, but some appear months or even years later. They affect roughly 4 to 18% of people who have open abdominal surgery. Laparoscopic surgery uses smaller incisions, but research suggests it doesn’t dramatically lower the overall hernia rate. The hernias that do form after laparoscopic procedures tend to be smaller, typically appearing at the site where tissue was extracted rather than at the tiny port incisions.
Early on, the hernia may be so small that you only notice it when coughing or straining hard. Over time, the opening in the muscle wall can gradually widen, allowing more tissue to push through. This is why a hernia that started as a barely visible bump near your scar can slowly grow into a prominent bulge over months or years. They rarely resolve on their own, and most continue to enlarge without surgical repair.
How to Tell It Apart From Normal Scar Changes
Surgical scars can feel lumpy or raised on their own, especially in the first year after surgery. The key difference is behavior. A normal scar lump stays the same size whether you’re standing or lying down, coughing or relaxed. An incisional hernia changes size with position and effort. If you can make the lump appear by standing and bearing down, and it flattens when you lie down and relax, that’s the hallmark of a hernia rather than scar tissue.
Another distinguishing feature is location relative to the scar. Scar tissue sits within the scar line itself and feels firm and fibrous. A hernia bulges outward from beneath the scar or alongside it, and the soft, compressible quality feels distinctly different from the hard ridge of scar tissue. If you’re unsure, a simple ultrasound or physical exam can confirm which one you’re dealing with.