Umbilical hernia

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at May 31, 2016
StartDiseasesUmbilical hernia

An umbilical hernia is a condition found mainly in infants though it can also occur in adulthood. For babies, most umbilical hernias are painless and will typically heal on their own before the child’s first birthday.

Contents

Definition & Facts

There are two types of hernias which present themselves in patients: congenital and acquired. A congenital umbilical hernia, present at birth, occurs as a result of the intestines and other soft tissue bulging through a weak spot around the belly button where stomach muscles have not properly closed. These hernias are more prevalent in babies who are premature or have low birth weights. Acquired hernias develop over time and are typically the result of some sort of injury.

African American babies tend to experience higher rates of hernias than other children. In addition, those with Beckwith-Wiedemann syndrome and Down syndrome run a higher risk. There has been no discernible difference in the occurrence of hernias in boys and girls.

For adults, hernias are more common in women than in men. While hernias in babies typically resolve themselves, hernias in adults can be painful and will usually require treatment. For infants who experience an umbilical hernia, they are slightly more likely to experience them again as adults due to the fact that the abdominal lining may not have completely healed. 

Symptoms & Complaints

For infants, the presence of an umbilical hernia is typically spotted when the baby is laughing or crying and is indicated by a protrusion of the belly button. Babies experiencing any of the following symptoms may have an umbilical hernia and require immediate medical attention as they may be indicative of trapped or incarcerated intestines:

Causes

For adults, the weakening of the stomach muscles resulting in an umbilical hernia can be related to the following factors:

For newborns, the umbilical cord passes through a small opening in the baby’s abdominal muscles. Normally, this opening closes shortly after birth. An umbilical hernia can occur when the abdominal muscles do not join completely together.

Diagnosis & Tests

A doctor will diagnose an umbilical hernia by performing a physical examination. X-rays and ultrasounds are used to check for any potential complications related to an umbilical hernia. Intestines which are trapped or incarcerated can result in reduced blood supply causing further complications, including gangrene. CT scan and MRIs may also be used for capturing images of the lower abdomen to diagnose a hernia.

Treatment & Therapy

Treatment is typically unnecessary for infants with an umbilical hernia. In some cases, doctors can push the bulge into place during a physical examination. This should only be performed by a doctor. If treatment is required for children, it is typically in instances where:

  • Complications such as trapped intestines have occurred
  • The area is painful
  • The child has reached four years of age
  • A hernia is greater than 1.5 cm in size

In order to repair a hernia, there are typically two types of surgical procedure options: open hernia surgery and laparoscopic surgery. Open surgery involves the doctor making a small incision at the base of the belly button. The bulging tissue is placed back into the abdominal wall and the abdominal wall is then stitched closed. This surgery is usually performed on an outpatient basis under general anesthesia and patients can typically go home on the same day.

A doctor will prescribe pain medication along with advice for keeping the stitches dry. The majority of people can return to their normal routine within two to four weeks of surgery. After surgery, there will be some swelling around the incision known as the healing ridge. This firm ridge is usually found under the belly button and can last for several months. It goes away on its own over time. Once the surgery is complete, an umbilical hernia rarely reoccurs.

Laparoscopic surgery involves the surgeon making between two and four small incisions allowing a camera and surgical instruments to be inserted. The camera allows the surgeon to view what is happening on a television monitor during the procedure. The stomach area is filled with gas to create ample room for the surgeon to work. The gas is released once the procedure is complete.

Laparoscopic surgery is considered to be a newer, less invasive procedure than open surgery. Similar to open surgery, patients typically go home the same day. In the case of both laparoscopic and open surgery, the affected tissue is reinforced with mesh to help prevent a hernia from reoccurring. General anesthesia is typically used during both procedures.

As with any surgery, there are always potential complications related to both the anesthesia provided during surgery and the surgical procedure itself. Allergic reactions to the anesthesia medicine used and breathing problems, though rare, have been known to occur. During surgery, there is also a small risk of injury to the small intestine and large intestine. Infections of the skin, deep tissue, or mesh are a potential risk. Chronic pain (that lasting greater than three months) is a sign of complications during surgery and should be reported to the patient’s healthcare provider right away.

Prevention & Prophylaxis

While an umbilical hernia cannot be prevented in infants, there are steps which adults can take to reduce the chance of occurrence. This relies heavily on taking steps to maintain a healthy weight, reduce pressure while coughing and sneezing, and use good techniques when lifting heavy objects.

For occupations that require constant heavy lifting such as construction jobs, back braces may assist in reducing pressure on the lower abdomen. Avoiding constant pressure on the lower abdomen including that caused by straining during a bowel movement will help to reduce chances of a hernia occurring. Even sharp movements, though they may seem minor, can contribute to the occurrence of an umbilical hernia.

In some communities, there is a superstitious practice to tape coins over the affected area with the notion that this would restrain the bulge and allow it to heal faster. This has not proven to be the case and can actually lead to infection of the affected area if left unattended; it should be avoided.