A part of the intestine protrudes through the belly button in the abdominal muscles. This condition is called umbilical hernia. However, this can also be due to the abdominal fluid causing the bulge. Umbilical hernia is harmless in most cases and is common in children. The condition can affect adults too, while commonly it is found in children. Umbilical hernia causes the belly button to protrude when the child cries. This closes around the age of 1 or 2 in many children. When the condition does not go off naturally until the age of 4, surgical intervention is required. This condition occurs in 10 to 20% of children and is very common in African Americans.
In adults, the umbilical hernia can bulge out suddenly. When the age increases, the abdominal walls weaken resulting in umbilical hernia in elders. In 90% of the cases, umbilical hernia is acquired in adults. This implies that umbilical hernia bulges due to the pressure caused around the umbilical region.
Symptoms of Umbilical Hernia:
– Bulge: An umbilical hernia appears as a bulge in the belly button. This is more obvious when the child cries. This can also be clearly seen when the child coughs. This disappears when the child becomes quiet. In a few children, it can become smaller instead of disappearing.
– Disappears when pushed: When the physician pushes it down gently when the child is not crying and calm, the bulge usually goes in.
– Pain: The baby experiences pain
– Vomiting: The baby can also start vomiting
– Firm in adults: In a few cases, the bulge can be red and firm. This is because the intensities get trapped with an umbilical hernia. Known as incarcerated hernia, can cause severe pain to the children. In case of the incarcerated umbilical hernia, an emergency medical checkup is required. However, this is a very rare case.
– Discomfort: In adults, the major symptom is the bulge or swelling close to the navel region. In adults, this can cause severe pain and discomfort, and surgery is required.
– The bulge is red, swollen and discoloured in both babies and adults
– Increasing sharp pain in the abdominal area accompanied by vomiting in case of strangulated or incarcerated hernia. Immediate medical attention and surgical removal of a hernia are required.
– Pain or pressure in the site of a hernia
– Loss of appetite too can occur as the bulge in the abdominal wall can mess up with the intestinal functions.
Causes of Umbilical Hernia:
– In children: When a mother is pregnant, the umbilical cord is how the baby survives. A small opening lets the cord to pass through the abdominal muscles. Soon after birth, the opening closes. When there is not the complete joining of the muscles midline of the abdomen, the abdominal wall becomes weak. This can cause an umbilical hernia in the child immediately, or at any point in time.
– Multiple pregnancies
– Any abdominal surgery in the past
– Chronic peritoneal surgery
– Fluid in the abdominal cavity
– Pregnancies with multiple fetuses
– A persistent cough
All these causes exert much pressure in the weak abdominal walls causing the intestine to bulge through near the navel area.
Risk factors related to Umbilical Hernia:
– Ageing is a risk factor. The abdominal walls weaken, and any pressure exerted can lead to an umbilical hernia.
– Compared with the individuals of normal height and weight, the obese individuals have a higher risk of an umbilical hernia.
– Males have a higher risk of an umbilical hernia, compared with females.
How to diagnosed Umbilical Hernia?
– A physical examination is most of the times enough to diagnose an umbilical hernia. The doctor checks if a hernia can be pushed back into the abdominal cavity, popularly called reducible hernia.
– In case of incarcerated hernia, the physician checks if the intestinal part is trapped in the bulge. This can be a severe complication for the trapped contents, as they do not get blood supply and are strangulated. The result can be permanent tissue damage.
– X-ray and ultrasound scan are performed to rule out complications.
– In the case of incarcerating a hernia, blood tests are also recommended. This is to check for chances of infection or ischemia. The blood test can also be recommended in a reducible hernia too.
– Computerized Tomography scan is also required to get a clear picture of the strangulated hernia.
– ECG is required for patients over 45 years of age, and also patients who have a high risk of heart problems.
Prevention of Umbilical Hernia:
– Carrying heavy objects and weight can push the weak abdominal walls causing an umbilical hernia. Effective weightlifting techniques can help in preventing an umbilical hernia.
– Managing weight is also a good option to keep off umbilical hernia. Excess weight can add to the pressure on the abdominal walls.
– Likelihood of developing umbilical hernia can be prevented during pregnancy, by undertaking certain preventive measures. Avoiding lifting heavy objects can help.
– If one’s job demands to carry heavy objects, then using good weight lifting techniques is necessary. Using back braces is an effective technique.
– Straining during bowel movement should be avoided. Taking a fibre-rich diet can help in easing the release of bowels.
– Coughing and sneezing should not be done with too much pressure.
– Minor sharp movements too can result in an umbilical hernia.
Treatment of Umbilical Hernia:
In children, umbilical hernia disappears around the age of 4. When this does not occur naturally, surgical repair is advised. In a few children, the hernia grows after the age of 1 or 2 years.
– Surgical repair is required when the intensities are trapped in the hernia sac. This reduces the movement of the intestines and a surgery is mandatory.
– When the bulge remains even after the years of 4, surgery is necessary.
It is a small and swift operation that pushes the bulge back to the intestines. The patient can get back to home on the same day in most of the cases. The muscle layers are stitched over the abdominal area and these results in a strengthening of the same. This can avoid bulge recurring. It takes a maximum of 30 minutes to complete the surgery.
– In adults, an umbilical hernia can worsen ending up in the rupture, and this can result in strangulation. Surgery is necessary to avoid permanent tissue repair.
The surgical procedure is of 2 types:
– Open hernia repair
– Laparoscopic hernia repair
Open Hernia Repair:
– The incision is made near the site of a hernia. A mesh is used by the surgeon, or the muscle layer is sutured.
– Only Repair: The hernia sac is removed in this procedure, and the tissue along the muscle edge is sutured. Then the umbilicus is fixed to the muscle. When the condition is not severe, this technique is used.
– Open Mesh Repair: A mesh is placed under the hernia site. The stronger tissues and the mesh are sutured together. When the hernia repairs are larger, then the muscles are used. This is to avoid the risk of recurrence.
– Staples, sutures, and surgical glue are used for the open repairs.
– Local anaesthesia might be given instead of the general anaesthesia for the simple open repairs. The local anaesthesia can be given through IV or at the hernia site.
– When a complex hernia is removed through surgery, large drains are placed outside the abdomen.
Laparoscopic Hernia Repair:
– Small incisions are made in the laparoscopic procedure. Instruments are used to place the mesh or sutures inside the incisions. This is a minimally invasive procedure, and the recovery time is faster.
– The number of small punctures may depend on the severity of the hernia bulge.
– The camera and tools are sent through the multiple ports. Before this, the abdomen is inflated with the carbon dioxide.
– The ports are closed after the insertion of the mesh and suturing it using surgical glue or sutures.
Open vs. Laparoscopic hernia repair:
– Chances of recurrence or hospital stay are not different in both these surgical procedures.
– The wound complication rate is, however, lower in the laparoscopic hernia repair. The long-term results are however similar.
– Open repairs can be done under local anaesthesia, and are often outpatient procedures. A strangulated hernia can be repaired only under this choice.
– Mesh is used for avoiding recurrence and offers a strong repair.
– Laparoscopic repairs have lesser scar compared with the open hernia repair procedure.
Complications of Umbilical Hernia:
– Infection around the wound area or the area of the incision can arise. This can be controlled with the antibiotics, and wound drainage is needed. It is advised to stop smoking, as this can increase the risk.
– Blood clots, surgical infections, kidney complications, and cardiac complications are present. These are common complications seen in people over 45 years of age when administered general anaesthesia.
– Infection in the lungs
– Infection of kidneys and bladder are also present. This can be reduced by catheter care, and taking adequate fluids.
– After the procedure, you need to slowly increase the activities. Doctors advise to get up once in an hour and walk around to prevent the formation of blood clots.
– Getting back to work takes 2 to 3 days after recovery. Strenuous activities like climbing stairs, and lifting heavy objects should be postponed for 6 weeks.
– A fibre-rich diet is recommended to avoid straining during the bowel movements. 10 glasses of water have to be taken per day to smooth bowel movements. Over the counter medicines are also prescribed for the same.
– Getting soaked in the bathtub should refrain until the sutures or the staples are removed.
– Tight or rough clothing around the incision area can prevent healing.
Myths about Umbilical Hernia:
Myth #1: An outie belly button (a convex naval) means an umbilical hernia
This is not true. An umbilical hernia is a condition where the muscle passage that let the umbilical cord to pass through in the fetus does not close properly. An outie belly button can be normal and not all outie belly buttons are signs of a hernia. After cutting the umbilical cord, most children are seen with outie belly button for a few weeks. Later they the belly button reaches the position in a couple of months, or even longer for a few children.
Myth #2: Placing a 50 cent coin helps
Never. Old wives recommend placing a 50 cents coin on the navel of the child with umbilical hernia. They recommend wrapping the coin tight with a cloth. But, this is of no good and only can hurt the baby when it turns around or moves when asleep. The skin can be bruised because of the coin.
Myth #3: Recurrence of hernia cannot be prevented
High fibre diet, regular moderate exercises and a healthy weight can help in preventing the hernia from hitting back after the surgery. Your doctor suggests the safe exercises and diet plan after the surgery.
Myth #4: Non-surgical procedure is possible in any stage of Umbilical Hernia
In adults, watchful waiting is not an option when affected by umbilical hernia. If the hernia is reducible, then one can wait to push it back, and this is not going to cause discomfort. In case of incarcerated hernia, the condition is worsened, as the intestine can be squeezed without any blood supply. In such cases, the immediate operation is required.
– Sudden pain and vomiting can be experienced when an operation is not chosen with incarcerate hernia. The hernia pouch is where the intestine is squeezed and can cause too much of discomfort, if not a sharp pain.
– This can also lead to the bladder injury, intestines, nerves and the blood vessels.
– Intense pain in the hernia site can be experienced, when the intestines are squeezed beyond a certain limit.
– The operation is done under general anaesthesia. Doctors suggest urinalysis, blood tests, and ECG if you are over 40 years before the surgery is carried out. The health and medical history are evaluated before the surgery is done.
– Before and after 6 hours of the administration of general anaesthesia, the patient is required to stay off from eating and drinking.
– If the repair is simple, you can get back home the same day, but cannot drive.
– After the surgery, when you have a fever of more than 101 degrees Fahrenheit, or no bowel movements for 3 days contact the doctor immediately.
– When there is an odour or discharge from the incision, immediately get back to the doctor.
Umbilical Hernia might look like a minor condition from the outside. However, it is a much more serious situation and must be treated as soon as one or more symptoms become visible. You should contact your Doctor immediately if you observe any deformation/protrusion in the belly button or around the naval area.