The umbilical hernia (umbilical hernia) is the exit of an abdominal organ (usually the intestine) from the cavity in which it is contained (abdomen) occurring through the abdominal muscles of the umbilical zone.
Umbilical hernias are more common in children and infants, but can also affect the elderly.
In children, the umbilical hernia becomes particularly evident when the child cries or coughs. This is a classic sign of an umbilical hernia.
What are the causes of an umbilical hernia?
When the fetus develops in the mother’s womb, there is a small opening between its abdominal muscles, through which the umbilical cord passes.
This umbilical cord connects the child with the mother.
At birth, this opening between the abdominal muscles should close.
If the opening does not close completely, fatty tissue or part of the intestines can emerge and form an umbilical hernia.
Newborns are particularly affected:
- of African origin,
- with low weight,
- Premature birth.
If great pressure is exerted on the abdominal wall, fatty tissue and parts of the intestine can escape through a weaker part in the abdominal muscles.
Exercises for bodybuilding can aggravate a hernia, especially during exercises designed to strengthen the abdominal muscles.
Hernias can develop in people who have diseases in which abnormal pressure develops in the abdomen, such as:
- fluid accumulations in the abdomen (ascites),
- surgical interventions.
Another cause of an umbilical hernia is childbirth.
What are the risks of an umbilical hernia?
If an umbilical hernia is not treated, the following problems may arise:
- Incarcerated hernia: the doctor can not push the hernial sac back into the abdomen. The tissue becomes trapped and can provoke intestinal obstruction.
Umbilical hernias can easily become pinched.
- Hernial strangulation: a leaked intestinal loop can be strangled. The result is reduced blood flow in this area. In this case, severe pain arises in the abdomen.
With an incarcerated hernia, possible consequences are:
- Stomach ache
- nausea and vomiting.
If the hernia is not treated immediately, the strangulated part of the intestine may die (risk of gangrene) and the faecal contents may leak out of the intestine, possibly resulting in peritonitis.
These complications are very rare in children.
Signs and symptoms of umbilical hernia
In adults, an umbilical hernia may be asymptomatic, but as it grows larger, manifests itself with the following symptoms:
- protrusion near the navel, which increases with coughing, abdominal tension and standing;
- abdominal pain around the navel area;
- Abdominal bloating.
Symptoms in newborns and infants
The umbilical hernia leads to a soft swelling near the navel.
If the child has an umbilical hernia, it is especially visible if it:
The protrusion may disappear if the child is still or lying on his back.
Umbilical hernias in children are usually painless.
Diagnosis of umbilical hernia
The doctor can diagnose umbilical hernia during examination and palpation of the abdomen.
During the physical examination, one can observe whether the hernia recedes (re-enters the abdomen).
The doctor may order abdominal bandages or perform an ultrasound examination to determine if there is a risk of complications.
When is a doctor’s visit necessary?
One should go to the emergency room if the child has an umbilical hernia and
- feels severe pain at the level of the navel,
- begins to vomit,
- the expansion becomes pressure-sensitive, swells or discoloured.
Therapy of umbilical hernia
In most cases, in infants, the umbilical hernia recurs within 18 months.
Fixing the hernia with a bandage is not correct, because it does not solve the problem and can cause skin abrasions.
When is surgery performed in children?
Surgical intervention in children is carried out for:
- painful hernia,
- hernia with a diameter of more than 2 centimeters,
- hernia, which has not decreased after 6-12 months,
- Hernias that have not passed after 3 years and do not cause discomfort, in most cases disappear within 18 months.
- Hernia that is incarcerated or strangulated.
Intervention in adults is recommended to avoid possible complications, especially if the hernia becomes larger or painful.
Surgical intervention for umbilical hernia
The operation for umbilical hernia repair is relatively simple.
- As a rule, the operation takes 60-90 minutes.
- The procedure is performed under local or general anesthesia, so you do not feel any pain.
The mesh technique without suture is performed under local anesthesia.
In children, general anesthesia is used.
- The surgeon may make an incision below the navel or make some small incisions (laparoscopy) to insert the surgical instruments into the abdomen.
- The leaked tissue is pressed into the abdomen.
In the conventional method, the hernial portal in the abdominal wall is closed with seams. In a new surgical procedure, the surgeon uses a mesh consisting of 2 layers: the outside is made of polypropylene with micropores, the inside (in contact with the intestinal loops) of non-stick polytetrafluoroethylene (PTFE).
Today there are also biological materials.
- The net has two outer wings, with which it is moved in the abdomen; the mesh does not need to be attached to the abdominal wall through a seam, it adheres to the surrounding tissues or biological adhesives are used.
- The laparoscopic technique provides for the introduction of a polypropylene or
mersilene mesh and a collagen layer, which prevents the formation of adhesions with the intestinal loops.
This prosthesis leads to the formation of fibrous tissue.
- The procedure is minimally invasive and the patient can be discharged on the same day a few hours after surgery.
- After a few months, the scar in the navel area is almost invisible.
After the operation, no heavy activities may be carried out for a week.
Surgical risks are:
- Scar adhesions.
If the operation was performed under general anesthesia, you have to rest until the side effects of the anesthesia have passed.
When discharged from the hospital, a relative should be present and for the first 24 hours after the operation, one should not be alone at home for safety reasons.
Before discharge from the hospital, one learns all the necessities for the treatment of the wound. The surgeon may also prescribe antibiotics over a few days.
At the time of discharge, the doctor sets an appointment for the check-up, usually 7 days after the procedure.
After umbilical hernia surgery
After the surgical procedure, the patient is taken to a separate room where he can meet with his relatives before he is brought back to the ward.
Recovery time after repair of the umbilical hernia
If the anesthetic effect wears off, the painkiller such as ibuprofen or acetaminophen may recommend.
Regarding the dose and duration of use should ask his doctor or pharmacist.
General anesthesia temporarily impairs coordination and sanity. It is therefore not recommended to use after surgery:
- to drink alcohol,
- to travel by car,
- sign legal documents.
In the first 1-2 weeks of convalescence, slight pain may occur in the navel area.
- One should not exert oneself or stretch the scar, as this could increase the abdominal swelling and slow down the healing process.
- For at least 4 weeks you should not perform lifting exercises or strenuous exercises.
However, some light exercises, such as walking, can be performed that speed up healing.
- In the first two days you should not wet the navel area, because this could detach the bandage.
The absorbable threads of the sutures disappear on their own after 7-10 days.
Nutrition after surgery for umbilical hernia
To favor the functioning of the intestine, the doctor recommends eating light food, avoiding heavy food and drinking enough water.
What are the long-term prospects for an umbilical hernia?
Once cured spontaneously or surgically, it is possible for the hernia to recur.
Recurrences are more common in the elderly.