Contents
What is umbilical hernia?
Umbilical hernia (ICD-10 K42) is characterized by the protrusion in or around the umbilicus (region of the umbilical scar), consisting of fat or a portion of the intestine that has managed to pass through the abdomen muscle, called the umbilical ring, considered the weakest point abdominal wall.
This can happen due to increased abdominal pressure due to excessive physical effort, in addition to congenital or contracted problems.
The disorder is more common in children, with 1 in 10 suffering from umbilical hernia, but it can also be triggered in adults, especially in women during the stage of pregnancy.
Among the symptoms, we can highlight the pain in the umbilical region, nausea and vomiting. If the problem is not treated correctly, there is a risk of complications and even death.
Causes
The causes of umbilical hernia are associated with abdominal muscle weakness and the clinical history of the disease.
In babies
The appearance of umbilical hernia is more common in premature babies, born with a body mass of less than 2,500 grams. About 20% of them are born with the problem. It is also more frequent in brown-skinned children.
In early pregnancy, the intestines develop outside the fetus’ body. When 3 months of gestation are complete , the intestines return into the abdomen and the muscular wall is sealed, only allowing the passage of the umbilical cord (connection structure between mother and fetus, which ensures that the baby receives blood, oxygen and nutrients ).
To do this, the umbilical cord passes through a small hole called the umbilical ring, consisting of muscles and tissues, and is usually closed after the baby is born.
When this closure of the abdominal wall does not occur in its entirety, organs and tissues can cross the canal around the navel, forming the hernia.
The hernia appears at birth or over the years. However, she tends to disappear on her own until she is 5 years old.
In adults
In adults, the disease can be acquired by exaggerating physical strength and certain health conditions.
Physical effort
Carrying a lot of weight (either in the bag or in the work environment itself) and doing intense physical activities, such as weight training , increase abdominal pressure. As a consequence, the muscle wall becomes fragile.
Prolonged constipation
Intestinal constipation or constipation as it is also called, happens when there is a reduction in the amount of bowel movements and difficulty in performing the act.
The person feels pain from overexertion when trying to evacuate. In some cases, she may experience bleeding and feel “unfinished”. This force exerts pressure on the lower abdomen and, in a prolonged way, can generate the umbilical hernia.
The most common cause for the onset of constipation is a low intake of fluids and foods rich in fiber.
Chronic cough
The cough chronic happens when the cough lasts for more than 8 weeks. The act of coughing causes pressure and stress in the abdomen, which can cause the hernia.
Because it is related to disorders, chronic cough requires medical assistance. Among the most common causes are:
- Asthma;
- Gastroesophageal reflux;
- Upper airway cough syndrome (STVAS);
- Smoking;
- Chronic bronchitis;
- Cough by EICA – enzyme that has the function of decomposing bradykinin in the respiratory tract. Bradykinin, in turn, dilates blood vessels and is used in medicines for high blood pressure;
- Tuberculosis;
- Neoplasia (abnormal tissue mass).
Ascites
The ascites , also known as water belly, is characterized by the accumulation of fluid within the abdominal cavity, increasing its size. The most common cause is portal hypertension – a disease that increases blood pressure in the veins that carry blood to the liver, originating, most of the time, from cirrhosis .
When the volume of liquids is very large, the abdominal wall is elongated, creating umbilical hernias, pain in the abdomen and shortness of breath due to the limited movement of the diaphragm (muscle responsible for human breathing).
The diagnosis is made by analyzing the liquid. Usually, the decrease in salt and the use of diuretics solve the problem.
Risk factors
Some health conditions facilitate the emergence of umbilical hernia. In general, they include those who increase pressure on muscles and abdominal wall tissue. Are they:
Pregnancy
The disease arises mainly in women who had the condition in childhood. In pregnancy, because the abdominal muscle is already weakened by the presence of the fetus, the pressure inside the belly causes a fissure.
Therefore, multiple pregnancies increase the chances of umbilical hernia. Usually the problem does not affect the health of the baby and the mother, nor does it hinder the moment of delivery. In addition, the effort generated during childbirth can also cause the hernia to appear.
Obesity
The obesity is defined by the accumulation of excess fat in the individual’s body. According to the Ministry of Health, 1 in 5 Brazilians are obese. In 2006, 11.8% of the population suffered from this disease, in 2016, this estimate increased to 18.9%.
For these people, umbilical hernias are common. 8% of patients in doctors’ offices who wish to have bariatric surgery have the problem. This is because excess fat weakens the abdominal wall.
Cystic fibrosis
Cystic fibrosis is a genetic and chronic pathology that affects the lungs, pancreas and digestive system. On average, 70 thousand people in the world are affected, mainly during childhood.
Its characteristic is the accumulation of mucus produced by the body, about 30 to 60 times more than normal. Among the most common symptoms are:
- Elimination of excess salt by sweat, in which the person can taste it. That is why the condition is also known as salty kiss disease;
- Loss of body mass;
- Continuous cough, in some cases, there is presence of phlegm;
- Pulmonary infections (pneumonia and bronchitis);
- Difficulty in evacuating, bulky and greasy stools;
- Nasal polyp (benign tumor within the nasal cavity).
Undescended testicles (cryptorchidism)
Usually the testicles descend into the scrotum (muscle sac) in the last months of pregnancy. When this process does not occur, it is called cryptorchidism.
One of the causes of the problem is related to the appearance of hernias through the canal where the testicles descend from the abdomen to the scrotum. Other circumstances include hormonal changes, low birth weight and premature birth .
Urethral problems
People with problems in the urethra – the channel through which urine is expelled -, such as cysts, infections and cystitis , need to use more force when urinating, which can cause umbilical hernia.
Hip dysplasia
The hip comprises the lateral part of the human body, from the waist to the thigh joint. Dysplasia occurs when there is malformation in the acetabulum (a structure that, together with the head of the femur, constitutes the hip joint), which does not allow for proper bone fitting.
As a result, there is friction between the parts, causing wear. Umbilical hernia is one of the symptoms.
Symptoms of umbilical hernia
The larger the size of the hernia, the more intense the symptoms will be, especially in situations of weightlifting, pressure on the abdominal muscles and long periods of standing.
The disease, in most cases, is perceived only by the bulge in the navel. In certain cases, there is abdominal discomfort. In the most severe cases, however, the symptoms include:
- Sudden and severe abdominal pain;
- Enjoo;
- Vomiting;
- Cold.
In children, hernia is usually painless, but the symptoms are related to the severity of the disease. See a doctor immediately if your child has:
- Ache;
- Vomiting;
- Soft, swollen or discolored protrusion.
The condition can be worsened when the child cries while coughing, moving a lot or making a lot of effort. In contrast, if she is lying down or calm, the symptoms subside.
How is the diagnosis made?
The doctor who should be consulted is the pediatrician or general practitioner . In cases of umbilical hernia, the following procedures can be adopted:
Physical exam
The specialist will look and touch the abdomen region. He can also ask the patient to cough or blow his hand without letting the oxygen out. The aim is to increase abdominal tension and reveal the hernia.
In addition, to measure its shape and size, the doctor can hold it tightly or stretch it.
Abdominal ultrasound
Abdominal ultrasound is used in more severe cases. It consists of capturing images of organs from the upper abdomen using a device called an ultrasound.
The procedure does not cause pain and lasts an average of 5 minutes, being done through the introduction of a probe in the abdominal region.
X-ray
The X-ray or X-ray exam is used in specific situations. In it, it is possible to have images of organs, such as spleen, stomach and intestines.
To make the diagnosis, the person must lie on their backs. The X-ray instrument will be positioned on top of the abdomen. Oxygen must be retained at this point so that there is no image tampering.
Is umbilical hernia curable?
There is no treatment to “cure” the umbilical hernia. It can disappear on its own or be removed through surgical intervention.
Treatment
When it appears in children, the umbilical hernia measures around 1 to 5 centimeters and usually disappears on its own between 4 and 5 years of age. When feasible, the doctor can also force the lump back into the abdomen.
If the lump continues, even after this period, it is possible that the pediatrician will indicate surgery . In cases of major hernias, the intervention can be done in children from 2 years old.
Other factors also require the removal of the protrusion:
- If the hernia increases in size in children 1 to 2 years old;
- If the intestines are located inside the hernial sac, which makes it impossible or slows down the bowel movements (peristalsis);
- If the hernia is stuck.
In adults, however, the umbilical hernia does not disappear naturally, it even increases in size, requiring surgery to avoid complications, such as incarceration and strangulation.
Surgery
Surgery can be performed at a hospital or outpatient surgery center. It usually lasts around 45 minutes, requiring anesthesia. Most children are discharged after a few hours after the procedure.
The procedures can be:
Herniorrafia
Also known as hernioplasty, herniorrhaphy is a simple operation, but it requires anesthesia. An incision is made in the abdomen to remove the hernia.
Once this is done, the hernial ring is closed by means of thick and rigid screens that will help prevent new hernias, or even by surgical stitches that prevent the organs from leaving.
Laparoscopy
In laparoscopy, 3 to 6 small holes are made in the abdominal region. Through these holes, a microcamera is passed in order to analyze the abdominal interior, as well as the necessary instruments to remove the hernia.
Due to the use of general anesthesia, the patient needs to stay at least one day in the hospital. Unlike the conventional method, in which a large cut is made, this procedure leaves smaller scars, around 1.5 cm, which reduces the recovery time and the risk of infections and complications.
Single-hole laparoscopy
In 2011 a new method of laparoscopy emerged. Known as scarless surgery or single port , only one cut is made in the abdomen, with a size of 2.5 cm and hidden under the navel itself.
In addition to enabling faster rehabilitation, single-hole laparoscopy decreases postoperative pain and bleeding.
Postoperative
In aggravated situations, the surgical procedure is efficient. The risk of complications and recurrences is almost nil.
For most children who remove the umbilical hernia through surgery, they are discharged within hours of the procedure. To relieve postoperative discomfort, the child can use painkillers.
Some precautions must be followed, such as not swimming for a period of 5 to 10 days and not playing sports for 2 to 3 weeks. The return to the pediatrician should occur in 2 to 4 weeks.
However, some health conditions of the child must be observed. If you have them, medical care must be immediate:
- Fever;
- Redness;
- Swelling;
- Ache;
- Overhang near the navel;
- Blood or foul-smelling liquid near the cut;
- Illness,
- Vomiting;
- Diarrhea;
- Long-term constipation.
In adults undergoing surgery, it is recommended to stay in absolute rest for a period of 1 to 2 weeks. Afterwards, the doctor should be consulted and tell you what activities will be allowed.
Certain foods, such as those abundant in lean protein (egg, chicken breast and fish) help in healing, as they help in the growth of tissues. Drinking a lot of water is also recommended, as it moisturizes and increases the skin’s elasticity.
Medicines
In the postoperative period, it is normal for the patient to experience abdominal pain and swelling, which can be resolved using analgesics and anti-inflammatories:
- Sodium Dipyrone Monohydrate ( Dipyrone );
- Celecoxibe;
- Cloridrato de Tramadol (Tramal);
- Codeine ;
- Ibuprofen ( Ibuprofen );
- Paracetamol.
Attention!
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
Complications
If the umbilical hernia is not removed, complications may arise, which will require emergency surgery. Problems related to the disease include:
Hernia incarceration
Hernia incarceration is rare, being more common in adults. The problem occurs when the intestine is trapped inside the hernia and fails to return to the abdomen. As a consequence, blood flow is decreased, causing umbilical pain and contusions in the tissue. If the interruption of blood is definitive, it can develop into a strangled hernia.
Hernia strangulation
Approximately 3% of all types of hernias are strangled. It is one of the most feared complications, as it can lead to death and requires immediate surgery. Delay in treatment can result in intestinal necrosis, meaning the organ dies, so the infection can spread throughout the body and create a life-threatening situation.
The non-functioning of the intestine, in turn, causes elongation of the abdomen (stuffing), loss of appetite, nausea and vomiting. The person may also experience severe continuous pain in the area where the hernia is contained.
It is not possible to predict when the strangulation will appear, as this does not depend on the size of the hernia and on how long you have the disease.
Intestinal occlusion
Intestinal occlusion is a consequence of strangulation, characterized by the suspension of intestinal functioning. Intense abdominal pain, vomiting and lack of gas or stools, are some of the symptoms of intestinal occlusion
The individual must be hospitalized immediately, otherwise, he may have a series of complications, such as:
- Dehydration;
- Renal insufficiency;
- Heart diseases;
- Peritonitis (inflammation by bacteria or fungus in the abdominal tissue);
- Shock state (when oxygen decreases or stops reaching cells).
Treatment varies in each case, and can be medication, endoscopic and surgical.
Related diseases
Umbilical hernia, however, can still be associated with other diseases, such as:
Congenital hypothyroidism
The hypothyroidism Congenital is a disease that prevents the baby create the hormone thyroxine thyroid (T4), responsible for regulating metabolism. The lack of it impairs the child’s physical and mental development.
The most common causes are the low amount of iodine in the food (which produces T4), the absence of the thyroid gland or heredity. Signs include anemia , excessive sleep, umbilical hernia and dry skin.
The disorder is diagnosed as early as the first week of birth, through the heel prick test . Treatment is done through deficient hormone replacement in the body throughout its life.
Síndrome de Beckwith-Wiedmann
Beckwith-Wiedmann syndrome is a rare disease that affects 1 in 13,700 children at birth. The causes are diverse, from genetic and epigenetic changes (transformations of the genome but which do not change the DNA sequence) on chromosome 11 to heredity.
Its main feature is the abnormal growth of certain internal and external organs and body deformity. Umbilical hernia, embryonic tumors and neonatal hypoglycemia (low glucose level, below 70 mg / dL) are also indications of the syndrome.
The diagnosis is made during prenatal care or shortly after delivery by means of exams. The treatment varies according to the symptoms presented, as well as the specialists (pediatrician, cardiologist, surgeon or dentist).
Mucopolissacaridose I (MPS I)
Also rare, mucopolysaccharidosis I is a disorder that causes the malformation of enzymes, which act in several functions of the organism. In all, of genetic or hereditary origin, 7 types of MPS are identified.
The most common is lysosomal deposit disorder (DDL), characterized by a deficiency of the enzyme alpha-L-iduronidase, responsible for fragmenting glycosaminoglycans (GAGs) – chains of sugar molecules that make up bones, cartilage, skin and other tissues. The person may develop problems, such as stiffening of the joints, deafness, hernia (inguinal or umbilical) and enlargement of the liver and spleen.
In the medical evaluation tests are performed to measure the levels of enzymes in the blood. Depending on the degree of severity of the symptoms, the person may undergo enzyme replacement or even bone marrow transplantation. The patient must be diagnosed and treated early in the disease to avoid possible complications.
How to prevent
There are no ways to prevent umbilical hernia in babies and children. In adults, the recommended thing is to maintain an upright posture when lifting weight, to have a healthy diet, as this contributes to the intestinal flow, and control of the body mass, in addition to practicing physical activities that strengthen the abdominal muscles.
Umbilical hernia is a common disease in babies at birth, but it can also be derived from excessive physical effort, in the case of adults. Complications can lead the patient to death.
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