Umbilical Hernia

What Is An Umbilical Hernia? What Causes An Umbilical Hernia?

An umbilical hernia occurs when part of the bowel or fatty tissue pokes through an area near the belly button (navel, umbilicus), pushing through a weak spot in the surrounding abdominal wall. Approximately 1 in every 10 infants is affected by an umbilical hernia - they are common in premature babies.

While the developing fetus is in the uterus (womb), the umbilical cord passes through an opening in the abdominal wall, which should close before the baby is born, or soon after. However, sometimes the muscles do not completely seal, leaving a weak spot through which an umbilical hernia can develop. The hernia looks like a lump in the navel, which may become more evident when the baby is laughing, crying, heaving (going to the toilet), or coughing. When the child is lying down or relaxed the lump may shrink. It is not usually painful.

In the majority of cases an infant's umbilical hernia closes on its own by the age of 12 months. If the hernia is still there by the time the child is 4 years old, the doctor may recommend surgery.

Umbilical hernias may also develop in adults, especially if they are very overweight, lifting heavy objects, or have a persistent cough. Women who have had multiple pregnancies have a higher risk of developing an umbilical hernia.

In adults, hernias are much more common in females. Among infants, the risk is about the same for boys and girls.

According to Medilexicon's medical dictionary:

an umbilical hernia is

a hernia in which bowel or omentum protrudes through the abdominal wall under the skin at the umbilicus.

What are the signs and symptoms of an umbilical hernia?

A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign.

There may be a soft bulge/swelling near the umbilicus (navel), ranging from about 1 to 5 cms in diameter (0.5 to 2 inches). The bulge is usually more noticeable if the baby cries, laughs, coughs or strains.

Pain - in children and infants umbilical hernias are not usually painful. Adults may feel pain or discomfort.

When to see a doctor:

• If you see a bulge and would like to know what it is
• The bulge becomes painful
• The infant/adult vomits (and there is a bulge)
• The bulge swells up more
• The bulge becomes discolored

What are the risk factors for umbilical hernias?

A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2.
Age - infants, especially those born prematurely, have a higher risk of having an umbilical hernia than older humans.

Being obese - obese children and adults have a significantly higher risk of developing an umbilical hernia, compared to individuals of normal weight for their height and age.

Coughing - prolonged periods of coughing increase the risk of hernias.

Multiple pregnancies - when the pregnant mother is carrying more than one baby inside her. The risk of an umbilical hernia is higher if the woman has a multiple pregnancy.

What causes an umbilical hernia?

Babies - as the fetus develops in the mother's uterus (womb), there is a small opening in the abdominal muscles allowing the umbilical cord to pass through - this connects the mother to the baby.

Around the time of birth, or shortly afterwards, this opening in the abdominal muscles should close. When this does not happen - if the opening does not close completely, fatty tissue or part of the bowel can protrude (poke through), causing an umbilical hernia.

Adults - if there is too much pressure on the abdominal wall, fatty tissue or a part of the bowel can poke through a weak part of the abdominal muscle. Individuals at high risk (see Risk Factors) are more likely to have higher-than-normal pressure in areas where fatty tissue or parts of the gut can protrude.

How is an umbilical hernia diagnosed?

A doctor will be able to diagnose an umbilical hernia during a physical examination. He/she may also be able to determine what is protruding; what is caught in the hernia sac.

If the doctor wants to screen for complications, an abdominal ultrasound, X-ray or blood tests may be ordered.

What are the treatment options for umbilical hernia?

Babies and children - in the majority of cases the hernia closes on its own by the age of 12 months. Sometimes the doctor may be able to push the lump back into the abdomen (it is important that only the doctor do this).

Surgery may be ordered if:

• The hernia grows after the child is one or two years old
• The bulge is still there by the age of four years
• If the hernia blocks the intestines
• If the hernia becomes trapped

Adults - surgery is usually recommended, to prevent potential complications, especially if the hernia grows or starts to hurt.

Surgery - this is a small, quick operation to push the bulge back into place and to make the abdominal wall stronger. In most cases the child (patient) will be able to go home on the same day.

The surgeon makes an incision at the base of the belly button and pushes either the fatty lump or bowel back into the abdomen. Muscle layers are stitched over the weak area in the abdomen wall, effectively strengthening it. Dissolvable stitches or a special glue are used to close the wound. Sometimes the surgeon will place a pressure dressing, which remains there for four to five days.

An umbilical hernia operation usually takes about 20 or 30 minutes.

What are the possible complications of an umbilical hernia?

Umbilical hernia complications are very rare in children. If the protrusion becomes incarcerated (trapped) and cannot be pushed back into the abdominal cavity it may lose some of its blood supply and become damaged. If the blood supply is completely cut off there is a risk of gangrene, and life-threatening infection.

Incarceration is also rare in adults, but more common than in children. .