An umbilical hernia, technically known as an umbilical hernia, refers to a tear or opening in the abdominal wall through which the intestines can visibly leak forward. Infants are often affected, but middle-aged women are also affected. Experts advise that umbilical hernias in adults should always be operated on.
What is an umbilical hernia?
Schematic diagram of an umbilical hernia in infants. Click to enlarge. By an umbilical hernia, medical professionals do not mean a hernia in the strict sense. Rather, it is a tear or hole in the abdominal wall that allows the intestines to come forward. Often this happens due to a violent pressing or pressure, which causes the abdominal wall to give way. The viscera are then held in place only by the skin inside. Visually, an umbilical hernia can be recognized by a clearly visible bulge in the area of the navel, the so-called hernia sac. Umbilical hernias occur particularly frequently in infants. However, adults, especially women between the ages of 50 and 70, can also be affected.
Causes
An umbilical hernia can occur for a variety of reasons. Basically, a weakness of the abdominal wall in the area of the former umbilical cord is the trigger for the leakage of the intestines. This weakness is genetically determined. It can either be congenital or develop slowly during life. Often, the abdominal wall does not grow together properly after birth, which is the reason for common umbilical hernias in infants. If an adult suffers from an umbilical hernia, the weakness of the abdominal wall has developed over the years. Then, a heavy load on the abdominal muscles or heavy pushing during pregnancy or even constipation is enough to cause a tear in the abdominal wall.
Symptoms, complaints and signs
An umbilical hernia is first noticeable by a swelling or protrusion in the area of the umbilicus. The swelling usually does not cause any symptoms at first. Depending on whether parts of the intestine are trapped, a pulling or burning sensation may develop. Signs of inflammation such as hard or reddened areas are also characteristic. The pain occurs mainly when bending, pressing, coughing or lifting heavy loads. Rarely, the bowel may become lodged in the hernia sac, resulting in severe pain. The affected intestinal region is also no longer adequately supplied with blood and oxygen, which can lead to necrosis. Such a severe course is also manifested by blood in the stool and other discomfort during bowel movements. In addition, colic, fever, and nausea and vomiting occur in some cases. Incarceration of the bowel occurs in four out of one hundred patients. In the remaining cases, the umbilical hernia is asymptomatic and is only detected during a routine examination. If the umbilical hernia is not treated, symptoms increase. Eventually, perforation may occur, leading to internal bleeding, infection and other life-threatening complications. With early evaluation and treatment, umbilical hernia symptoms resolve completely within a few weeks.
Diagnosis and course
The attending physician can determine whether an umbilical hernia is present primarily by performing an ultrasound examination. In this way, he can see if the intestines have changed position. He can also try to move them back into the abdominal cavity with light pressure. If this is not possible or if pain occurs, it may be that the intestines are trapped. Then a quick operation becomes necessary. Basically, an umbilical hernia does not necessarily need to be treated, because it does not pose an immediate threat to health without jamming of the organs. However, affected persons must be aware that it does not heal on its own – this only happens in infants up to three years of age.
Complications
During the first two years of life, an umbilical hernia usually heals on its own. At older ages, serious, sometimes life-threatening complications can be expected with an umbilical hernia, especially if it is not treated promptly. Parts of the intestine can become trapped in the hernia sac, which is associated with very severe, colicky pain. The abdomen becomes very sensitive to pressure; even light touch during the examination can cause extreme pain in the patient.Larger umbilical hernias with parts of the large or small intestine in the hernia sac can cause diarrhea or constipation, and sometimes patients observe blood in the stool. In addition, there is a risk that the trapped parts of the intestine will no longer be supplied with sufficient blood and will strive away. If the protective abdominal wall is missing, dangerous injuries to the intestine can occur, often requiring emergency surgery. Other possible complications include high fever combined with nausea and vomiting. If entrapment occurs, sweating, excruciating thirst, rapid heartbeat and a sharp drop in blood pressure are also common. If treatment is delayed, there is also a risk that the contents of the hernia will become inflamed or stick to the surrounding area, making it impossible to reduce the hernia. If emergency surgery is required as a result of delayed treatment, the risk for pulmonary embolism also increases.
When should you see a doctor?
Irregularities and disturbances in the navel area should be presented to a physician. If there is swelling, discoloration of the skin appearance or deformity, action is needed. A visit to the doctor is necessary if there is a protrusion or lump formation on the navel. If the swelling increases in size, a doctor should be consulted as soon as possible. If pain occurs, the affected person needs help. Painkilling medication should not be taken and should only be administered in consultation with a physician. There is a risk of risks and side effects, about which the affected person must be informed and educated. Bleeding or loss of other bodily fluids from the umbilicus is a cause for concern. They must be presented to a physician so that clarification of the cause can be made and a treatment plan established. If blood occurs in the stool or urine, these complaints should be discussed with a physician. A general feeling of malaise, nausea, indigestion, irregularities in heart rhythm or internal weakness are signs of impaired health. If the symptoms persist or show increasing intensity, a doctor is needed. In case of fever, cramps or colic, a visit to the doctor should be made immediately. Since an umbilical hernia can be life-threatening, a follow-up visit to a doctor should be made at the first signs.
Treatment and therapy
If the attending physician has clearly diagnosed an umbilical hernia, it must be considered whether and how it should be treated. In young children, there is usually no treatment of the hernia, because it usually heals on its own without complications up to the age of about three years. In some circumstances, the abdomen may be bandaged to help this process. If an adult suffers from an umbilical hernia, there is no chance of self-healing. Experts advise having the hernia treated surgically to minimize the risk of life-threatening organ entrapment. Such a surgical procedure can even be performed on an outpatient basis; the patient can usually leave the clinic after just a few hours. Basically, there are two surgical methods to choose from, which differ in how large the umbilical hernia is in the individual case. For tears up to about 2 cm, the abdominal wall is sutured with a firm suture. In this case, only a very small surgical scar remains. In the case of larger tears or holes, the abdominal wall is additionally reinforced with a plastic net so that further or repeated umbilical hernias cannot occur. If the operation proceeds without complications, the patient can return to sporting activities without hesitation after about 14 days.
Outlook and prognosis
In infants, the prognosis for healing is very good. Umbilical hernias heal without complications in infants in 90 percent of all cases in the first year of life. Sometimes parents need a little more patience, as complete closure of the abdominal wall can take until 3 years of age. If the umbilical hernia is painless and an ultrasound shows no abnormalities, conditions in children are good for self-healing. Adults, on the other hand, need to have an umbilical hernia operated on sooner or later to avoid complications. The adult body no longer closes the holes and tears on its own. Self-healing is almost impossible. In an operation, the hole is covered with a plastic mesh and healing is accelerated. Complications rarely occur after such an operation.Some patients experience severe scarring. There remains an increased risk of fracture at the treated site due to heavy exertion (heavy coughing, intensive sports or heavy lifting). Physical activities should be largely restricted as long as the rupture is not treated. The risk of the umbilical hernia becoming larger and surgery more difficult is high.
Prevention
Because an umbilical hernia is caused by a weakness in the abdominal wall, it cannot be directly prevented. If an umbilical hernia is suspected, a doctor should definitely be consulted to rule out organ obstruction. Even if no treatment is usually necessary for small children, they should also always be presented to the doctor if an umbilical hernia is present. In this way, possible complications can be avoided and healing can be supported.
Aftercare
One of the purposes of follow-up care is to prevent recurrence of symptoms. Therefore, physicians rely on a close-meshed follow-up. In umbilical hernia, external circumstances lead to the disease. The patient can only try to avoid them. Preventive measures include refraining from lifting heavy loads and reducing excess weight. Strengthening the abdominal muscles has also been shown to prevent another umbilical hernia. Implementation of these precautions is the responsibility of the patient. If necessary, the physician will provide information on suitable preventive measures as part of the initial treatment. An umbilical hernia always heals completely. In infants and expectant mothers, no treatment is even necessary. They usually heal spontaneously after a short time. Due to the absence of symptoms, there is no relevance for follow-up care at the end of the therapy. Neither long-term treatment nor everyday care is necessary. The patient may leave the hospital after only a few days. In the case of an outpatient procedure, recovery takes place at home. During a final examination, the doctor palpates the affected area with his hands. Possibly, an ultrasound examination provides information that everything is healing according to expectations.
What you can do yourself
Because umbilical hernia is often due to a weakness of the connective tissue in the abdomen, there is little the affected patient can do about it. In children, umbilical hernias are relatively common and usually harmless. Since an umbilical hernia in children very often regresses on its own, no therapeutic measures are usually taken. Bandaging the center of the body can promote the healing process, but is rarely mandatory. However, the hernia site, which is visible as a bulge under the skin, should be observed by the child’s caregivers. If the area changes, if the child has pain or if the skin turns bluish, a doctor must be consulted immediately. Umbilical hernias also occasionally occur during pregnancy, but they also very often resolve on their own after birth. Pregnancy exercises and avoiding excessive weight gain can reduce the risk of umbilical hernia in pregnant women. Umbilical hernias in adults who are not expecting a child are often due to improper exercise or severe obesity. They are usually not dangerous, but should be treated surgically to prevent life-threatening organ entrapment, which is much more common in adults than in children. Those suffering from an acute umbilical hernia should above all refrain from heavy lifting in order not to enlarge the hernia site. Even after a successful operation, heavy lifting should be avoided to prevent another umbilical hernia. If the patient is overweight, weight reduction lowers the risk of umbilical hernia.
