What is an umbilical hernia?

An umbilical hernia is an abnormal bulge that can be seen or felt at the umbilicus (belly button). This hernia develops when a portion of the lining of the abdomen, part of the intestine, and / or fluid from the abdomen, comes through the muscle of the abdominal wall.

Umbilical hernias are common, occurring in 10 percent to 20 percent of all children. They are, however, more common in African-Americans.

Low birth weight and premature infants are also more likely to have an umbilical hernia. Boys and girls are equally affected.

Causes

During pregnancy, the umbilical cord passes through an opening in the baby’s abdomen (tummy). This opening should close shortly after birth, but in some cases the muscles don’t seal completely.

This leaves a weak spot in the surrounding muscle wall (abdominal wall). An umbilical hernia can develop when fatty tissue or a part of the bowel pokes through into an area near the navel.

In adults, factors that can contribute to developing an umbilical hernia include:

  • being overweight or obese
  • straining while moving or lifting heavy objects
  • having a persistent heavy cough
  • having a multiple pregnancy (such as twins or triplets)

Symptoms and outcomes

An umbilical hernia can usually be seen after the umbilical cord stump falls off, within a few weeks after birth. But some children don’t get a hernia until they’re a little older.

When a child has an umbilical hernia:

  • You may notice a soft bulge under the skin of the belly button.
  • The doctor can push part of the bulge back in.
  • The bulge may be easier to see when your child sits or stands upright or strains stomach muscles during normal activities such as crying, coughing, or having a bowel movement.

Umbilical hernias can vary in size. They are rarely bigger than about 1 in. (2.5 cm) across. Most children don’t feel pain from the hernia.

Talk to your doctor if your child is vomiting, has pain, or has a swollen belly.

Treatment

Many umbilical hernias close spontaneously by ages 3 to 4. If closure does not occur by this time, surgical repair is usually advised. In younger children, if there is an episode of incarceration or if the hernia is very large, surgical repair may be recommended.

Surgery to repair the hernia is performed under general anesthesia.

A small incision is made at the base of the belly button. If any intestine is present in the hernia, it is placed back into the abdominal cavity. The opening in the muscle is then repaired with multiple layers of stitches to prevent another hernia. A dressing is placed to keep the belly button flat.

While premature infants and children with certain medical conditions may require overnight observation in the hospital, most children are able to return home within a few hours after surgery.

When is surgery needed?

If necessary, umbilical hernias can be treated with surgery to push the bulge back into place and strengthen the weakness in the abdominal wall.

This operation may be recommended for your child if the hernia is large or hasn’t disappeared by the time they reach four or five years old.

You’ll usually be advised to wait for your child to reach this age because the operation isn’t essential unless there are complications. The risk of your child developing complications is very low.

However, surgery is recommended for most adults with an umbilical hernia as the hernia is unlikely to get better by itself when you’re older and the risk of complications is higher.

Complications that can develop as a result of an umbilical hernia include:

  • obstruction – where a section of the bowel becomes stuck outside the abdomen, causing nausea, vomiting and pain
  • strangulation- where a section of bowel becomes trapped and its blood supply is cut off; this requires emergency surgery within hours to release the trapped tissue and restore its blood supply so it doesn’t die
  • Incarcerated hernia-Very few complications are associated with having an umbilical hernia. However, parents should be aware of the possibility of an incarcerated hernia. Incarceration occurs when the contents of the hernia “get stuck” and cannot be pushed back into the abdominal cavity. If this happens, the blood supply may be impaired (strangulation) to the organs in the hernia sac. This can be an emergency.If you see these signs contact your doctor or take your child to the emergency room:
    • pain from the hernia
    • discoloration of the hernia
    • a hernia that cannot be pushed back into the abdominal cavity (when the child is relaxed)
    • a hernia that looks different than before.

    Surgery will get rid of the hernia and prevent any serious complications, although there’s a chance of it returning after the operation.

Are there any risks from surgery?

Complications from an umbilical hernia repair are uncommon, but can include:

  • the wound becoming infected and needing antibiotics
  • the hernia returning
  • feeling sick and having a headache or numbness in the legs a few hours after the operation

The belly button often looks normal after surgery, but there’s a chance its appearance may change as a result of the operation.

 

Sources

http://www.webmd.com/parenting/baby/tc/umbilical-hernia-in-children-topic-overview#1

https://www.cincinnatichildrens.org/health/u/umbilical-hernia

http://pedsurg.ucsf.edu/conditions–procedures/umbilical-hernia.aspx

http://www.nhs.uk/conditions/Umbilicalhernia/Pages/Whatisitpage.aspx

http://www.nhs.uk/conditions/Umbilicalhernia/Pages/Whatisitpage.aspx

 

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