Umbilical hernia: symptoms, cause, treatment and prognosis

An umbilical hernia is a protrusion of the peritoneum and abdominal organs through an opening in the abdominal wall at the level of the navel. An umbilical hernia does not have to cause any complaints. Complaints that may occur include some discomfort or a nagging pain and/or burning sensation near the fracture. A congenital umbilical hernia (see photo) is usually visible during the first months of life and normally heals spontaneously within the first three years of life. If an umbilical hernia is diagnosed later in life, the surgeon will discuss with you how the hernia can be treated. Surgery is not always necessary for an umbilical hernia. Sometimes an umbilical hernia in adults must be treated surgically. In case of complications, emergency surgery is required.

  • What is an umbilical hernia?
  • Cause of umbilical hernia
  • Congenital umbilical hernia
  • Acquired umbilical hernia
  • Risk factors
  • Symptoms of umbilical hernia in adults and babies
  • Adults
  • Baby
  • Complications
  • Examination and diagnosis
  • Umbilical hernia treatment
  • No treatment
  • Emergency surgery
  • Surgical procedure
  • Prevention
  • Prognosis

What is an umbilical hernia?

An umbilical hernia is a protrusion of the peritoneum and abdominal organs through an opening or a weak spot in the abdominal wall at the level of the navel. This may be accompanied by some discomfort or a nagging pain and/or burning sensation in the area in question. The medical name for an umbilical hernia is umbilical hernia .

Cause of umbilical hernia

A distinction is made between congenital and acquired umbilical hernia.

Congenital umbilical hernia

A congenital umbilical hernia is usually visible during the first months of life and normally heals spontaneously within the first three years of life. Black babies, premature children and children with a low birth weight are more likely to have an umbilical hernia.

Acquired umbilical hernia

An acquired umbilical hernia occurs at a later age as a result of increased pressure in the abdominal wall, where there is often a weak spot. The navel is already the thinnest layer of the abdominal wall and therefore the weakest spot. The increased pressure can be caused by:

  • pregnancy(s);
  • significant weight gain;
  • by lifting heavy things.

Being overweight is a risk factor for an umbilical hernia / Source: Istock.com/VladimirFLoyd

Risk factors

Umbilical hernia is most common in babies – especially premature babies and low birth weight newborns. The condition affects boys and girls equally. For adults, being overweight or having multiple pregnancies are risk factors.

Symptoms of umbilical hernia in adults and babies

Adults

An umbilical hernia does not have to cause any complaints. Possible complaints may consist of some discomfort or a nagging pain and/or burning sensation in the affected area. In adults, the intestine can become trapped in the hernia. This is a medical emergency that requires rapid intervention

Baby

An umbilical hernia in a baby is visible as a slight swelling above the navel, which often bulges out when the baby sits upright, cries, pushes or coughs. The lump may disappear when the baby lies on his back and is calm. An umbilical hernia normally does not cause any complaints in a baby and entrapment of the intestines through the opening in the abdominal wall is rare in children. This is more common in adults.

Complications

Complications of an umbilical hernia are rare in children. Complications can occur when the umbilical hernia can no longer be pushed back into the abdominal cavity. This blocks the blood supply to part of the intestine and can lead to pain and tissue damage. If the blood supply to the intestine is completely cut off, intestinal necrosis (death of the intestine) can occur. Infection can spread throughout the abdominal cavity, creating a life-threatening situation. Adults with an umbilical hernia are slightly more likely to develop this complication. Emergency surgery is necessary to deal with these complications (see below).

Symptoms of a strangulated umbilical hernia
Symptoms include:

  • fever;
  • constipation;
  • severe abdominal pain;
  • tenderness in the lower abdomen;
  • vomit;
  • a bulge or bump around the abdomen; and
  • redness or discoloration.

CT scan is sometimes necessary for an umbilical hernia / Source: IStock.com/Pavel Losevsky

Examination and diagnosis

An umbilical hernia is diagnosed during a physical examination. Sometimes imaging tests, such as an abdominal ultrasound or CT scan, are necessary to screen for complications

Umbilical hernia treatment

No treatment

A congenital umbilical hernia usually does not need to be treated, as the hernia gate usually closes on its own in the first three years of life. There is also a small chance that the intestines will become trapped in the hernia port. If the fracture has not closed after three years, surgery may be necessary.

Emergency surgery

An umbilical hernia very occasionally becomes clamped. This is accompanied by alarm symptoms such as unexplained abdominal pain or vomiting in the case of a painful, non-retractable umbilical hernia (an umbilical hernia that you cannot push in). According to estimates, this is 1 in 1,500 umbilical hernias. Surgical correction is indicated for these symptoms or a large fracture gate. In the event of entrapment, emergency surgery is indicated within 6 hours, due to the risk of strangulation (occlusion of the blood supply to the intestine) with the complication of intestinal necrosis (death of the intestine).ยน

Surgical procedure

If a fracture is diagnosed later in life, the surgeon will discuss with the patient how the fracture can be treated. Treatment is not always necessary. In case of repeated pain complaints or recurring tightness, surgical intervention will generally be advised. The bulge is removed via an incision at the location of the fracture. If necessary, the abdominal wall is reinforced by applying a plastic material, using the tissue of the abdominal wall itself or a plastic mat. The chance of complications (bleeding and wound infection) as a result of the procedure is small.

Prevention

Preventing an umbilical hernia can be done by using good lifting techniques, maintaining a healthy weight, reducing pressure during coughing and sneezing, and preventing straining while defecating.

Prognosis

The chance of recurrence is approximately 10 percent. The risk is greater in overweight patients.

Note

  1. Zohra Ebrahimi, Olivier Weijer, Joost CJM Swaanenburg and Joop PW van den Bergh. An infant with a painful swelling of the navel. Ned Tijdschr Geneeskd. 2012;156:A1696

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