Umbilical Hernia

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Dr Chong Choon Seng

MBBS | MRCS | Masters in Medicine (Surgery) | FRCS (Edinburgh)

An umbilical hernia occurs when part of the intestine or abdominal tissue protrudes through a weakness in the abdominal wall at or near the navel (umbilicus). This condition appears as a soft bulge or outward protrusion at the belly button area. While umbilical hernias are common in infants and usually resolve naturally by the age of 4 to 5, they can also develop in adults due to a variety of factors that increase abdominal pressure.

Symptoms of Umbilical Hernia Symptoms of Umbilical Hernia

Symptoms of Umbilical Hernia

The signs and symptoms of umbilical hernias can vary among individuals and often depend on activity levels and the size of the hernia. Key symptoms include:

  • Visible Bulge: A soft, noticeable swelling or protrusion near the navel, which often becomes more prominent during activities like coughing, straining, or standing.
  • Pain or Discomfort: A sensation of mild to moderate pain or tenderness around the umbilical area, especially during physical exertion, prolonged standing, or direct pressure on the hernia.
  • Size Changes: The size of the hernia may fluctuate, appearing larger when standing or straining and smaller or less noticeable when lying down.
  • Digestive Symptoms: In some cases, the hernia may interfere with bowel function, causing symptoms like nausea, vomiting, bloating, or constipation, particularly if part of the intestine is involved.

Causes and Risk Factors

Umbilical hernias develop due to weakness in the abdominal wall, often exacerbated by factors that increase internal pressure or strain the surrounding tissues. Contributing factors include:

  • Increased Abdominal Pressure: Activities or conditions that raise intra-abdominal pressure, such as chronic coughing, heavy lifting, straining during bowel movements, or obesity, can weaken the abdominal wall and lead to hernia formation.
  • Pregnancy: Repeated pregnancies, carrying large babies or multiple pregnancies stretch the abdominal muscles, increasing susceptibility to hernias.
  • Previous Surgery: Abdominal surgeries can compromise the strength of nearby tissues, creating weak points where hernias may develop.
  • Birth Factors: Premature birth and low birth weight are associated with incomplete abdominal wall closure, increasing the likelihood of umbilical hernias in infants.

Types of Umbilical Hernias

Umbilical hernias can be categorised into distinct types, each requiring different management strategies and carrying varying risks of complications:

Reducible Hernias

These hernias can be pushed back into the abdominal cavity with gentle pressure, indicating that the tissue within the hernia sac moves freely. Patients can often reduce these hernias themselves while lying down, and they generally cause minimal discomfort unless aggravated by activity.

Incarcerated Hernias

In this type, the herniated tissue becomes trapped outside the abdominal wall and cannot be pushed back into place manually. Incarcerated hernias may cause persistent pain, swelling, and a higher risk of complications, including reduced blood flow to the trapped tissue.

Strangulated Hernias

This is a severe condition where the blood supply to the herniated tissue is cut off, leading to tissue death if untreated. Strangulated hernias are characterised by intense pain, redness, and tenderness around the hernia site, along with possible darkening or discolouration of the affected area.

Diagnosis of Umbilical Hernia

Physical Examination

The doctor carefully inspects the umbilical area while the patient is in both standing and lying positions. This allows the hernia to become more or less prominent based on changes in abdominal pressure. The examination includes gentle attempts to reduce the hernia back into the abdomen and an evaluation of its size, shape, and any associated tenderness or discomfort.

Medical History Review

A thorough review of the patient’s symptoms, previous surgeries, and family history is conducted to identify risk factors and understand the context of the hernia. This information aids in diagnosing the condition accurately and tailoring the treatment approach to the individual’s needs.

Imaging Studies

Diagnostic imaging, such as ultrasound or CT scans, provides detailed views of the hernia and surrounding structures. These studies help determine the size of the hernia defect, identify the contents of the hernia sac (such as bowel or fat), and detect potential complications like incarceration or strangulation.

Treatment Options

The treatment of umbilical hernias depends on factors such as the size of the hernia, symptoms, and the patient’s age and overall health.

Non-Surgical Management

Non-surgical management is primarily recommended for small, asymptomatic umbilical hernias, particularly in infants. In such cases, an active monitoring approach is often adopted, where the hernia is regularly assessed by a healthcare provider to ensure no complications arise. Many infant hernias close naturally on their own within the first few years of life without requiring intervention.

Surgical Treatment

  • Open Surgery: This procedure involves making an incision near the umbilicus to access the hernia. The surgeon repairs the weakened abdominal wall by stitching the tissues together, and in cases of larger hernias, a surgical mesh is placed to reinforce the area and prevent recurrence. Open surgery is effective for addressing smaller hernias and laparoscopic surgery is preferred for larger hernias with the use of mesh.
  • Laparoscopic Repair: This minimally invasive procedure involves small incisions through which specialised instruments and a camera are inserted. The surgeon repairs the hernia from inside the abdomen, often using a mesh to strengthen the defect. Laparoscopic repair usually offers a faster recovery, less post-operative pain, and smaller scars compared to open surgery.

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Prevention and Management

Preventing and managing umbilical hernias involves minimising abdominal strain and promoting abdominal wall strength. Maintaining a healthy body weight reduces pressure on the abdominal muscles, lowering the risk of hernia development. Regular exercises focused on core strength can help support the abdominal wall. Using proper techniques when lifting objects prevents unnecessary strain.

For post-surgery patients, adhering to activity restrictions and wearing compression garments as recommended by the surgeon aids recovery and prevents recurrence. Regular follow-up appointments with a healthcare provider ensure early detection of any potential complications or signs of recurrence.

Frequently Asked Questions

Can umbilical hernias resolve without treatment in adults?

No, umbilical hernias in adults do not resolve on their own and generally require surgical intervention. Without treatment, the hernia may enlarge over time and increase the risk of complications such as incarceration or strangulation, which can necessitate emergency surgery.

How long does it take to recover from umbilical hernia surgery?

Recovery from umbilical hernia surgery typically ranges from 2 to 6 weeks, depending on the surgical method used (open or laparoscopic) and the patient’s overall health. Most patients can return to light activities, such as walking or desk work, within a few days. Strenuous activities, including heavy lifting and intense exercise, are usually restricted for several weeks to allow full healing of the abdominal wall.

Can umbilical hernias recur after surgery?

Although uncommon, umbilical hernias can recur after surgery, particularly if underlying risk factors such as obesity, chronic coughing, or heavy lifting are not addressed. Adhering to post-operative care instructions, maintaining a healthy weight, and avoiding activities that strain the abdominal muscles can significantly reduce the likelihood of recurrence.

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Dr Chong Choon Seng

MBBS (NUS)

MRCS (Edinburgh)

Masters in Medicine (Surgery)(NUS)

FRCS (Edinburgh)

Dr Chong is the former Program Director of General Surgery Residency at NUHS, and has more than 10 years of experience as a colorectal and general surgeon.

As an esteemed professional in minimally invasive surgery, Dr. Chong remains committed to achieving optimal outcomes for all surgical conditions, from piles to cancer treatment.

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