Umbilical Hernia

What is Umbilical Hernia?

An umbilical hernia, according to the European Hernia Society, is a type of hernia located 3 cm above or below your belly button. These hernias represent 6% to 14% of all adult abdomen hernias, making them second most common after inguinal hernias. In babies, 10% to 15% experience an umbilical hernia, but they often go away naturally by the time they’re 2 years old. However, if it doesn’t disappear by the age of 5 or the hernia becomes larger than 1.5 cm, surgery might be necessary. This discussion will focus on umbilical hernias in adults.

The European and American Hernia Societies categorize adult umbilical hernias by their size. A small hernia is less than 1 cm, a medium one is between 1 and 4 cm, while a large hernia is more than 4 cm. The hernia often contains fat or omentum (a layer of fat in the abdomen) but could also hold a portion of the small intestine or, less commonly, the colon.

Umbilical hernias are often discovered during regular physical check-ups. If it’s not causing any discomfort, many people might decide to wait and observe the hernia rather than having surgery right away. However, 65% of adults with an umbilical hernia will eventually need surgery, and 3% to 5% of these cases will require immediate operation. If you have an asymptomatic umbilical hernia, meaning you don’t feel any symptoms, it’s important to be aware of the signs and symptoms of complications such as incarceration and strangulation. You should also be mindful about how you lift heavy objects.

Surgical repair is recommended if the umbilical hernia is causing pain, discomfort, or is growing. The type of surgical repair chosen depends on the size of the hernia, other health issues you may have, your body mass index, and the presence of other hernias in your abdominal wall. While a scheduled hernia repair can be performed under local anesthesia with sedation or general anesthesia, emergency surgery often requires general anesthesia.

What Causes Umbilical Hernia?

About 90% of umbilical hernias in adults are not present from birth, but develop later in life. These types of hernias, which are bulges through the belly button area, are more common in people who are obese, have metabolic syndrome, or have a condition that causes fluid in the abdomen known as ascites. They’re also more likely in individuals who have had many pregnancies.

The shape and size of the belly button area can influence whether or not an umbilical hernia forms. Also, any long-term or repeated increases in pressure inside the abdomen could raise the risk of getting an umbilical hernia. This includes activities like heavy weight lifting or chronic coughing. In some cases, the use of umbrella-shaped surgical devices inserted through the belly button during laparoscopic surgery could be associated with these hernias.

Other factors that might make it more likely for an adult to develop an umbilical hernia include certain genetic disorders, such as Beckwith-Wiedemann syndrome and Trisomy 21, commonly known as Down syndrome. Other potential risk factors are connective tissue disorders, ethnicity, and poor nutrition.

Risk Factors and Frequency for Umbilical Hernia

Umbilical hernias are quite common in adults, with about 23% to 50% of them experiencing this condition. Women between the age of 31 to 40 and men between 61 to 70 tend to have the highest frequency of umbilical hernias. They occur three times more frequently in women, due to factors such as pregnancy, childbirth, and obesity. However, it’s interesting to note that even though women have a higher incidence, 70% of all surgical procedures to fix umbilical hernias are carried out on men. Every year in the United States, around 175,000 of these procedures are done, and globally, this number is as high as 20 million.

Signs and Symptoms of Umbilical Hernia

Umbilical hernias are common in adults, but they often don’t cause any symptoms. They’re usually discovered during routine physical checks or while performing an unrelated abdominal scan. Sometimes, patients may notice a lump, particularly during physical activity or when changing positions that puts pressure on the abdomen. Men often report painful hernias that disrupt their activities, while women usually have larger, painless hernias.

Up to 90% of pregnant women may have an umbilical hernia, but treatment is only needed if it’s trapped (incarcerated) or causing symptoms. For those with a symptomatic hernia, the most common complaint (reported by 44% of patients) is pain. Patients also often mention activity limitations due to discomfort or episodes of nausea and vomiting accompanying a temporary lump.

Adults frequently have asymptomatic umbilical hernias
Discovered during routine checkups or unrelated scans
Patients may notice a lump during physical activity or position changes
Men often have painful hernias while women usually have larger, painless ones
Up to 90% of pregnant women may have umbilical hernias
Treatment is necessary only if hernia is trapped or symptomatic
Pain and activity limitations due to discomfort are common symptoms
Nausea and vomiting may accompany a temporary lump

In case of a suspected hernia, a patient should be checked while lying flat on their back. In asymptomatic cases, the hernia can often be identified and reduced (pushed back in) when the patient strains (Valsalva’s maneuver). The doctor might be able to feel the edges of the gap in the abdomen’s wall and estimate the size of the hernia’s opening. They should also look for other problems with the abdomen wall or signs of illness that might be related. Big hernias might not be reducible owing to space limitation within the abdomen.

People with symptomatic hernias often have an obvious lump coming out of their umbilicus (belly button). If the hernia is trapped or blood supply is cut off (strangulated), patients might show symptoms of a lump that cannot be pushed back into the abdomen and is tender or discolored. They might appear unwell, with active vomiting, a rapid heart rate, and low blood pressure. Many of these patients may have had previous painful episodes and lump protrusion, which resolved on their own.

Testing for Umbilical Hernia

If your doctor thinks you might have an umbilical hernia, they will do a physical exam by looking closely at the skin on the front of your stomach. Changes in your skin’s color, such as it becoming thicker or the development of sores, could point to the very serious condition of a strangulated hernia. Strangulation happens when blood flow to the herniated tissue gets cut off.

For someone who has a stuck, or ‘incarcerated’, hernia, the doctor may attempt to gently push it back into place. If this works and the patient is in a stable condition, they can be sent home with a plan for surgical repair in the future. However, if the hernia can’t be reduced, or if the doctor is concerned about damage to the tissue inside, a surgeon should be consulted immediately.

Imaging tests can help if the doctor can’t tell for sure if you have an umbilical hernia from the physical exam. Ultrasound is quick and cost-effective, and in one study, it found umbilical hernias in about 1 in 4 adults. But ultrasound is not as accurate for very large hernias or in people with significant obesity. A CT scan can show more clearly if there is a hernia, its size, what’s inside it and if there are any other problems in the abdomen.

Magnetic resonance imaging (MRI) is very accurate in diagnosing hernias, but it takes longer than other imaging tests, may not be available at all facilities and can be more costly. An MRI might be used when an ultrasound and CT scan don’t give a clear picture.

If you have an umbilical hernia that can be pushed back into place and you feel well, you won’t need any blood tests. However, if you are feeling unwell or need urgent surgery to fix a stuck or strangulated hernia, you should have a blood test to check for high levels of white blood cells, a sign of infection.

Treatment Options for Umbilical Hernia

If a patient has an umbilical hernia but isn’t experiencing any symptoms, it may not be necessary to have immediate surgery. The risk of the hernia becoming strangulated, or cut off from its blood supply, is less than 1% yearly for these patients. However, for patients who are obese or have a condition called ascites, which causes excess fluid in the abdomen, surgery may still be recommended as these conditions can complicate emergency hernia repairs. A hernia that’s causing symptoms or getting larger should usually be operated on.

Before having their hernia operated on, some patients, such as those with significant liver disease (Child-Pugh class B and C cirrhosis) or uncontrolled ascites (an excessive build-up of fluid in the abdomen), bleeding disorders (coagulopathy), or active infections, require careful consideration due to increased surgical risk. Even so, research shows that electively repairing umbilical hernias is generally safe for most patients with these conditions. However, patients with uncontrolled ascites may face certain risks such as a 2% mortality rate and a high chance of hernia recurrence.

Before surgery, a patient can take measures to reduce the risk of complications. Stopping smoking at least 4 weeks before surgery and reducing weight to achieve a body mass index (BMI) less than 30 can decrease the risk of infection at the surgical site and other complications.

Small umbilical hernias, less than 2 cm in diameter, can usually be fixed with a straightforward surgery that involves removing or inverting the herniated sac and then stitching the layers of the abdominal wall closed. This operation typically involves making a small, curved incision just below the belly button.

Larger umbilical hernias, over 2 cm in diameter, are usually repaired using a special type of mesh. Not using mesh for these larger hernias may lead to a 10 to 14% chance of the hernia coming back. The type of mesh placement—underneath or over the abdominal wall—affects the rate of complications like fluid collections (seromas), hematomas (blood-filled swellings), and infections. The recurrence rate for umbilical hernias repaired with a mesh ranges from 0 to 3%.

In some cases, laparoscopic hernia repair might be more beneficial. This minimally invasive technique involves making small incisions for inserting instruments and a camera, and it can be useful for patients with severe obesity, multiple abdominal wall defects, intra-abdominal disease, or a recurring hernia. There are risks with this approach, including the formation of hernias at the sites of the instrument incisions (trocar site hernias), particularly in patients with weak tissue.

In emergency situations, such as when a hernia becomes trapped (incarcerated) or strangulated (cut off from its blood supply), urgent surgery is required. These surgeries can be more challenging and may require removal of damaged tissue or organs. In these cases, using mesh for the repair is advised whenever possible to decrease the risk of recurrence.

Many illnesses can appear as a lump around the belly button area. Masses under the skin often move freely within the subcutaneous space, and physicians may not feel any defect. Abnormal conditions like a leftover part of the urachus or an abscess may present with a discharge. Conditions like lymphoma or cancer spread may feel bumpy or consist of dead tissue, and may be anchored to the neighboring tissues.

Here are some possible diagnoses other than umbilical hernia:

Abscess
Desmoid tumor
Granuloma
Hemangioma
Hematoma
Keloid
Lipoma
Lymphoma
Umbilical cyst caused by hydatid disease
Urachal anomaly or tumor
Umbilical endometriosis
Umbilical sebaceous cyst
Metastatic disease (cancer spread)

What to expect with Umbilical Hernia

The success of repairing an umbilical hernia, which is a bulge or pouch that forms in the navel, can be influenced by a number of factors. These include the size of the hernia, whether the patient smokes tobacco, and if the patient has other health conditions.

Factors that could make the repair less successful include a high score on the American Society of Anesthesiologists (ASA) scale (which is used to assess a patient’s fitness for surgery), not using a mesh to repair hernias bigger than 2 cm, a history of smoking, liver failure, and diabetes.

The risk of surgical complications increases slightly as the hernia gets larger. For every extra millimeter in the size of the hernia, the risk of complications goes up by 1%.

Lastly, if a patient has liver disease, doctors use a tool called the Model for End-State Liver Disease (MELD) score to estimate their risk of complications. For every point that a patient’s MELD score is above the average level of 8.5, their risk of major complications after surgery increases by nearly 14%.

Possible Complications When Diagnosed with Umbilical Hernia

: Following an open repair surgery without the use of a mesh, complications are more likely. These could include infections at the site of surgery, large bruises (medically termed hematomas), and a rapid return of the hernia. Factors such as wound infections, diabetes, tobacco use, extreme overweight, and uncontrolled fluid in the abdomen can increase the risk of the hernia reoccurring.

With regard to mesh placement, specific complications may include seromas (pockets of fluid), adhesions (internal scarring), injury to the bowel, an unwelcome response to a foreign body, and either infection or displacement of the mesh. In some cases, complications may require the removal of the mesh. A very rare complication is the formation of an antibioma, which is an undrained abscess (a collection of pus) surrounded by a fibrous shell that happens due to medical treatment with antibiotics instead of drainage.

Common Complications:

Infections at the surgical site
Large abdominal wall bruises
Rapid hernia recurrence
Complications from mesh placement
Seromas (fluid pockets)
Adhesions (internal scars)
Bowel injury
Foreign body response
Mesh infections or displacements
Formation of an antibioma (rare)

Recovery from Umbilical Hernia

Fixing a non-urgent umbilical hernia is generally a one-day procedure. After the surgery, the main focus points include managing pain, getting the patient up and walking as soon as possible, looking after the wound, and ensuring lung health. For several weeks after, patients may be asked to avoid heavy lifting, but they are encouraged to engage in light activities.

Doctors might also provide a stool softener to make sure the patient doesn’t suffer from constipation, particularly when pain medicines are being taken. Patients should avoid swimming or submerging themselves in water for 2 weeks following the operation, and specific instructions would be provided to help them take care of the wound and the dressing applied to it.

Preventing Umbilical Hernia

Umbilical hernias, a common medical condition where a part of the intestine or fat pushes through a weak spot in the belly button, are often detected during regular medical check-ups. Usually, primary care practitioners, like your family doctor, or emergency department doctors are the first ones to notice symptomatic (displaying symptoms) or asymptomatic (without symptoms) umbilical hernias in patients. It’s the responsibility of the entire medical team to give correct information about this condition and, if needed, refer the patient to a specialist for further treatment.

Frequently asked questions

The prognosis for umbilical hernia depends on various factors, including the size of the hernia, the presence of other health conditions, and lifestyle factors such as smoking and obesity. Factors that could make the repair less successful include a high score on the American Society of Anesthesiologists (ASA) scale, not using a mesh for larger hernias, a history of smoking, liver failure, and diabetes. The risk of surgical complications increases slightly as the hernia gets larger, and patients with liver disease have an increased risk of major complications after surgery.

Umbilical hernias in adults can develop later in life and are more common in people who are obese, have metabolic syndrome, have a condition that causes fluid in the abdomen known as ascites, or have had many pregnancies. Other factors that might make it more likely for an adult to develop an umbilical hernia include certain genetic disorders, connective tissue disorders, ethnicity, and poor nutrition.

Signs and symptoms of umbilical hernia include: - Asymptomatic hernias are common in adults. - Hernias are often discovered during routine checkups or unrelated scans. - Patients may notice a lump in the abdomen, particularly during physical activity or when changing positions that put pressure on the abdomen. - Men often experience painful hernias that disrupt their activities. - Women usually have larger, painless hernias. - Up to 90% of pregnant women may have umbilical hernias. - Treatment is necessary only if the hernia is trapped or causing symptoms. - The most common complaint in symptomatic hernias is pain. - Activity limitations due to discomfort are often reported by patients. - Nausea and vomiting may accompany a temporary lump in the abdomen.

The types of tests that may be needed for diagnosing an umbilical hernia include: 1. Physical exam: The doctor will closely examine the skin on the front of the stomach to look for any changes in color or the development of sores. 2. Ultrasound: This imaging test is quick and cost-effective, and it can help determine if there is a hernia present. However, it may not be as accurate for very large hernias or in people with significant obesity. 3. CT scan: This imaging test provides a clearer picture of the hernia, its size, and any other problems in the abdomen. It can show what's inside the hernia and help with diagnosis. 4. MRI: Magnetic resonance imaging is very accurate in diagnosing hernias, but it takes longer than other imaging tests and may not be available at all facilities. It is typically used when an ultrasound and CT scan don't provide a clear picture. 5. Blood tests: If a patient is feeling unwell or needs urgent surgery for a stuck or strangulated hernia, a blood test may be done to check for high levels of white blood cells, which can indicate infection. It is important to note that not all of these tests may be necessary for every patient with an umbilical hernia. The specific tests ordered will depend on the individual case and the doctor's judgment.

The doctor needs to rule out the following conditions when diagnosing Umbilical Hernia: - Abscess - Desmoid tumor - Granuloma - Hemangioma - Hematoma - Keloid - Lipoma - Lymphoma - Umbilical cyst caused by hydatid disease - Urachal anomaly or tumor - Umbilical endometriosis - Umbilical sebaceous cyst - Metastatic disease (cancer spread)

The side effects when treating Umbilical Hernia may include: - Infections at the surgical site - Large abdominal wall bruises (hematomas) - Rapid hernia recurrence - Complications from mesh placement - Seromas (fluid pockets) - Adhesions (internal scars) - Bowel injury - Foreign body response - Mesh infections or displacements - Formation of an antibioma (rare)

You should see a primary care practitioner or an emergency department doctor for an umbilical hernia followed by a surgeon

Umbilical hernias are quite common in adults, with about 23% to 50% of them experiencing this condition.

Umbilical hernias can be treated through surgery. The treatment approach depends on the size of the hernia. Small umbilical hernias, less than 2 cm in diameter, can usually be fixed with a straightforward surgery that involves removing or inverting the herniated sac and then stitching the layers of the abdominal wall closed. Larger umbilical hernias, over 2 cm in diameter, are usually repaired using a special type of mesh. Laparoscopic hernia repair may be more beneficial in certain cases, such as severe obesity or recurring hernias. In emergency situations, urgent surgery is required, and using mesh for the repair is advised whenever possible to decrease the risk of recurrence.

An umbilical hernia is a type of hernia located 3 cm above or below the belly button. It is the second most common type of hernia in adults, representing 6% to 14% of all adult abdomen hernias. In babies, 10% to 15% experience an umbilical hernia, but they often go away naturally by the age of 2.

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