Umbilical hernia is a health condition where there is a defect in the abdominal wall, and
through which the intestine and the fats around the intestine, what we call omentum, they
push through the defect and appear as a lump. It causes a variety of symptoms. It can be
present in infants, it can represent in any age group. Actually, this is three times more
common in women than men. And among the children, the ratio is equal. And also, it's noted to
be very common in children of African descent. In here, it is worth mentioning there is another
related hernia that occurs around the belly button. It's called paraumbilical hernia.
And it is just a similar hernia which is just above or around the umbilicus.
What causes umbilical hernia, I think I need to divide it into two groups: infants and
adults. In infants, during birth the mother and the baby is connected by umbilical cord
for nutrition and carrying oxygen from mother to the baby, but after birth, this tube closes
spontaneously, but if it persists, then it presents an infantile or congenital umbilical
hernia. Whereas in adults, this scar or the weakness may reopen due to increase raised
pressure inside the tummy for straining activities or in lifting heavy weights and for a variety
of reasons. And then it presents as an acquired adult umbilical hernia. And the similar things
happen in paraumbilical hernia. And the sudden factors where the pressure inside your tummy
can be increased, multiple pregnancy or there is ascites like excessive fluids inside your
tummy due to liver conditions, or sometimes people have to have a tube in the belly button
for peritoneal dialysis. These are the some of the few conditions where there is a risk
of getting umbilical hernia.
Of course, the adult can develop an umbilical hernia as we see in babies. The principle is
same, but the causes are slightly different. In babies it's due to the persistence of the
umbilical cord, which is the connection between the mother and the baby during birth, whereas
in adult it is the weakness or the scar has reopened due to raised pressure inside the
abdomen or the tummy. And also, the treatment is slightly different in infants as opposed
to the adults. And also, the timing of surgery is different in different age groups.
The symptoms of an umbilical hernia is more or less similar whether in infants or adults.
Let's talk about the infant first. In infants, the mother notices a little lump at the belly
button when the baby's crying or laughing. And sometimes they may be crying unnecessarily
because of pain at the belly button, whereas in adults the symptoms may range from a discomfort
around the belly button or pain around the belly button when lifting heavy weights and
heavy objects. Also, they may notice a lump on the belly button. But, to be honest, a
lot of the people don't notice the lump at the belly button unless it is noticed by the
general practitioner during a routine clinical examination.
The diagnosis of umbilical hernia is quite simple during routine physical examination.
You will see a lump at the belly button and you will detect that by impulse and coughing
which is a test. If you put the hand over the belly button when the patient coughs,
you can feel an impulse. That's what we call impulse and coughing. And when the patient
lies down and relax, you can actually feel the defect. Sometimes you don't see a lump
or you don't see a defect, then only you can diagnose this by an ultrasound examination
or very rarely with the CT scan.
The umbilical hernia can be treated in different ways: open surgery by keyhole surgery what
we call laparoscopic surgery and conservative surgery. First of all, I want to emphasise,
in infants this hernia usually closes by 18 months and if the operation is needed it should
be done at the age around four years. That is the rule of thumb. In open surgery, you
open up the hernia by making a small incision around the belly button and you approach the
hernia, reduce the content of the hernia, and then put a mesh; which is like a plug
to seal the hernia and then they close it off. So, this is from going outside to inwards,
whereas in keyhole or laparoscopic surgery, you make the operation by making two small
holes, you put a camera in and the camera looks from inside to outside the hole or the
defect and you reduce everything inside the hernia and then you put a mesh at the back
of the hole so that nothing goes in. And finally, there is a rule of doing nothing here what
we call conservative treatment. When you've got a very high-risk patient and the hernia
is not causing any symptoms, there is a rule of doing nothing here other than conservative
management, knowing there is a little risk of strangulations which should be explained
to the patient.