Diseases

Umbilical hernia - causes, symptoms and treatment


The umbilical or umbilical hernia (umbilical hernia) affects especially newborns very often. Statistics show that just over one in five infants experiences such a rupture of the navel in the first months after birth, making umbilical hernia one of the most common complications in obstetrics. However, it should be said that adults can also suffer an umbilical hernia.

Definition

The umbilicus is what is left of an infant's physical connection to its mother after birth. It was once the starting point for the umbilical cord (Funiculus umbilicalis), which supplied the unborn child's placenta with important nutrients via the mother's bloodstream. After childbirth, when the umbilical cord is no longer needed and is consequently separated, the wound on the child's abdomen thus grows into the navel. This special abdominal section is subject to a special sensitivity throughout its life, since, as already mentioned, it is actually a scar.

The navel rupture is not a rupture in the traditional sense. Rather, it is a tissue tear that occurs after high tissue pressure or with insufficient elasticity of the tissue. A distinction is made here between an innate umbilical hernia in infancy and the acquired umbilical hernia in later adolescence or adulthood. A congenital umbilical hernia usually results from an existing connective tissue weakness of the abdominal wall. Acquired navel use is usually caused by increased pressure that prevails in the abdomen and can be triggered by various scenarios. For more information, see the possible causes section.

The word hernia comes from Latin and translates as 'bud'. What is meant by this is the protrusion typical of hernias of the tissue located above the “fracture”. The reason for this is the fact that organs and tissue elements located under the hernia push outwards through the hernia to form a bud-like hubbel, the so-called hernial sac. In the case of an umbilical hernia, this hernial sac consists of exposed peritoneum, which contains flapsed intestines, which can swell outwards through the hernia. A delicate matter with treacherous potential for complications.

For example, the contents of the fracture can jam in the fracture portal or have accumulations of inflammatory tissue fluid. On the one hand, this causes inflammation, which can affect not only the fracture portal itself, but also the pinched organ. On the other hand, the contents of the fracture can also be cut off from the blood and oxygen supply if the vessels are affected by the complication. In the worst case, this leads to necrosis in the area of ​​the umbilical hernia, which makes emergency surgery unavoidable.

Last but not least, if the umbilical hernia is not treated, the portal of fracture can open further, making the hernia worse. Everyday activities such as walking, climbing stairs or stretching put great pressure on the umbilical hernia in this regard, which is why it is not advisable to leave the wound to itself in the hope that it will heal on its own.

By the way: a hernia can not only develop on the sensitive navel. For example, the umbilical hernia together with the inguinal hernia and the scar fracture belongs to the so-called abdominal wall hernias, which already shows that there are local variants of the hernia here. Medicine distinguishes the following main forms of hernias:

  • Umbilical hernia (umbilical hernia et paraumbilicalis),
  • Epigastric hernia (Hernia epigastrica),
  • Hip hernia (hernia obturatoria),
  • Inguinal hernia (Hernia inguinalis),
  • Scar hernia (hernia cicatrica),
  • Femoral hernia (Hernia femoralis),
  • Mirror hernia (Hernia spigeli) and
  • Diaphragmatic hernia (diaphragmatic hernia).

Special form: physiological umbilical hernia

Weak spots in the abdominal wall often arise during the development of an embryo in the womb and are even wanted there. The area around the later navel houses the rapidly growing small intestine loops outside the body cavity until it has enough space in the course of the later development of an unborn child to be able to absorb the small intestine. Then the resulting gap in the abdominal wall closes for the most part down to the umbilical cord, which can lead to prenatal umbilical hernia in the event of a weak connective tissue. However, since this is an effect based on natural embryonic development processes, it is also referred to as a physiological umbilical hernia.

If the physiological umbilical hernia does not completely regress until birth, an omphalocele, as the congenital umbilical hernia is medically called, is very likely. Children suffering from this form of the umbilical hernia are born with intestinal loops located outside the body cavity. Surgery to correct the fracture and move the viscera back into the abdominal cavity has no alternative with this hernia form, which accounts for almost 98% of the most common reasons for umbilical hernias.

Causes of an umbilical hernia

Far from the physiological umbilical hernia, the causes of an umbilical hernia are differentiated according to the patient's age group. For hernias in infancy are usually different factors than for an umbilical hernia in adulthood. Due to age, one can roughly differentiate between connective tissue weakness in infancy and extreme pressure in adolescence and adulthood.

Umbilical hernias due to congenital weakness of the connective tissue

Newborns have an increased risk of developing an acquired umbilical hernia after birth. The fracture portal of the physiological umbilical hernia is usually already closed at this point, but it is not sufficiently scarred and therefore more susceptible to injury. If the newborn is struggling with increased pressure inside the abdomen, the recently closed hernia can open again and organs and tissues can emerge. Premature babies in particular are predestined for this type of umbilical hernia. Furthermore, certain pressure effects can have a beneficial effect, such as

  • Severe coughing of the infant: In adulthood, a strong cough usually doesn't bother the navel. On the other hand, cough attacks can lead to an umbilical hernia due to the existing weak connective tissue around the navel in infancy. Because even if it does not appear at first glance, the cough is a strong pressure load for the newly closed navel.
  • Strong crying of the infant: When babies cry, enormous pressure is exerted on the abdominal wall, similar to coughing. Screaming is a relatively natural behavior for infants, but in some cases the screaming gets out of hand, which increases the risk of an umbilical hernia. Accordingly, crying children and infants who suffer from severe pain due to illness and are therefore constantly screeching are particularly at risk.
  • Wound healing disorders in the area of ​​the navel: After cutting the umbilical cord, wound healing disorders can occasionally occur in infants. This is the case, for example, if the umbilical cord has not been properly disconnected or cleaned. The resulting wound on the navel can occasionally cause complications in healing and result in a hernia.

Umbilical hernias due to acquired weak connective tissue

The possible causes of an acquired umbilical hernia in adolescence and adulthood are particularly varied. The reasons for possible weakness of the connective tissue can range from injuries in the area of ​​the navel to health factors. Injuries in the region of the navel often result from the use of violence, such as physical conflicts, which include blows into the abdominal cavity with the fist or with hand weapons.

In terms of health, too fast weight loss can be responsible for the hernia. Because a rapid loss of weight does not give the connective tissue enough time to adjust to the changed tissue volume, which makes it easy to relax. That is why, especially with extreme weight loss, the umbilical hernia is a common complication.

In the area of ​​acquired connective tissue weakness, surgical wounds on the navel should not be underestimated. If the abdominal wall is opened here, for example, as part of a gastrointestinal operation, this always means a weakening of the tissue structures. Patients who undergo a corresponding operation therefore often have to wear an abdominal net during the recovery period in order to take the pressure off the umbilical region. However, the affected tissue often remains weak after wound healing, which increases the risk of umbilical hernia.

Increased pressure in the abdomen

Almost all acquired forms of umbilical hernia involve not only connective tissue weaknesses but also increased pressure in the abdomen (intra-abdominal pressure). The pressure-triggering situations can be very different. As in infancy, for example, strong cough or sneeze stimuli are able to trigger a hernia. In addition, there are unfavorable behaviors in everyday life, such as

  • lifting heavy loads,
  • strong physical activity,
  • or strong presses during bowel movements.

When it comes to physical factors, the following aspects must also be mentioned:

  • Pregnancy: Carrying an unborn child within is particularly stressful for the belly of an expectant mother. The tension that arises here makes the abdominal wall and thus the navel much more susceptible to a hernia. This is especially true for multiple births, where the abdominal wall has to stretch far beyond the natural level of pregnancy. And the pressing process during childbirth also creates an additional pressure load, which promotes an umbilical hernia.
  • Overweight: Being overweight is like pregnancy in relation to umbilical hernias. The difference, however, is that pregnancy's tummy tucks are predictable, whereas being overweight can weaken the connective tissue of the abdomen for years. The elasticity of the abdominal tissue is often irreparably damaged as a result, which is why the risk of a hernia is particularly great for overweight people.
  • Abdominal and intestinal disorders: The diseases that theoretically can cause a bloated stomach include space-consuming health problems in the area of ​​the intestine. For example, the bloated belly (meteorism) causes chronic flatulence, which permanently increases the volume of the intestine and exerts additional pressure on the abdominal wall. The situation is similar with ascites. The disease describes an unnatural accumulation of tissue water in the abdomen, which can result in pressure on the belly button similar to that caused by persistent flatulence. Ulcers in the abdomen are also conceivable as the cause of the umbilical hernia. Incidentally, it does not matter whether the ulcers are benign or malignant.

Symptoms

In the early stages of an umbilical hernia, the symptoms are mostly limited, which is why the hernia is not always noticed immediately. However, if the fracture port is increasingly stressed, any symptoms usually become clearer quickly. Stress pain in particular will speak relatively reliably in the further course. This applies in particular to umbilical hernias in which the organs contained in the hernia sac have been pinched. Medicine also speaks of the so-called incarceration. In addition to malfunctions of the organs affected, it can also lead to dangerous inflammation, problems in the organ's own oxygen and nutrient supply and, as a result, serious tissue necrosis, which is why the first signs of an umbilical hernia must be taken seriously by those affected. Overall, the following symptoms may indicate a navel hernia:

  • Increased feeling of pressure around the umbilical region,
  • Feeling unwell in the abdomen,
  • Redness on the abdomen,
  • Swelling around the navel,
  • enlarged lymph nodes,
  • Vascular changes or
  • Inflammation of the hernia.

Diagnosis of an umbilical hernia

To diagnose an umbilical hernia, it is usually sufficient to palpate the abdominal wall. For this, the patient goes supine while the doctor scans the abdominal area for abnormalities and tests whether the abdominal structures can be easily pushed back (reduced). This repositionability of an umbilical hernia later also has an impact on the subsequent therapeutic measures.

To confirm the diagnosis, it is advisable to examine the hernial sac and the surrounding tissue sonographically. This enables the doctor to determine whether there are intestinal loops in the hernial sac and whether an emergency operation is necessary.

Therapy for a broken navel

Many umbilical hernias are harmless and often asymptomatic. However, they always harbor the risk that intestinal loops or the peritoneum are pressed into the hernial sac and a harmless umbilical hernia comes to a life-threatening condition, for example in the form of an intestinal obstruction (ileus) or inflammation of the peritoneum (peritonitis). For this reason, even smaller umbilical hernias are often treated with preventive surgery. Fortunately, as medical advances progress, the risk of surgery and anesthesia has become so low that surgery is less dangerous than the complications that would result from non-treatment.

Surgical therapy

In young infants, the umbilical hernia usually resolves on its own, so surgery is rarely necessary. In the case of umbilical hernias in pregnancy or in adulthood, on the other hand, surgical intervention is more often necessary, for example to correct incarcerations.

Laparoscopy

In the meantime, umbilical hernia operations are mostly performed laparoscopically using a minimally invasive procedure. Depending on the severity of the hernia, the abdominal wall is opened using small, arch-shaped incisions under local or general anesthesia. The surgeon then introduces the necessary surgical instruments into the abdominal cavity through the opening in order to move the organs that have been turned outwards back into the abdominal cavity and, if necessary, to remove the hernial sac and stored broken water. In the next step, the break gate is sewn using various suturing techniques or closed with the help of an inserted plastic net. In this regard, the use of a plastic net is generally indicated for umbilical hernias with a diameter of more than two centimeters.

Complicated or large hernias sometimes require larger incisions to fix them. Here, the surgeon often uses an overlapping suture technique of the abdominal wall layers in order to avoid recurrence of the umbilical hernia.

Use of trusses

A method to be classified as outdated is the use of hernia to prevent organs and tissues from emerging from existing hernia. In the past, these ligaments were used frequently because the procedure for umbilical hernia operations was very complicated due to the lack of progress in medical technology. Nowadays, trusses are only prescribed temporarily until the surgery date.

Fractured ligaments cannot heal umbilical hernias, moreover, they weigh the victim in a false sense of security, since he is missing the warning signal of the organs emerging and he is therefore more stressed, which can worsen the umbilical hernia.

Medical therapy

Unfortunately, the umbilical hernia itself cannot be treated with medication. Only for symptom control, i.e. for the treatment of inflammation, abdominal cramps, severe pain or fever, in the acute situation, analgesic, antispasmodic and / or anti-inflammatory drugs can be used.

Medicinal treatment

Even the medicinal and homeopathic approach cannot cure an umbilical hernia that has occurred. However, there is the possibility to support the connective tissue. Silicea, for example, is considered the homeopathic remedy of choice for connective tissue that is too weak.

Home remedies and everyday measures

Sufferers who are at high risk of developing an umbilical hernia can use a few tricks and home remedies in everyday life that minimize the risk of a hernia. This includes, among other things, ensuring a soft bowel movement and freedom from flatulence through a diet rich in ballast and nutrients (especially lots of vegetables, fruit and whole grains). Moderate but regular exercise, a regular hydration and the targeted consumption of digestive foods such as buttermilk or probiotic yoghurts additionally support this project.

It is a matter of course not to lift heavy loads during the treatment of umbilical hernias. Even after a successful cure, those affected should not exaggerate carrying and lifting heavy loads, since the tissue usually remains weakened after a hernia. In order to strengthen the abdominal wall again, targeted abdominal muscle training can help, but at the beginning, however, please only be carried out under instruction in physiotherapy or rehab, so that there is no renewed incorrect loading of the navel during the training.

Diseases of the umbilical hernia:

Weak connective tissue, obesity, meteorism, ascites, ulceration (ma)

Author and source information

This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Miriam Adam, Barbara Schindewolf-Lensch

Swell:

  • Professional Association of Pediatricians e. V .: Umbilical hernia (retrieval: 14.07.2019), kinderaerzte-im-netz.de
  • Schumpelick, Volker / Arlt, Georg / Conze, Klaus Joachim / u.a .: Hernien, Thieme, 5th edition, 2015
  • Merck & Co., Inc.,: Hernias of the Abdominal Wall (accessed: July 14, 2019), merckmanuals.com
  • Mayo Clinic: Umbilical hernia (accessed: July 14, 2019), mayoclinic.org
  • Amboss GmbH: Outer hernias (accessed: July 14, 2019), amboss.com
  • UpToDate, Inc .: Overview of abdominal wall hernias in adults (accessed: July 14, 2019), uptodate.com
  • Zens, Tiffany / Nichol, Peter F. / Cartmill, Randi / et al .: Management of asymptomatic pediatric umbilical hernias: a systematic review, Journal of Pediatric Surgery, 2017, jpedsurg.org

ICD codes for this disease: K42ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.


Video: Abdominal Wall Hernias (December 2021).