Definition of umbilical hernia
An umbilical hernia is an outward bulge of the abdominal lining - or part of an organ contained in the cavity of the abdomen - across the navel.
A different argument must be made for the umbilical hernia in the adult: in this case, we speak of herniation due to "weakness of the abdominal muscles", caused by the "increase in intra-abdominal pressure (ascites, cirrhosis, multiple pregnancies, tumor in the abdominal cavity and obesity).
Umbilical hernia in adults almost always requires surgery.
Symptoms
In small umbilical hernias, pain is a recurring symptom, always accompanied by evident swelling and localized burning. The pain can become acute with a cough, sneeze, or lifting heavy loads. Even the standing position, maintained for a long time, can aggravate the symptoms.
To the touch, the swelling feels soft or more lumpy and stiff, depending on the severity of the condition. The skin covering the umbilical hernia appears swollen and red; sometimes, the color of the umbilical skin varies from gray to bluish.
Some patients with umbilical hernia also complain of some dyspeptic and intestinal disorders.
In young children, the volume of the hernia tends to increase during crying and during exertion, an expression of intra-abdominal pressure increase.
Complications
In infants and young children affected by umbilical hernia, complications are extremely rare, unless the condition is linked to very serious underlying diseases.
In adults, however, an umbilical hernia that is not properly treated can create serious complications:
- Jailed hernia: The protruding abdominal tissue remains "trapped" and therefore cannot return to its natural position. In this case, the patient can experience serious problems: intestinal obstruction, severe abdominal pain and vomiting are the most recurrent complications.
- Strangled umbilical hernia: complication even more serious than the previous one since the blood supply to the intestine is completely denied. In this condition, a section of the intestine is literally strangled: the patient complains of excruciating and unbearable pains in the abdominal level, associated at vomiting and complete intestinal obstruction. Death occurs from tissue gangrene and from rapid spread of the infection to other sites in the body.
Diagnosis
The diagnosis of small umbilical herniation is quite simple and does not present particular difficulties (except for small hernias that have arisen in obese patients).
In normal weight patients, a suspicion of umbilical hernia is confirmed by simple medical observation and palpation, accompanied by anamnestic analysis:
- Observation of the umbilical site of the lesion
- Tendency of the hernia to increase in size during standing
- Increased abdominal pain with a cough or sneeze
When needed, the doctor may subject the patient to more in-depth diagnostic tests (X-ray or ultrasound imaging tests).
The differential diagnosis must be made with omphalitis, umbilical and periumbilical swellings (eg lipomas) and neoplastic umbilical metastases.
Therapies
In general, infantile umbilical hernias - especially if small in size - are not particularly serious: they tend to regress spontaneously within 12-18 months of life. Sometimes, the doctor can stimulate healing by wrapping the abdomen of the child affected by an umbilical hernia with elastic-containment bandages: this method seems to reduce the lateral tension of the abdominal wall, so the swelling is reduced more quickly.
Some ancient folk remedies aimed at promoting recovery from umbilical hernia suggested inserting a coin in the umbilical groove, and fixing it to the abdomen with adhesive tape. This practice, however, does not appear to be very effective for healing purposes; on the contrary, it is potentially harmful because germs, accumulating under the coin, can create infection.
When is it necessary to intervene surgically to cure umbilical hernia in the baby?
In the newborn and young child, the surgical procedure may be indispensable in the following cases:
- The umbilical hernia is extremely painful
- The diameter of the hernia is greater than 2 cm
- The size of the umbilical hernia does not decrease after 6-12 months from the manifestation of the very first symptoms
- The umbilical hernia still persists at the age of 3
- The medical bandage does not promote any improvement in symptoms
- Complicated umbilical hernia (strangulated or incarcerated)
Alternative therapies
For adults suffering from umbilical hernia and for children who are unable to heal spontaneously or with the bandage, it is possible to proceed with an "umbilical skin incision. The intervention, carried out under local anesthesia, is performed by making a" proximity of the umbilical orifice. The "incision" must be made at least 1 cm from the navel to minimize the risk of damaging the normal vascularity. Subsequently, the bulge is pushed inwards. After closing the wound, the patient can go home on the day of the operation.
After surgery, paracetamol or ibuprofen can be given to ease the pain; acetylsalicylic acid is also an excellent pain reliever, but should not be given to children under the age of 12.
The prognosis is almost always excellent, however it is unlikely that an umbilical hernia will occur more than once in a lifetime.
