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What You Need to Know About Hernias, Part II

April 29, 2017

Hernias affect millions of Americans every year, but too often people delay getting treatment until they experience noticeable pain.

More patients need to understand this condition, which is why we’ve launched a multi-part blog series about the different types of hernias and treatment options. In the first part of our series, we discussed incisional ventral hernias, which occur in the abdominal wall. Next, we’ll delve into umbilical hernias, one of the most common forms of hernia. Here’s what you need to know:

Umbilical Hernias

Hernias occur when a portion of an organ bulges outward through a muscle or tissue opening. With umbilical hernias, this occurs around the bellybutton.

There are more than 200,000 cases of umbilical hernias every year. We often refer to an umbilical hernia as the original hernia, because most people have a hernia in this region at some point since this is where the umbilical cord passes through to transport nutrients to babies in the womb. After the umbilical cord falls out, the hole that it used to pass through has to slowly scar down. In most people, that takes place by the time they’re 5 years old or it fails to take place and gets corrected while they’re children.

In adults, umbilical hernias are caused by a few things: either a hole that failed to close and went unrecognized, a partially closed hole that still has a small defect at the site, or the recreation of a new defect because of the belly button’s location on the body. Factors that predispose people to developing a hernia are things that increase pressure in the abdomen that stretch this existing weak spot; whether it never quite closed all the way, or because it will always be the weakest spot because of the hole that was once there. Obesity, chronic cough, chronic constipation and urinary retention (a condition that blocks the urinary tract and prevents someone from completely emptying his or her bladder) are all risk factors for hernias because they increase pressure in the abdomen.

Umbilical hernias can be more dangerous than ventral hernias because they often are smaller. This can lead to intestinal contents that herniate through and obstruct or cause bowel perforation. This site also has a higher risk for causing pressure on the overlying skin, leading people to develop wounds related to their hernias.

Umbilical hernias are fairly common. I often see a lot of people who say “I have a bulge here,” but don’t think much of it until it becomes a problem. For some people, it never becomes an issue so they never get it addressed by a doctor. For people who are obese, it’s often difficult to identify a hernia, so unless it causes pain they also may not know a hernia is there since it doesn’t present cosmetically.

Even if you don’t experience pain in the area, hernias do come with several identifiable symptoms, of which you should be aware. If a hernia causes a bowel obstruction you may experience nausea, vomiting, pain and skin redness in the area where the hernia is

located. However, most people will feel or start to see a visual bulge, which begins at the base of the bellybutton. Once the hernia becomes more obvious, it tends to skew toward the lower or upper portion of the bellybutton. They then feel fullness in their bellybutton before the belly button finally begins to stick out. Depending on how attuned you are to that area of the body, you’ll notice these changes sooner.

Treatment for Umbilical Hernias

Umbilical hernias are much smaller than incisional hernias, which gives us more options for repair. These hernias can be fixed with a little incision around the belly button, laparoscopically or robotically. The repair is performed by placing the herniated tissue back to its proper position behind the abdominal wall, and closing the area with stitches, often with small piece of mesh as reinforcement. The smaller a hernia is when it’s fixed, the better the odds it doesn’t recur. Patients also experience a shorter recovery time.

While minimally invasive surgery is a fix for this condition, prevention may be the best medicine for very small umbilical hernias. The more you increase pressure around the belly button’s weak spot, the higher the likelihood it’s going to get worse and you’ll develop a hernia that requires surgery. If you have one of the risk factors I previously mentioned — obesity, chronic cough, constipation or urinary retention — see a doctor to address these conditions. In particular, if you are overweight or obese, losing weight will reduce your risk for hernias. However, you may need the support of a doctor, dietitian or nutritionist to put you on the path toward a healthier lifestyle.

If an umbilical hernia is relatively small and you can reduce these risk factors, then you’ll also improve your odds of the hernia staying the same size and you may be able to avoid surgery altogether. This becomes important because even if you get an umbilical hernia fixed, all of these same risk factors also are risk factors for a recurrence after a repair. So, if you want to avoid an umbilical hernia in the first place or keep it from returning, prevention and addressing certain chronic conditions are the best ways to reduce your risk.

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