Umbilical Hernia

A swelling or pain in the tummy button, (called the umbilicus) could be due to a rupture known as a hernia. Because of its position in the tummy button, the rupture is called an umbilical hernia.

What is a hernia?

A hernia is a pouch of varying size that pushes through a muscle sheet because the muscles aren't fully developed. A tummy wall is an example of a muscle sheet. Any hernias usually disappear before birth, but there is often a weakness there throughout life.

Umbilical hernia in babies

Sometimes babies can be born with a hernia present at the site of the umbilicus navel, or belly button in the newborn; although sometimes quite large, these hernias tend to resolve themselves without any treatment by around the age of 2-3 years. Obstruction and strangulation of the hernia is rare because the underlying defect in the abdominal wall is larger than in an inguinal hernia of the newborn. The size of the base of the herniated tissue is inversely correlated with risk of strangulation i.e. a narrow base is more likely to strangulate. In appearance it will look like a soft bulge underneath the skin, this is where the hernia has occurred.

Babies are prone to this malformation because of the fetal development process. During this, the abdominal organs initially form outside the abdominal cavity. They later return into the abdominal cavity through an opening which will become the umbilicus.

If a hernia is going to develop in a baby it will normally happen in the first few weeks or months after the baby is born. This can happen if there is a weakness in the muscles of the abdomen. There is another type of hernia called inguinal hernia which develops in the groin area of babies as opposed to the belly button.

When the baby is born, the small opening in the abdominal muscles closes as the baby starts to mature. However, in some cases this does not always happen; these muscles don't meet and grow together completely, which leaves a small opening present. This opening allows a small loop of intestine to move into the opening between the abdominal muscles, and it is this that causes a hernia.

It is thought that around 10% of all babies are born with an umbilical hernia. The chances of a baby having a hernia are increased if:

• A sibling or parent has had a hernia as a baby.
• The baby has any abnormalities of the urethra, cystic fibrosis, or developmental dysplasia of the hip.

Umbilical hernias will usually occur in newborn babies. However, sometimes they aren't noticeable until several weeks or even months after a birth. Some people believe straining and crying may cause a hernia. This is not true, however, straining may make any hernia already present more noticeable due to increased pressure in the abdomen.

How do I know if it's an umbilical hernia?

The way to check for a hernia in a baby is to check the area around their belly button. If a bulge or swelling starts to appear, then it could be a hernia. Usually, a hernia will be more noticeable if a baby is crying, so use this time to check. Once your baby is relaxed and calm, the swelling may reduce. This is because the hernia is retracting back into the abdomen.

If you are unsure of anything regarding your baby, or believe they may have a hernia then pay a visit to your doctor. Umbilical hernias can close on their own by the time a child reaches its first birthday without the need of surgery; however, it is always best to seek a professional opinion as you would not want your child to be in pain.

How is an umbilical hernia treated?

An umbilical hernia can be fixed in two different ways. The surgeon can opt to stitch the walls of the abdominal or can place mesh over the opening and stitch it to the abdominal walls. The latter is of a stronger hold and is commonly used for larger tears in the abdominal wall. Most surgeons will repair the hernia 6 weeks after the baby is born.

The main concern regarding a hernia is that on occasions a loop of intestine which protrudes through a hernia can become stuck. This means it is no longer reducible. If this occurs, it will not be possible to gently push the intestinal loop back into the abdominal cavity. If this does happen then the section of intestine may possibly lose its blood supply. It is necessary for the intestine to have a good blood supply to be able to be healthy and function properly.

Congenital umbilical hernia is a congenital malformation, common in infants of African descent. Among adults, it is three times more common in women than in men; among children, the ratio is roughly equal. An acquired umbilical hernia directly results from increased intra-abdominal pressure caused by obesity, heavy lifting, a long history of coughing, or multiple pregnancies.