Umbilical Hernia

Definition:
Umbilical hernia is a congenital aberration in which a part of intestine protrudes through the weaker part of the skin in the abdominal wall. This bulge commonly takes place under the skin at umbilicus (belly button). This complexity is also known as 'exomphalos'.

Umbilical hernia is most commonly found among infants but they can affect adults also.

Description:
The human body consists of abdominal cavity which comprises the stomach and the intestine. The abdominal cavity is protected by three layers; the first inner layer is the peritoneum, the second layer made up of muscles and the third layer is the outer skin. If the muscles become weak, the intestine along with the peritoneum will be forced to protrude through the weaker part of the muscles. This causes hernia.

Causes in Babies:
During gestation, the fetus gets nourishment from its mother through umbilical chord. It is attached to the baby's abdominal muscles and this opening is normally covered by the muscles after birth and this region is called umbilicus. If the opening is not covered properly or if the muscles of this region become weak, it results in umbilical hernia at birth.

Hernia, if it is small, may be gradually closed by the age of two. But for large hernias, it will not get closed normally and hence surgery is required.

Causes in Adults:
A lot of abdominal pressure may leads to umbilical hernia in adults. The main causal agents in adults are,

• Obesity
• Heavy weightlifting
• Tumor in abdominal cavity
• Secretion of fluid in the abdomen
• Due to multiple pregnancies
• Heavy workload during delivery period

Symptoms:
Symptoms may vary from one person to another. The most common symptoms are bulging or protruding of the skin at the umbilicus or navel region and the bulge may be 1 to 6 cm in diameter. It may pain sometimes and the bulging enlarges during sneezing, coughing, lifting weights etc. The layer over the hernia is usually red, yellow or blue in color. The bulge reduces when the infant lied down.

Effects:
When umbilical hernia is not treated properly it leads to two conditions.

• The hernia cannot be pushed back into the abdominal cavity and left confined which leads to severe pain and nausea.
• The hernia is compressed and the blood supply is stopped to that part of intestine. This leads to constipation and gangrene (the particular part of intestine dies).

Treatment for the Malformation:
Umbilical hernia can be diagnosed by physical examination, sometimes by x-ray or ultrasound. If it is not severe, the doctor may even push the intestine inside the abdominal cavity in case of infants. But when it is severe, surgery is the only option.

During surgery, the person is given local or general anesthesia depending upon the enlargement. A small incision is made near the umbilicus and the tissues are pushed into the abdomen. The muscles are sutured and the opening is closed by stitches. If the defect is large and cannot be sutured, a mesh is placed inside to hold the tissues. A mesh is nothing but a synthetic patch used to close the incision during the surgery.

After Surgery:
After surgery, the child can leave the hospital in a few hours and can resume normal diet. But the child is restricted to touch or damage the operated area. Heavy exercises and bulk clothing should be avoided. Children should be given sponge bathing only till the stitches fall off. After surgery, if the child suffers from high temperature, swelling, bleeding or unable urinate, it is advisable to consult the doctor.