Umbilical Hernia
How common are Umbilical Hernias?
Umbilical hernias are common. In children this is due to failure of the abdominal wall muscles to close around the opening where the umbilical cord, and its blood vessels, comes through. This process can only start once the baby has been born and the umbilical cord is cut, as the baby no longer needs the umbilical blood vessels. This process usually takes several months or even years to complete with up to 20% of children at 6 months and 10% of children at 5 years having an umbilical hernia.
Umbilical hernias are also common in adults. Up to 6-14% of adults may develop, or acquire, an umbilical hernia during adult-life. In the majority cases this will be a new hernia and not one present in childhood. The main reason for adults to develop an umbilical hernia is an increase in pressure inside the abdomen resulting in the stretching of the abdominal wall opening of the umbilicus. Common causes for increased intra-abdominal pressure are pregnancy, obesity and any disease process, such as liver disease, that results in fluid buildup inside the abdomen (called ascites). Due to the association with pregnancy adult hernias are slightly more common in females.
In the remaining 10% of adults there may be a small umbilical defect, usually only a few millimetres, leftover from childhood. These hernias are most commonly identified when a surgeon examines your abdomen for another reason and identifies your umbilical hernia as an incidental finding.
How do Umbilical Hernias present in adults?
Incidental umbilical hernias, are by definition, often symptom-free and unlikely to cause any problem as long as they do not increase in size. They do, however, need to be identified if you are having an abdominal operation with a cut (incision) through or near your umbilicus.
Acquired umbilical hernias can present with a variety of symptoms. The most common symptom is a bulge or lump in or just beside your umbilicus. Depending of the cause of your hernia this can increase in size over time. The hernia can also contain other organs including fat and or bowel. If you have underlying liver disease this can also include fluid (ascites) and blood vessels that lie around your umbilicus. Pain is less common unless there is a complication of your hernia. Often the size of the hole in the abdominal wall (called the hernia neck) can be much smaller than the size of the hernia sac and this increases the risk of any bowel in your hernia sac becoming stuck (an obstructed or incarcerated hernia) and/or the blood supply being cut off (strangulated). These complications will result in some or all of the following symptoms: increased pain at the site of the hernia; abdominal distension; nausea and vomiting; swelling of the overlying skin and change in colour of the skin (most commonly to a red or dusky colour). This is a serious complication and requires urgent assessment and management (see below).
Treatment for Umbilical Hernias
Not all umbilical hernias need an operation and treatment is often dependent on identifying and treating the underlying cause for developing the hernia. Women who develop an umbilical hernia during a pregnancy often find the hernia closes or becomes significantly smaller after delivery and often never need surgical care. Women with a persistent sizable defect or abdominal symptoms post-partum may warrant a surgical consultation to discuss treatment options.
In patients with an umbilical hernia due to obesity, weight loss is an important part of your management. In some cases, weight loss may result in the hernia defect becoming smaller and asymptomatic, thus decreasing the need for an operation. However, in patients with obesity who go on to require an operation, weight reduction prior to surgery has been shown to significantly decrease post-operative complications including wound infections, as well as decreasing the risk of the hernia repair failing. During your consultation with our surgeons, weight loss will be part of the discussion and we will help and support you to create a plan that works for you.
In patients with underlying liver disease or any disease that causes fluid build-up in the abdomen, your condition should be adequately treated by your liver specialist and the fluid in the abdomen resolved or reduced before any operation.
Incidental umbilical hernias mostly do not need an operation. However, it might need to be fixed if you are undergoing an abdominal operation for another cause with an incision through or close to the umbilicus. Your surgeon will discuss with you how your umbilical hernia will be dealt with. In most instances the umbilical hernia will be closed at the same time as the other surgical incision is closed.
Any patient with symptoms or clinical findings suggestive of obstructed/incarcerated or strangulated umbilical hernias, should contact their surgeon urgently or present to an emergency department for urgent surgical assessment.
If you do need an operation there are several different operations for umbilical hernia repairs, including open surgery, with an incision under your umbilicus, or minimally invasive surgery (MIS or key-hole) where smaller incisions are used for a telescope and instruments to repair your hernia from the inside. In most instances surgical mesh may be used to reinforce and strengthen the hernia repair. Research has shown this decreases the risk of the hernia repair failing.