Definition

An umbilical hernia is a medical disorder characterized by the protrusion of a portion of the intestine through an opening in the abdominal muscles, specifically in the region surrounding the navel. Umbilical hernias are mostly benign. Umbilical hernias are more prevalent in infants and are characterized by a discernible protrusion that becomes more apparent during episodes of crying.

Approximately 2% of the overall population experiences umbilical hernias in adulthood. Umbilical hernias typically manifest in people who are obese, pregnant or have other coexisting conditions, such as liver cirrhosis. Approximately 20% of people suffering from liver failure, also known as liver cirrhosis, develop abdominal fluid accumulation, known as ascites, which can lead to the formation of hernias. Complications arising from umbilical hernias are more prevalent in males. Umbilical hernias typically do not result in symptoms other than a bump in the abdominal region. Umbilical hernias in children can spontaneously resolve between 1 and 2 years old. However, in certain instances, the hernia may persist until the child reaches the age of 5 years.

Causes

During pregnancy, the transfer of nutrients from the mother to the fetus occurs via the umbilical cord or placenta. The umbilical cord is attached to the infant's stomach via a small aperture in the abdominal muscles. This hole often closes following childbirth. However, if these muscles fail to merge fully, an umbilical hernia may develop shortly after birth or later.

Adults typically acquire approximately 90% of umbilical hernias. Elevated abdominal or gastric pressure can result in the development of an umbilical hernia. Factors contributing to high pressure include:

• Obesity
• Twin pregnancy
• Abdominal ascites
• History of  abdominal surgery
• Dialysis treatments for chronic renal failure

Risk factor

Umbilical hernias frequently manifest in infants who are born prematurely or have a low birth weight. This disease can manifest in both male and female infants. Umbilical hernia risk is elevated in individuals who are overweight and have experienced multiple pregnancies. Females are more likely to experience this type of hernia.

Symptoms

An umbilical hernia manifests as a protrusion around the navel. The visibility of the protrusion in babies with an umbilical hernia will increase during crying, coughing, or exertion episodes. Umbilical hernias in children are not associated with pain. Umbilical hernias can result in stomach discomfort in adults. Additional indications of a hernia include:

• Pain when lifting heavy objects
• Enlarged protrusion of the abdomen
• Abdominal protrusion pain
• Sensation of satiety in the stomach.

Under certain circumstances, a hernia may not result in a protrusion of the stomach but instead manifests symptoms such as abdominal distension, dysphagia, food regurgitation, and chest pain.

Diagnosis

During the consultation, your doctor will inquire about your smoking habits and medical background, specifically any cases of liver or kidney disease. Additionally, they will assess your body mass index. Typically, a doctor will perform a physical examination to diagnose a hernia. The doctor will thoroughly examine the abdomen to assess the dimensions of the aperture in the connective tissue layer within the stomach and the contents of the developed hernia. If your doctor detects problems or encounters difficulties during a physical examination, other diagnostic procedures may be conducted, such as a CT scan or ultrasound imaging.

Management

Umbilical hernias in children can close on their own by the age of 1–2 years. In Indonesian society, certain habits pose a risk of exacerbating the condition of an umbilical hernia, such as attempting to manually push the hernia protrusion back into the abdominal cavity by placing a coin on top of it. It is advisable to avoid it, as it can lead to an infection.

In pediatric patients, surgical intervention may be indicated in cases where the hernia:

• Inducing pain
• Greater in size than 1-2 cm
• After two years of age, the lump remains the same size.
• Protrusion persists for 5 years.
• Restricted within the cavity.

Surgical intervention is advised in adult patients to avoid complications, particularly in cases where the hernia enlarges and intensifies in pain. There are various types of hernia surgery, which include:

• Open surgery

A surgical procedure in which the protruding intestine is inserted into the stomach through an incision. Reconstructed muscles will be repaired with sutures. In certain instances, mesh is utilized to support the abdominal muscles.

• Laparoscopy

The surgical procedure uses the same principles as open surgery but with fewer incisions, and it also makes use of a camera scope to visualize the stomach's anatomy properly.

Before the surgical operation, anaesthetics will be administered to prevent any kind of pain throughout the procedure. Postoperatively, you will experience abdominal pain and will need to restrict physical activity for a few weeks. It is advisable to avoid engaging in work or attending school for several days to one week following the surgical procedure.

Postoperative Care

• Avoid constipation by drinking 8–10 glasses of water and eating fibre-rich meals.
• Returning home the same day following surgery is generally possible, barring complications or additional medical conditions. Physical activity and lifting exceeding 4.5 kg are not advised until six weeks after surgery.
• Maintaining a clean and sterile surgical wound is essential. After surgery, you should not swim or bathe for one to two weeks.
• Analgesics, including ibuprofen or paracetamol, are available without a prescription. Consult your physician before using any medicine to relieve pain.

Complications

Complications from umbilical hernias in children are uncommon. If the projecting intestine gets entangled around the orifice, it might cause complications. The ability to propel the intestines into the abdominal cavity is impaired in this situation. Strangulation, in which intestinal tissue dies from a restricted blood supply, can occur if left untreated for an extended period. Another ideal environment for bacterial growth is the precise site of tissue death. An urgent medical response is necessary to prevent the potentially fatal spread of an infection in the abdomen.

Post-surgery, the prognosis for an umbilical hernia is frequently beneficial, with minimal risk of complications. Nevertheless, in the case of an overweight individual, the occurrence of a hernia increases the likelihood of its recurrence. Individuals with a body mass index greater than 30 kg/m2, diabetes, and infections are more susceptible to disease recurrence.

Postoperative complications arise in 10% of individuals. The complications are as follows:

• The appearance of surgical scars that are red and rotting indicates the presence of infection at the surgical site.
• Hemorrhaging
• Changes in the morphology of the umbilicus
• Wound laceration

Prevention

Umbilical hernias are common in infants and usually resolve on their own. However, in adults, certain strategies may help reduce the risk of developing umbilical hernias:

• Eat nutritious foods and exercise to maintain a healthy weight.
• Consume fiber-rich fruits and vegetables to avoid constipation.
• Use proper weights for weightlifting. Do not lift large weights until you've trained.
• Maintain proper posture when lifting large objects.
• Repeated coughing or sneezing requires medical attention.
• Stop smoking

When to see a doctor?

Consult your pediatrician regarding an umbilical hernia. If your newborn has an umbilical hernia with these symptoms, get medical attention:

• Pain
• Vomit
• Red and swollen hernia

Adults should also watch for these warning indicators. Immediate and appropriate diagnosis and treatment are required to prevent additional complications.

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