A paraumbilical hernia is a common abdominal condition where internal tissue or an organ protrudes through a weakened area near the navel. While often appearing as a noticeable bulge, this type of hernia can sometimes remain undetected. Understanding its characteristics, causes, and available treatments is important for individuals seeking information about this condition.
What is a Paraumbilical Hernia
A paraumbilical hernia involves the protrusion of internal contents, typically fat or a section of the intestine, through a defect in the abdominal wall fascia adjacent to the navel. This differs from an umbilical hernia, which occurs directly through the navel; paraumbilical hernias are more common in adults.
The underlying issue is a weak spot in the linea alba, a fibrous band of tissue down the midline of the abdomen. When internal pressure increases, the peritoneum can push through this defect, forming a sac containing the protruding tissue.
Paraumbilical hernias are classified as ventral or abdominal wall hernias. They can occur either above (supraumbilical) or below (infraumbilical) the navel.
How to Identify a Paraumbilical Hernia
The most prominent sign of a paraumbilical hernia is a visible lump or bulge around the navel. This swelling may become more noticeable when standing, coughing, or straining, and might temporarily disappear when gently pushed back into the abdomen or when lying down.
Individuals may also experience discomfort or a dull aching sensation in the umbilical region. This pain can worsen with physical activity, prolonged standing, or vigorous exercise.
Paraumbilical hernias are described as either reducible or irreducible. A reducible hernia means the protruding tissue can be pushed back into the abdominal cavity. In contrast, an irreducible hernia, also known as an incarcerated hernia, means the contents cannot be easily returned.
Why Paraumbilical Hernias Occur
Paraumbilical hernias primarily develop due to inherent weaknesses in the abdominal wall and factors that increase pressure within the abdomen. The abdominal wall can have weak spots, which may be present from birth or develop over time. Some individuals may have a genetic predisposition to weaker connective tissue, increasing their likelihood of hernia formation.
Conditions and activities that significantly raise intra-abdominal pressure frequently contribute to these hernias. These include chronic coughing, repetitive heavy lifting or straining, obesity, and pregnancy. Chronic constipation can also contribute.
Diagnosing and Treating Paraumbilical Hernias
Diagnosis of a paraumbilical hernia begins with a physical examination. The doctor will inspect and feel for a bulge in the umbilical region, assessing its size, location, and reducibility. Patients may be asked to cough or strain to make the hernia more apparent.
While a physical exam is often sufficient, imaging tests like an abdominal ultrasound or CT scan may be used if diagnosis is unclear or to evaluate contents. These studies confirm the hernia and identify complications.
Surgery is the definitive treatment for paraumbilical hernias in adults. Small, asymptomatic hernias may be observed. However, surgical repair is generally recommended to prevent complications like strangulation.
Surgical repair can be performed using open or laparoscopic (keyhole) techniques. Open repair involves an incision to return tissues and close the weakened area with sutures. Laparoscopic repair uses small incisions for instruments and a camera. A synthetic mesh is often used to reinforce the abdominal wall (hernioplasty), reducing recurrence rates compared to suture-only repair (herniorrhaphy).