A hernia occurs when tissue pushes through a weak spot in muscle. A periumbilical hernia is a specific type of abdominal wall hernia that develops around the navel or belly button. This common condition affects individuals of all ages, including infants and adults, forming a noticeable lump.
Understanding Periumbilical Hernias
A periumbilical hernia involves a protrusion of internal tissue, often fatty tissue or a section of the bowel, through an opening or weakness in the abdominal wall muscles near the navel. This weakness allows abdominal contents to push outwards, creating a visible or palpable lump. The defect typically occurs in the linea alba, a fibrous band of tissue in the midline of the abdomen, adjacent to the umbilicus.
Abdominal wall weakness can stem from various factors. In infants, it commonly arises when the umbilical cord opening does not fully close after birth. For adults, periumbilical hernias often result from increased pressure within the abdominal cavity. This can be due to conditions like obesity, multiple pregnancies, chronic coughing, or straining during bowel movements.
Recognizing the Signs
The primary sign of a periumbilical hernia is a soft swelling or bulge around the navel. This lump may become more prominent with increased abdominal pressure, such as during coughing, crying, straining, or standing. While some periumbilical hernias may be painless, adults are more likely to experience discomfort, a dull ache, or pressure in the navel area.
Hernias can be categorized as reducible or irreducible. A reducible hernia means the bulge can be gently pushed back into the abdominal cavity or disappears when lying down. Conversely, an irreducible, or incarcerated, hernia indicates that the contents are trapped and cannot be pushed back. Seek immediate medical attention if the bulge becomes firm, tender, discolored, or is accompanied by severe pain, nausea, or vomiting, as these could be signs of a strangulated hernia. Strangulation occurs when the blood supply to the trapped tissue is cut off, a medical emergency.
Treatment Approaches
The management of periumbilical hernias varies, with surgical repair being the definitive treatment for most cases in adults. For infants, however, watchful waiting is often recommended, as many umbilical hernias, especially those less than 1.5 cm in diameter, close spontaneously by age 2 to 5 years. If a hernia in a child persists beyond this age or causes symptoms, surgical intervention may be considered.
Surgical repair typically involves pushing the protruding tissue back into the abdomen and then closing the opening or strengthening the weakened abdominal wall. For larger defects or in adults, a synthetic mesh is often used to reinforce the area and reduce the risk of recurrence. Two common surgical approaches are open repair, which uses a single incision near the hernia site, and laparoscopic repair, which involves several small incisions through which specialized instruments and a camera are inserted. Laparoscopic repair often results in less postoperative pain and a quicker return to normal activities, though both methods are considered effective.