Umbilical hernia
and Carola Felchner, science journalistDr. med. Mira Seidel is a freelance writer for the medical team.
More about the expertsCarola Felchner is a freelance writer in the medical department and a certified training and nutrition advisor. She worked for various specialist magazines and online portals before becoming a freelance journalist in 2015. Before starting her internship, she studied translation and interpreting in Kempten and Munich.
More about the experts All content is checked by medical journalists.If there is a gap in the connective tissue covering the abdominal wall, especially in the area of the navel, it is called an umbilical hernia. In medicine, this phenomenon is also called umbilical hernia or umbilical hernia (Latin hernia = break). An umbilical hernia is noticeable as a bulge in the umbilical area and often does not cause any discomfort. Sometimes, however, parts of the abdominal organs push through the umbilical hernia fissure and become trapped. This triggers severe abdominal pain. Read more about the symptoms, causes, treatment and prognosis of umbilical hernia here!
ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. K42
Brief overview
- What is an umbilical hernia? Gap in the abdominal connective tissue in the navel area
- Symptoms: swelling or bulging in the umbilical region; with pinched organs pain, possibly blood in the stool, possibly general signs such as fever, nausea, palpitations
- Causes: Combination of a weak point in the connective tissue and increased internal pressure in the abdominal cavity; favored by obesity, pregnancy, heavy lifting, coughing or certain diseases such as ascites
- Diagnostics: palpation examination, if necessary ultrasound
- Treatment: Umbilical hernia often heals on its own in children. In adults, surgery is usually necessary.
Umbilical hernia: description
In the case of an umbilical hernia (belly button hernia), the navel does not break like a bone would, even if the name suggests it. Rather, it creates a gap or tear in the so-called abdominal wall fascia in the navel area. This is the connective tissue sheath (muscle skin) that stabilizes the abdominal wall. The umbilical hernia is one of the so-called external hernias. These are "breaks" in the abdominal wall. There are also internal hernias such as the diaphragmatic hernia (diaphragmatic hernia).
Hernial port, hernial sac and hernial content
Behind the navel there is only a thin fascia and some connective tissue. This is a weak point in the abdominal wall that can give way under certain circumstances. The gap that then arises is the so-called break gate. If only the peritoneum - the innermost layer of the abdominal wall - is turned inside out through this gap, a small protuberance (bulge) occurs. It is called a hernial sac and usually does not cause any discomfort. With increased pressure in the abdominal cavity, parts of the abdominal organs (such as a loop of intestine) can push through the hernia into the protuberance (hernia contents). That can be painful - and even life-threatening if the organs are trapped!
That happens with the umbilical hernia
The risk of complications such as entrapment (incarceration) in adults with an umbilical hernia is around 30 percent.
Umbilical hernia: treatment
The umbilical hernia therapy depends mainly on the severity of the hernia and the age of the patient. A congenital umbilical hernia in babies, for example, is not treated at all: in around 90 percent of cases, it resolves on its own in the first few years of life.
Sometimes it is recommended to wear an umbilical hernia bandage. This is a corset-like band to stabilize the abdominal wall. However, this form of umbilical hernia treatment is usually not suitable. Because the bandage cannot prevent the abdominal organs from becoming trapped. It can also cause pressure damage to the skin and weaken the abdominal wall.
Umbilical hernia surgery is almost always necessary in adult patients and less often in children.
Umbilical hernia: OP
If the hernial opening in children has not yet grown together by pre-school age, an operation is usually performed. An umbilical hernia in adults usually also requires surgery. Only in the case of very small umbilical hernias that do not cause any symptoms can the doctor wait and examine the hernia regularly.
If abdominal organs (such as a loop of intestine) are trapped in the hernial opening (incarceration), an operation must be performed as soon as possible - this can be life-threatening!
Depending on the size of the hernial sac and the patient's state of health, different surgical methods are possible. In general, during the procedure, the doctor will move the contents of the hernia back into the abdomen and possibly remove the hernial sac. In the case of a smaller umbilical hernia, he can then sew up the hernial port directly. In the case of larger umbilical hernias, on the other hand, he will first sew a plastic mesh under the abdominal wall to stabilize it.
Hospitalization is not necessary for every umbilical hernia operation. Sometimes it can also be done on an outpatient basis. As a rule, the patient is given general anesthesia for the operation. In some cases it is sufficient to put the patient into a twilight sleep (analgesic sedation).
You can read everything you need to know about the surgical treatment of umbilical hernias in the article Umbilical hernia surgery.
Umbilical hernia: symptoms
One of the most important umbilical hernia symptoms is a swelling or bulging in the umbilical region. However, small umbilical hernias are sometimes not even visible - the typical bump only occurs when the abdominal pressure increases, for example from coughing, pressing or lifting heavily.
Usually a (small) umbilical hernia does not cause any symptoms. This is what is known as an asymptomatic umbilical hernia. If, on the other hand, symptoms occur, it is a symptomatic umbilical hernia.
Pinched umbilical hernia: symptoms
If the protuberance in the umbilical area becomes larger, it may be because parts of the abdominal organs (like a loop of intestine) have pushed themselves into the umbilical hernia fissure. Sometimes the contents of the hernial sac can be pushed back into the abdominal cavity (repositioned). If not, the umbilical hernia is not repositionable. The contents of the hernial sac are trapped (incarcerated hernia). Sudden severe pain and a pressure-sensitive abdominal wall (peritonism) then come as umbilical hernia symptoms. The pain usually occurs in the area of the navel hernia and can be long-lasting and colic-like. They are often associated with nausea and / or vomiting. Fever, palpitations and sweats are also possible. Stool retention may occur. Sometimes the skin over the umbilical hernia is also reddened.
Sudden, severe abdominal pain with a tight abdominal wall, often accompanied by nausea and / or vomiting, are referred to as "acute abdomen". It is an emergency that must be dealt with quickly - it can be life-threatening!
Umbilical hernia: causes
Doctors differentiate between congenital and acquired navel hernias:
Congenital umbilical hernia
A natural (physiological) umbilical hernia is the "standard" during embryonic development: the body of the embryo is still too small at this stage to accommodate the rapidly growing loops of the small intestine. However, this condition is temporary and normally disappears on its own in the further embryo development. With some babies, however, it stays the same: the children are born with an umbilical hernia. This congenital umbilical hernia is the most common type of umbilical hernia at 98 percent.
Acquired umbilical hernia
The abdominal wall of humans has weak points that favor an abdominal wall hernia. This applies to both infants and adults. A typical weak point is the belly button. This is because the umbilical cord started there in the womb. So the navel is more or less a scar only thinly backed by a muscular skin - and it is (er) prone to breakage.
At this connective tissue weak point in the abdominal wall, a gap can develop in the event of increased internal pressure in the abdominal cavity - an umbilical hernia occurs. The increase in pressure in the abdominal cavity can have the following causes, for example:
- Obesity
- pregnancy
- cough
- Lifting heavy loads
- Ascites
The acquired umbilical hernia usually affects premature babies who suffer from lung infections and often cough or scream. This puts a particularly heavy strain on the abdominal wall. The increased pressure in the abdomen creates an umbilical hernia.
Adults often get an umbilical hernia when the umbilicus is stretched for a long time. Women between the ages of 40 and 50, who often have several pregnancies and / or have weak connective tissue, are therefore particularly often affected. Other risk factors for an umbilical hernia in adults are obesity, severe weight loss, ascites and intense physical activity. Smoking also has a negative impact: it affects the collagen metabolism and thus the stability of the connective tissue. This favors an umbilical hernia.
Pregnancy is another risk factor: the pressure of the growing child in the abdomen and internal organs can result in an umbilical hernia. A small umbilical hernia usually does not cause any symptoms and is usually harmless. It usually disappears after the birth and does not need treatment. Postural gymnastics can also help, as it strengthens the muscles. If the gap does not close and surgery is necessary, it should not be done until several weeks after the birth.
Umbilical hernia in the baby
An umbilical hernia is quite common in babies and is usually harmless. It generally heals on its own: the umbilical ring - the point where the umbilical cord passes through the womb - usually scars after birth. However, this does not happen in around a fifth of all babies - the gap in the navel area remains.
Even if an umbilical hernia is common and usually harmless in babies, parents should take their child to the pediatrician. If the umbilical hernia does not cause any symptoms, the doctor will first push it back. If the circular muscles become stronger, the umbilical hernia will regress by itself over time. However, if the umbilical hernia is more than an inch in diameter or the child is uncomfortable, surgery may be necessary.
Find out more about the topic of umbilical hernia in babies in the article Umbilical hernia - baby.
Umbilical hernia: examinations and diagnosis
The best way to diagnose an umbilical hernia is to examine the patient in the supine position. He can usually feel the protrusion and the fracture opening well. In 95 percent of cases, the umbilical hernia is clearly visible from the outside. The doctor also tries to push the hernial sac back into the abdominal cavity (to reduce it). That is usually possible without any problems. If not (umbilical hernia that cannot be repositioned), this can be an alarm signal that abdominal organs have become protruding and may be jammed in a life-threatening manner. The doctor can determine whether there is actually an entrapment by means of an ultrasound examination.
Differentiation from other clinical pictures
A bulge in the umbilical area does not always have to be an umbilical hernia. Sometimes it is a lipoma. This is a benign fatty tumor. Alleged umbilical hernia symptoms such as abdominal pain can also turn out to be signs of another disease, for example inflammatory bowel diseases such as enterocolitis, irritable bowel colon irritable) or an intestinal obstruction (ileus). Sometimes there is also a different type of fracture than the umbilical hernia behind it. This can be an epigastric hernia (abdominal wall rupture between the navel and sternum) or a paraumbilical hernia. The latter is a break next to the navel.
Umbilical hernia: prevention
Anything that weakens the umbilical area can increase the risk of a breakage. For prevention, for example, you should avoid being overweight or years of physically hard work. When lifting heavy loads, be careful not to put too much strain on the abdominal wall. Through targeted exercises, you can additionally strengthen the abdominal and core muscles and thus reduce the risk of an umbilical hernia.
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