Disease Description (Causes and Symptoms)
- Definition: An umbilical hernia is a condition in which intra-abdominal organs (such as the omentum and intestines) push through an opening in the umbilical ring, displacing the skin and causing a bulge around the navel. It mainly occurs in newborns, but can also develop in adults due to acquired causes.
- Causes/Pathophysiology: It occurs when the umbilical ring does not completely close during fetal development or the birth process, or when an opening remains due to a defect at the umbilical cord site (congenital). In adults, pregnancy, ascites (due to cirrhosis), obesity, increased intra-abdominal pressure (such as with peritoneal dialysis), and recurrent coughing or constipation may be triggering factors (acquired).
- Main symptoms: A bulge around the navel (especially when crying or straining) that can be pushed back into the abdominal cavity with a finger (reducible). Pain mainly occurs when the hernia becomes trapped or its blood flow is impaired (irreducible/incarceration → possible strangulation). The size varies, but in children it is usually 1–5 cm.
Treatment Methods
- Conservative observation
- Newborns and infants: Small umbilical hernias commonly close spontaneously (when they develop before 6 months of age, most improve before 1 year of age or within several months thereafter). Many recommendations allow observation until 1–3 years of age (or, if necessary, up to 5–6 years) if the hernia is small and asymptomatic.
- If symptoms occur (pain, vomiting, or signs of intestinal obstruction) or the intestine becomes trapped, seek immediate medical attention.
- Surgical treatment
- Indications: Immediate surgery is indicated if the hernia persists (the age criterion varies according to the hospital’s policy, but generally if it persists beyond 3–5 years), is very large, causes cosmetic concerns, causes repeated discomfort, or involves incarceration or suspected ischemia.
- Surgical methods: In children, the umbilical ring is usually closed with sutures (herniorrhaphy) under local or general anesthesia. In adults or in cases of large defects or recurrence, extraperitoneal or intraperitoneal surgery using mesh reinforcement may be selected.
- Recovery: Most children can be briefly hospitalized or discharged the same day. Adults and patients undergoing complex surgery may require a longer recovery period and activity restrictions.
- Medication/supportive treatment: Pain control (analgesics), antibiotics if infection is suspected, and optimization of blood coagulation and medical conditions before and after surgery (management of liver disease and ascites).
- Lifestyle management and precautions: Avoid increased intra-abdominal pressure (avoid severe straining and lifting heavy objects), manage obesity, and treat coughing and constipation.
Checklist Before an Outpatient Visit (Items to Prepare and Points to Confirm)
- Materials to bring: A list of current medications (including anticoagulants), history of previous surgeries and medical conditions (such as cirrhosis and ascites), and, for newborns, birth history and records of umbilical cord problems.
- Recent symptom records: Frequency of the bulge (when it becomes larger), changes in size, presence and severity of pain, vomiting, fever, or abnormal bowel movements, and when symptoms began (age).
- Previous tests and imaging: Bring the results of an umbilical ultrasound or abdominal imaging if available.
- Lifestyle habits and risk factors: Whether pregnancy is possible (adult women), changes in body weight, chronic coughing or constipation, and whether peritoneal dialysis is being performed.
- Examples of questions for the outpatient visit: “Until what age can we wait and see whether this hernia improves?” and “What symptoms mean that I should go to the emergency department?”
Examples of General Questions to Ask the Doctor
- “What is the likelihood that this hernia will heal on its own?”
- “If surgery is recommended, what are the surgical options, and what should I expect regarding scarring and recovery time?”
- “What is the risk of surgical complications and the recurrence rate?”
- “I currently have ascites or liver disease. Is any special preparation needed for surgery?”
- “What activities should I avoid or what management methods should I follow in daily life?”
Examples of Condition-Specific Questions
- For newborns and infants: “Until how many months can we expect our child’s hernia to disappear spontaneously? Until when do you recommend observation?”
- For adults with cirrhosis: “Is surgery safe while I have cirrhosis and ascites? Is ascites control or any additional testing needed before surgery?”
Additional guidance: Situations requiring an immediate visit to the emergency department include when the hernia suddenly becomes hard (irreducible) or when symptoms suggesting ischemia or intestinal obstruction occur, such as severe pain, persistent vomiting, fever, or loss of intestinal activity (no bowel movements or passage of gas).