Disease Description (Causes and Symptoms)
- Definition: An umbilical hernia is a condition in which intra-abdominal organs (such as the intestine or part of the peritoneum) push up through the skin layer and protrude through the umbilical area due to a defect or weakening of the umbilical ring.
- Causes/Pathophysiology:
- Congenital: Occurs in newborns due to incomplete closure of the umbilical ring (the umbilical area does not close completely).
- Acquired (adults): Factors that increase intra-abdominal pressure — pregnancy, ascites (such as from cirrhosis), obesity, chronic cough, and after abdominal wall surgery.
- Main symptoms:
- A bulging protrusion in the umbilical area (especially increasing with crying, coughing, or straining)
- Often reducible by pressing with a finger
- Pain or tenderness (rarely, if the intestine becomes trapped, severe pain, vomiting, and peritoneal signs may occur)
- Size: Usually several mm to several cm (commonly in the range of 1–5 cm)
Treatment Methods
- Children (newborns and infants)
- Most heal spontaneously: Most umbilical hernias that develop before 6 months of age improve and heal before 1 year of age.
- Observation (conservative treatment): When there are no symptoms, the hernia is reducible, and it is small (generally small in diameter and asymptomatic), follow-up observation is used instead of active treatment.
- Indications for surgery:
- Persistence (usually when it persists until age 3–5 or older; for very large defects, it may be possible to wait until age 5–6)
- Repeated hernia necrosis or trapping (incarceration/strangulation), symptoms, or cosmetic concerns
- Surgical method: Suture closure of the defect (suturing the muscle and fascia) under local or general anesthesia. Mesh is generally not used in children.
- Adults
- In adults, surgical repair is recommended when symptoms are present or the hernia is large.
- Surgical methods: Closure of the defect (for small defects) or reinforcement with mesh insertion (for moderate or larger defects or when the risk of recurrence is high).
- Emergency surgery: Immediate emergency surgery is required if the hernia cannot be reduced or if there is severe pain, vomiting, or impaired blood flow (signs of strangulation).
- Conservative and lifestyle management
- Avoid activities that increase intra-abdominal pressure (lifting heavy objects, excessive straining due to severe constipation, etc.)
- Weight management, prevention of constipation (dietary fiber and fluids), treatment of chronic cough, and control of ascites (in patients with cirrhosis)
- Precautions/Risk of complications
- Incarceration (irreducible) → possible intestinal blood-flow impairment (strangulation): Seek emergency medical care if there is severe pain, vomiting, fever, or localized redness and tenderness.
- Risk of infection and recurrence after surgery (increased with obesity, ascites, or poor wound healing)
- Rarely, chronic pain or a foreign-body reaction may occur when mesh is used.
Outpatient Visit Checklist (Including Recommended Items to Bring and Example Questions)
- Recommended items to bring
- A list of medications currently being taken (including anticoagulants and antiplatelet agents)
- Information about previous surgeries and hospitalizations, birth history (for children), and liver disease, ascites, or pregnancy
- Recent changes in symptoms (when they began, how often they occur, and in what situations the protrusion becomes larger), and whether pain is present and its characteristics (including vomiting or bowel movement problems)
- Photographs (if the pattern of protrusion is clearly visible) or notes from a caregiver about changes in size
- Recent test results (such as abdominal ultrasound and blood tests) and allergy information
- Examples of symptom records to present to the doctor during the outpatient visit
- When the protrusion first appeared and its pattern of improvement and worsening
- Whether it goes back in when pushed by hand (reducibility), and symptoms when it cannot be reduced (pain or intestinal symptoms)
- Relevant underlying conditions (cirrhosis, ascites, pregnancy, obesity, etc.)
General Example Questions to Ask the Doctor
- What is the natural course of this condition? (Especially for children, how long is it safe to wait?)
- What are the criteria for determining that surgery is necessary?
- What are the surgical methods, expected recovery period, and possible complications (including the recurrence rate)?
- What precautions should be taken before and after surgery (medications, diet, and activity restrictions)?
- Is conservative management instead of surgery (such as wearing a support device) possible? Is it effective?
Examples of Condition-Specific Questions
- Regarding children:
- Until what age can we wait before treating our child’s hernia? (Including the recommended age based on the diameter and symptoms)
- Regarding adults/underlying conditions:
- I have ascites due to cirrhosis (or I am pregnant). Should the ascites (or the course of the pregnancy) be managed first before surgery? What preparation is needed to reduce the risk of recurrence?
(If necessary, an ultrasound examination may be used to check the size of the defect and its contents; if emergency signs occur, immediate evaluation in the emergency room is recommended.)