Umbilical Hernias
An umbilical hernia is a fairly common condition among infants. In most cases, these hernias don’t cause any problems, and they often go away on their own over time.

If your baby has a bulge around his belly button, he may have an umbilical hernia.  Before his umbilical cord falls off, you may notice that the area seems to stick out a little more when he cries. Or maybe, once the cord is gone, you see that his navel sticks out. For this reason it is commonly called an “outie”. In some cases, you might not see a bulge but might be able to feel one.

What Causes Umbilical Hernias?

Before a baby is born, the umbilical cord passes into the abdomen through a small opening in the abdominal muscles. After the baby is born the opening in those muscles usually closes. An umbilical hernia develops when this opening does not close. When this happens part of the small intestine slides out through it, creating a soft bulge of tissue around the navel. Some people believe that it forms due to the way the doctor cuts or clamps the cord when the baby is born. The truth is that there is no scientific evidence to support this idea. 

What Are the Symptoms?

Most infants present with asymptomatic umbilical hernias which are discovered during a physical exam. It is usually the parents who are very anxious about the bulge in their baby’s abdomen. Most time when there an umbilical hernia, you will be able to see it most clearly when your child cries, coughs, or strains as he tries to poop. This is because all of these things put pressure on his abdomen. When he rests, you might not be able to see the hernia. Usually, they don’t hurt. When there are symptoms, pain in the umbilical area is the most common. There may also be changes in coloration after physical activity. 

How is the diagnosis confirmed?

If you suspect that your child has an umbilical hernia, you should have your child evaluated by a healthcare provider. Umbilical hernias usually can easily be identified with a physical exam. In some cases, a health care provider may recommend an imaging exam, such as an abdominal ultrasound to check for potential complications or underlying problem.

Treatment of an Umbilical Hernia

Most umbilical hernias have a tendency to resolve spontaneously and disappear on their own before 2 years of age. In view of the favorable natural history of umbilical hernias, surgical treatment is indicated for: 

  • Umbilical hernias that are located above the umbilicus
  • Those hernias that persist beyond the age of 2-4 years
  • Those occurring in children with connective tissue disorders
  • Hernias present in girls. In girls it is recommended to do surgical treatment to avoid future complications during pregnancy.
  • Hernias that develop in young kids that are athletes.

It is contraindicated the use of material that compresses the abdomen to try the reduction of the umbilical hernia. In different cultures objects like buttons, coins and bands, are used as home remedies for umbilical hernias. These can cause respiratory restriction to the infant and also abrasions or scrapes of the skin that generate infections and discomfort.

Complications of Umbilical Hernias

Although complications involving umbilical hernias are rare, they can happen. If the tissue that’s sticking out through the abdominal muscle opening becomes trapped blood flow to that tissue may be reduced. This is called an “incarcerated hernia” This can cause pain and tissue damage. If the blood supply to the trapped tissue becomes cut off completely, that may lead to the trapped tissue’s death and could trigger a serious infection that requires emergency care.

Seek emergency care right away if a child who has an umbilical hernia develops the following symptoms:

  • Pain or tenderness in the area of the hernia
  • Swelling or discoloration of the hernia
  • An inability to easily push in the hernia tissue
  • Vomiting or constipation.

These symptoms may signal that a portion of the intestine has become trapped in the hernia. Incarceration and strangulation remain the only absolute indicators for surgical repair, and both of these are rare.

As a parent you can be at ease knowing that most umbilical hernias resolve on their own. And if it does not resolve on its own, know that currently, umbilical hernia surgery is a surgery with little risk of complications, a good recovery and no scars that alter body aesthetic. The overall complication rates after elective hernia repair are low at about 2%, whereas these are increased to 8–33% for the incarcerated hernias requiring emergency operations. If you suspect that your child might have an umbilical hernia and still have doubts, on your next visit to La Loma Luz Adventist Hospital we can discuss about the best approach.

Maria Fernanda Rizo, MD - Pediatric Surgeon

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