Umbilical hernias: everything you must know: part 1

An umbilical hernia manifests as a bulge near the belly button due to a hole in the abdominal fascia. It typically contains fat but may include bowel. Symptoms include a noticeable lump exacerbated by standing, coughing, or straining, though it may retract while lying down. Hernias don't heal on their own and can cause discomfort, pain, or aching, especially during physical activity. While usually not dangerous, severe pain or trapping requires immediate medical attention. Managing it involves conservative and surgical methods tailored to each patient to alleviate symptoms, prevent complications, and enhance quality of life.

In the first article of a two-part series, leading colorectal surgeon Mr Daniel Baird discusses the surgical options for umbilical hernias and answers any questions you may have about the condition.

What are the treatment options for an umbilical hernia?

An umbilical hernia is a hole in the fascia that presents as a bulge around the belly button. Most contain fat but bowel can also be present. If a hernia is causing symptoms then a day case surgical repair can be considered. Hernias larger than 1 cm commonly, but not always, a mesh will be required. If a hernia becomes trapped it is an emergency and you should seek immediate medical attention.

Conservative management

When the hernia is small and symptoms are minimal or absent, a conservative approach may be advised. This usually entails lifestyle adjustments, like refraining from heavy lifting or straining, staying at a healthy weight, and utilising supportive wear like trusses or belts. Regular evaluation and monitoring by a healthcare provider are beneficial to track any alterations in the hernia and the patient's symptoms.

Surgical management

Surgery proves to be an effective remedy for umbilical hernias, especially when symptoms are present or complications are possible. Typically, hernia repair is performed through an open operation, involving an incision near the hernia site, reinforcing the weakened abdominal wall with sutures. For larger hernias, mesh insertion aims to reduce recurrence rates. Most procedures can be completed as day cases, allowing patients to return home on the same day. The choice between surgical methods depends on factors like the patient's health and the hernia's size and type, with both approaches boasting high success rates and minimal recurrence.

Postoperative care

After hernia repair, patients receive oral pain medication to manage discomfort. They should slowly return to regular activities, avoiding heavy lifting and strenuous exercise for six weeks. Driving is permitted once the ability to perform an emergency stop is regained, with notification to the insurance company.  Management of umbilical hernias involves conservative methods and surgery, with surgery typically recommended for symptomatic or complex cases. The surgical technique choice depends on individual factors, and attentive postoperative care is essential for optimal recovery.

FAQ:

What are the risks of an operative hernia repair?

Umbilical hernia surgery is generally safe and well-tolerated, but like any surgical procedure, it carries some risks. It's important to note that the likelihood of complications varies among individuals and can be influenced by factors such the presence of other medical conditions and the specific surgical technique used.

The majority of patients do not suffer complications. However, the following complications may occur:

Pain: Some pain is to be expected after surgery. Oral painkillers will be used most patients will stop taking them between 2 and 14 days after the operation.

Infection: Infections at the surgical site are possible, though they are relatively uncommon. Antibiotics will be given on the day of surgery to minimise this risk.

Bleeding: Bleeding during or after surgery is a rare complication.

Haematoma: Accumulation of blood outside blood vessels (haematoma) at the surgical site may occur, leading to swelling and discomfort.

Seroma: A collection of clear fluid in the surgical area (seroma). In most cases, the body reabsorbs the fluid, but draining may be necessary in some instances.

Nerve damage: Nerves in the vicinity of the surgical site may be affected, leading to temporary or, in rare cases, persistent numbness, tingling, or pain.

Chronic pain: Some individuals may experience chronic pain at the site of the surgery. It is normal to have pain after the operation that should diminish with time. For some patients the pain will persist, but for most, it does not interrupt activities of daily living or quality of life. In rare circumstances, a patient may need to see a pain specialist for further treatments.

Recurrence: Despite the use of mesh to reinforce the repair, hernias can recur in a small number of cases. Recurrence rates are lower with mesh repairs compared to non-mesh repairs.

Mesh-related issues: Mesh related complications, such as migration, contraction, irritation or infection are rare but can occur. Advances in mesh technology aim to minimise these risks. A mesh does increase the risk of chronic pain and can occasionally become infected.

Urinary retention: Temporary difficulty in passing urine may occur, particularly in older male patients with pre-existing urinary issues.

Deep vein thrombosis (DVT) and pulmonary embolism (PE): Immobility during and after surgery may increase the risk of blood clot formation (DVT), which can potentially lead to a pulmonary embolism if a clot travels to the lungs. Early mobilisation, compression stocking and intraoperative calf massagers will be employed to reduce this risk.

Accidental visceral injuries: These events are very rare. Some hernias may contain internal organs such as bowel which can be injured.

When should I get my umbilical hernia repaired?

The decision on when to get an umbilical hernia repaired depends on several factors, including the severity of symptoms, the size and type of the hernia, and your overall health. I will make an assessment and discuss this with you in the outpatient clinic.

Symptoms and discomfort: If you are experiencing significant pain, discomfort, or other bothersome symptoms associated with the hernia, it may be an indication that surgical intervention is needed. Symptoms can include pain, a noticeable bulge, and difficulty with daily activities.

Size of the hernia: Larger hernias may be more likely to cause symptoms and may be considered for repair to prevent further enlargement or worsening of the symptoms. The larger a hernia is the higher the recurrence rate.

Complications: If the hernia becomes incarcerated (trapped outside the abdominal wall) or strangulated (blood supply to the trapped tissue is cut off), it is a medical emergency, and immediate surgical intervention is necessary.

Quality of life: If the hernia is affecting your quality of life, limiting your activities, or causing discomfort that is impacting your daily routine surgery in most patients will improve the issues.

Underlying health conditions: Your overall health plays a role in determining the timing of hernia repair. If you have other medical conditions that may increase the risks associated with surgery I will consider these factors when making recommendations.

It's crucial to have a thorough discussion with to assess your specific situation. A bespoke and personalised approach based on your medical history, the characteristics of the hernia, and your overall health will be made.

Remember that seeking medical advice promptly is essential, especially if you suspect complications such as incarceration or strangulation.

If you suspect you have a umbilical hernia and would like to book a consultation with Mr Baird, simply visit his Top Doctors profile today.