Umbilical Hernia

Umbilical Hernia

When a weakness in the abdominal muscles in the area of the belly button (umbilicus) allow abdominal tissues and/or organs to protrude, this is referred to as an umbilical hernia. Umbilical hernias typically occur in babies, especially newborns who have low birth weight or who were born prematurely. However, umbilical hernias can also occur in adults.  

Symptoms of Umbilical Hernia

In newborns, an umbilical hernia may become noticeable when the baby:  

  • Cries
  • Strains while making a bowel movement
  • Coughs  

Adults may experience more severe symptoms, such as:  

  • A noticeable bulge in the abdomen that gets bigger when coughing or straining
  • Pain at the area of the bulge  

Contact a doctor if the bulge is red, hardened, swollen, and/or extremely painful. Vomiting and/or constipation may be signs of a more serious condition called strangulated umbilical hernia. This occurs when the intestine has significantly protruded into the bulge and blood circulation is restricted. Strangulated umbilical hernias may need immediate medical attention.  

Causes of Umbilical Hernia

The umbilical cord is connected to the baby through a small opening in the abdomen and transfers nutrients from the mother to the fetus during pregnancy. After birth, the umbilical cord is disconnected and the abdomen begins to heal. Sometimes, the abdominal wall does not heal completely and a gap is left in the abdominal wall. This gap places the child at risk of developing an umbilical hernia.  

In adults, umbilical hernias can develop due to:  

  • Straining during childbirth
  • Obesity
  • Intense vomiting
  • Chronic constipation  
  • Persistent, severe coughing ●
  • Frequent pregnancies

What to Expect at Your Appointment

During your baby’s appointment, your doctor will press on the abdomen and observe the behavior of the bulge. He/she will ask you questions about the symptoms you have noticed in your child.  

For adult patients, your doctor will ask you questions about your symptoms and will perform a physical examination.

In order to make a definitive diagnosis and assess the severity of the hernia, your doctor may prescribe one of the following diagnostic techniques:  

  • MRI scan
  • CT scan
  • Ultrasound imaging  

Additionally, your doctor may want to check for signs of infection by prescribing a blood test or a urine test.

Non-surgical Treatments for Umbilical Hernia

Roughly 90 percent of cases of newborn umbilical hernias will heal on their own, before the age of five. If the hernia does not heal by the age of four, it is important to schedule an evaluation. This may indicate the need for surgical intervention. In adult cases of umbilical hernia, surgical intervention is required to repair the hernia.

Surgical Treatment for Umbilical Hernia and Post-Treatment

Open repair is typically recommended for umbilical hernias. During open umbilical hernia repair, the surgeon will make an incision at the belly button, gently push the protruding tissues to their natural position, and stitch the opening closed. In adults, surgeons may reinforce the abdominal muscles with mesh.  

This procedure typically takes about one hour and patients can usually go home the same day of the procedure, depending on their overall health and the complexity of the surgery. Adults can generally return to work within two to three days, but should avoid strenuous activities for as long as four to six weeks following surgery.  

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Minimally Invasive Gynecologic Surgery: Know Your Options

The Modern Landscape of Gynecologic Surgery

New surgical techniques and technologies are rapidly changing the outlook for women with gynecologic disorders, giving them faster, easier and better solutions to persistent problems. In fact, nearly every major condition that once required open abdominal surgery can now be treated with a less invasive approach.

Gone are the days when a woman with fibroids, for instance, had only two choices: Continue to suffer the consequences or surrender her uterus. Even most large fibroids can now be removed minimally invasively, resulting in shorter hospital stays, less pain, and reduced complications like post-procedure bleeding, infection or clots.  For women who also wish to preserve their fertility, today’s newer options are the perfect solution.  

“We have a variety of approaches to myomectomy—removing fibroids while leaving the uterus intact—at our fingertips,” says James Robinson, MD, director of Minimally Invasive Gynecologic Surgery at MedStar Washington Hospital Center.  “That includes laparoscopic surgery, which uses one or two tiny incisions, robotic-assisted laparoscopic surgery and, in some cases, the even less invasive hysteroscopic approach, which doesn’t involve any cutting of the abdomen at all since we reach the fibroids entirely through the cervix.”

Patients are up and about shortly after the minimally invasive procedures, with many going home the same day.

Tune in to the full podcast with Dr. James Robinson.

Endometriosis - Light At The End of the Tunnel

The outlook is equally good for women with endometriosis, the often painful condition in which tissue that normally lines the uterus somehow migrates beyond the organ’s walls, attaching to other pelvic structures.  

“Endometriosis has the potential to wreak havoc on the reproductive organs, including diminishing a woman’s ability to conceive, through scarring, blocking the fallopian tubes, and even matting organs together,” Dr. Robinson explains. “Many women also experience abnormal bleeding and chronic, often debilitating pain. In the worst cases, endometriosis can sometimes affect every organ in the pelvis, including the rectum, bladder, and ureters.”

Depending upon the extent of the damage, surgeons often must restore the anatomy of the bowel and bladder in addition to removing the errant endometrial tissue, requiring a high degree of expertise. Despite the complexity, Dr. Robinson reports that even severe cases can be treated with laparoscopic or robotic-assisted methods.

Perhaps some of today’s most dramatic changes involve hysterectomies. Nearly 100 percent of the procedures can now be accomplished with minimally invasive techniques, avoiding many of the complications associated with older approaches.    

“With today’s newer techniques, we don’t sever the ligaments that help support the pelvic floor,” Dr. Robinson explains. “As a result, women are much less likely to develop pelvic organ prolapse, one of the leading causes of female urinary incontinence.”

Ovaries, Fallopian Tubes, and Longterm Impact on Women's Health

Recent research has also shed light on the influence of the ovaries and fallopian tubes upon a woman’s overall health, positive or negative.

“We now know that ovaries fulfill a function well past the child-bearing years, affecting everything from a woman’s heart and bones to her skin and memory,” Dr. Robinson says. “Left in place, ovaries can even contribute to a longer life. So it’s often important to preserve them during a hysterectomy, even for a post-menopausal woman.”

Conversely, the fallopian tubes are now routinely removed during a hysterectomy to reduce the lifetime risk of ovarian cancer. With few symptoms, ovarian cancer is often not detected until it is advanced, making it the fifth most common cancer among women and one of the deadliest.

Despite the progress, Dr. Robinson is concerned that not all women are benefitting from the better, easier and safer techniques.

“I often find myself talking to a woman out of a larger surgery that I don’t think she needs,” he says, noting that not every Ob/Gyn is up-to-date on the latest minimally invasive procedures. “I urge every woman to do her own research in advance, and know what her options are before making a decision.” 

Listen to Dr. Robinson's full podcast here.