Umbilical Hernia

Overview of Umbilical Hernia

• The term can be applied to protrusion of a muscle through its fascial covering or of brain through fracture of skull or through foramen magnum into the spinal canal. But by far the commonest variety of hernia is protrusion of a viscus or a part of it through the abdominal wall. Of the abdominal herniae the common varieties are inguinal, femoral, umbilical, incisional and epigastric, while the rare varieties are obturator, lumbar, gluteal and Spigelian.[2] 

Epidemiology of Umbilical Hernia

Causes of Umbilical Hernia

• Straining.
• Lifting of heavy weight.
• Chronic cough (tuberculosis, chronic bronchitis, bronchial asthma, emphysema).
• Chronic constipation (habitual, rectal stricture).
• Appendicectomy.[1]

Types

Four definite varieties are seen: 

1)Exomphalos.  

• Abdominal contents are protruded into the umbilical cord being covered by a transparent membrane.

2) Congenital umbilical hernia.

• This hernia comes out through the centre of a congenital weak umbilical scar. It generally appears in the first few months after birth.

3) Acquired umbilical hernia.

• This hernia occurs in adult life and protrudes through the umbilical scar.

4) Para-umbilical hernia.

• It is the commonest acquired umbilical hernia. It occurs through a defect adjacent to the umbilicus. [2]

Risk Factor

• Old age: BPH, carcinoma prostate. 
• Young age: stricture urethra. 
• Very young age: phimosis, meatal stenosis. 
• Obesity.
• Pregnancy and pelvic anatomy (especially in femoral hernia in females).
• Smoking.[1]

Pathogenesis

Pathophysiology of Umbilical Hernia

Clinical Features 

• Presents with a swelling in the umbilical region within first few months after birth, the size increases during crying. It is hemispherical in shape.
• Defect can be felt with finger during crying
• Occasionally it can go for irreducibility and obstruction which presents with pain, distension, vomiting. 
• It presents as a swelling which has smooth surface, distinct edges, soft, resonant with dragging pain and impulse on coughing. Large hernias can present with intestinal colic due to subacute intestinal obstruction. Eventually strangulation can occur (Paraumbilical Hernia). [1] 

Sign & Symptoms of Umbilical Hernia

A) Pain. –

• In the beginning when there is a ‘tendency to hernia’ the patient complains of a dragging and aching type of pain which gets worse as the day passes.
• Pain may appear long before the lump is noticed. It continues so long as the hernia is progressing but ceases when it is fully formed.
• When the hernia becomes very painful and tender, it is probably strangulated.
• At this time the patient may complain of pain all over the abdomen due to drag on the mesentery or omentum.

B)Lump. –

• Many herniae may cause no pain and the patient presents because he noticed a swelling in the groin. But this is very rare and some sort of discomfort is almost always present.[2] 

Clinical Examination

Position of the patient. – 

Patient is first examined in the standing position and then in the supine position. 

INSPECTION. – 

1. Swelling, note for

•  Size & Shape.
• Position and Extent.
•  Visible peristalsis. 

2. Skin over the swelling.
3. Impulse on coughing.

PALPATION. – 

1. Position and Extent.
2. To get above the Swelling.
3. Consistency.
4. Relation of the swelling to the testis and spermatic cord.
5. Impulse on coughing.
6. Is the swelling reducible?
7. Invagination test.

PERCUSSION. – 

• A resonant note over a hernia means it contains intestine (enterocele). Whereas if the note is dull it contains omentum or extraperitoneal fatty tissue. [2] 

Diagnosis

CONGENITAL UMBILICAL HERNIA

(i) Bulge through the center of the umbilical scar everting the whole umbilicus 

(ii) Age of the patient 

(iii) The swelling is easily reducible (spontaneously reduced when the child lies down) and there is definite impulse on crying 

(iv) The size of the hernia varies — it may be a small defect admitting the tip of the little finger alone to quite a large opening admitting two or three fingers 

(v) The content is usually small intestine, so resonant to percussion. 

PARAUMBILICAL HERNIA

(i) Para-umbilical hernia develops in the middle and old age. 

(ii) Women with heavy weights are more commonly affected. 

(iii) Usual symptoms are pain and swelling. If the swelling is very small, it may not be noticed by the patient and the pain and discomfort become the main symptoms. 

(iv) The surface is smooth, and the edge is distinct except when the patient is very fat. 

(v) It contains omentum or bowel. The lump is firm when it contains omentum. The lump is soft and resonant to percussion when the content is bowel. 

(vi) Many paraumbilical herniae are irreducible when the contents become adherent to the sac or the neck of the sac becomes narrow. If the hernia can be reduced, the firm fibrous edge of the defect in the linea alba can be felt. 

(vii) As the defect in the linea alba is firm and does not enlarge proportionately these herniae do give rise to intermittent abdominal pain, though strangulation is not common.[2] 

Differential Diagnosis 

• Benign lymph node metastasis 
• Epididiymo orchitis 
• Epididymal cyst 
• Epididymitis 
• Hydrocele 
• Lymphadenopathy 
• Spermaotocoele 
• Testicular malignancy[5] 

Complications

Investigations of Umbilical Hernia

1. Routine investigations such as complete blood picture (CBP) and urine examination are done. In old aged patients, chest X-ray, electrocardiography or even pulmonary function tests may be necessary. Patients with urinary complaints are evaluated for prostatic enlargement and stricture urethra.
2. Ultrasound: Hernia is a clinical diagnosis. In the vast majority of the cases, no investigations are required specific to the diagnosis of hernia. However, in appropriate cases imaging can be done.
3. Computed tomography (CT) scan is ideal in cases of giant hernias, or special types such as obturator hernia, perinea! hernia, etc.
4. Magnetic resonance imaging (MRI): Ideal in sportsmen who complain of groin pain, to detect hernia or to rule out muscle sprain or any other orthopaedic disorders.[3]

Treatment

About 90% of Congenital Umbilical hernias disappear spontaneously during the first 5 years of life as the umbilical scar thickens and contracts. [2] 

1. Reduction of weight 
2. Anatomical repair
3. Most favoured surgery for umbilical hernia is mesh repair. It is a tensionless repair. It can also be done by laparoscopic method which is popular today.
4. Mayo’s repair [3]

Prevention of Umbilical Hernia

• Avoid Straining. 
• Avoid lifting of heavy weight. 
• Avoid any unnecessary activities that put pressure on abdomen.[5]

Homeopathic Treatment of UMBILICAL HERNIA 

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis. 

Which includes 

• The medical history of the patient, 
• Physical and mental constitution, 
• Family history, 
• Presenting symptoms, 
• Underlying pathology, 
• Possible causative factors etc. 

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions. 

What Homoeopathic doctors do? 

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’? 

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. Now a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition. 

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improve with homeopathic medicines. 

Homeopathic Medicines for Umbilical Hernia: 

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor. 

So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).  

Medicines  

Aconite. 

–When inflammation has commenced in the strangulated bowels. Soreness, burning and heat in affected part. Extreme sensitiveness to contact. 

Aur-met. 

Protrusion of inguinal hernia, sometimes with cramp-like pains. Inguinal and umbilical hernia of children caused by crying.  

Bell.

“Soon after strangulation which is caused by spasmodic action of the muscular fibres and before inflammation has set in”. 

Lyco.

Esp. indicated in hernia of right side.  

Nux-v.-

• • Strangulated hernia.
  • Sudden violent pain in hernial region.
  • It is a valuable remedy for inguinal and umbilical hernia.
  • When there is a feeling of weakness in abdomen, particularly in region of inguinal canal, in morning on rising.
  • Slow protrusion (Coccul.) in aged persons. Left side mostly affected. 

Rhus-t.

When caused by straining or lifting heavy weight. Efficacious in hernia of recent occurrence.
 

Borax.

–Infantile hernia. Child dreads downward motion, has anxious countenance when carried downstairs. Easily frightened. 

Calc-c.

Infantile hernia. Rachitic children; big-bellied; perspire about head when sleeping.  

Nux-m.

In umbilical hernia, abdomen enormously enlarged, Cutting pains about navel, better from pressure. Dry mouth without thirst.[4] 

Diet & Regimen

For Umbilibal Hernia 

Diet for Umbilical Hernia:

The primary goals are to prevent constipation and strain, maintain a healthy weight, and support tissue repair.

Fruits: Apples, berries, pears, oranges

• • Vegetables: Broccoli, carrots, spinach, sweet potatoes
  • Whole grains: Brown rice, quinoa, whole wheat bread, oats
     
    High-fiber foods: Prioritize whole grains, fruits, and vegetables. Fiber adds bulk to stool, making it easier to pass and reducing pressure on the abdominal muscles. Good choices include
• Healthy fats: In moderation, include sources like:
  • Avocado
  • Nuts and seeds 
     
  • Olive oil
• Hydration: Drink plenty of water throughout the day to keep things moving smoothly in your digestive system.
   

Foods to Limit or Avoid:

• Processed foods: High in unhealthy fats and low in nutrients.   
   
• Sugary drinks: Can contribute to weight gain and offer little nutritional value.
   
• Red meat: Choose leaner options and consume in moderation.
• Fried foods: Difficult to digest and can contribute to weight gain.
• Foods that cause gas and bloating: These can increase abdominal pressure. Common culprits include beans, lentils, broccoli, and carbonated drinks. 
   

Regimen for Umbilical Hernia:

• Weight management: Maintaining a healthy weight reduces pressure on the abdomen.
   
• Exercise: Gentle exercises like walking can improve core strength and overall health. Avoid heavy lifting or exercises that strain the abdominal muscles.
   
• Proper lifting technique: If you must lift something, bend your knees and keep your back straight to avoid straining your abdomen.
   
• Quit smoking: Smoking weakens connective tissue and can impair healing.   
   
• Manage constipation: Use stool softeners if needed and avoid straining during bowel movements

Do’s & Don’ts

Umbilical Hernia Do’s & Don’t 

Terminology 

References 

1. SRB’s Manual of Surgery 3rd Edition 
2. A Manual on Clinical Surgery by S.Das 9th Edition 
3. Manipal Manual of Surgery 4th Edition 
4. The Homoeopathic Prescriber By K. C. Bhanja 
5. Umbilical Hernia – StatPearls – NCBI Bookshelf (nih.gov) 
6. Diet Tips for Hernia Patients – Pristyn Care
7. Sharma HV, Rasool I, Gupta RK, Afeeh A, Khajuria A. Umbilical hernia in pediatric patients attending outpatient department in tertiary care centre. Int J Contemp Pediatr. 2024;11(9):3580-4. (2024).
8. Schwartz’s Principles of Surgery
   Edition: 11th Edition
   Writer: F. Charles Brunicardi, et al.
   (2019),Publication: McGraw-Hill Education.
9. Sabiston Textbook of Surgery
   Edition: 21st Edition
   Writer: Courtney M. Townsend, Jr., et al. (2022),Publication: Elsevier.
10. CURRENT Diagnosis & Treatment: Surgery
    Edition: 15th Edition
    Writer: Gerard M. Doherty
    (2023),Publication: McGraw Hill Professional

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