A hernia occurs when an
internal part of the body pushes through a weakness in the muscle or
surrounding tissue wall. An umbilical hernia appears as a
lump near the navel (bellybutton) that may get bigger when your child laughs,
coughs, cries or goes to the toilet. It may shrink when your child is relaxed
or lying down.
Umbilical hernias are very common
and affect 10% of infants and young children. They are especially common in
babies who are born prematurely. An umbilical hernia is not
painful. In 85% of cases, the umbilical hernia goes back in and the
muscles reseal before the child's first birthday.
During pregnancy, the umbilical
cord passes through an opening in the baby's abdominal wall. This opening
should close before birth, but in some cases the muscles do not seal
completely.
Schematic diagram showing an umbilical hernia.
This leaves a weak spot in the
surrounding muscle wall (abdominal wall). An umbilical hernia can develop when
fatty tissue or a part of the bowel pokes through into an area near the navel. Occasionally, an umbilical hernia
can develop in adults. The following factors make this more likely to happen:
- being overweight
- lifting heavy objects
- having a persistent cough
- having a multiple pregnancy.
If the umbilical hernia is large
or has not disappeared by the time the child reaches four years old, you may consider
an umbilical hernia repair. Your surgeon will usually advise
you to wait for your child to reach this age before considering an operation as
it is not an essential procedure unless there are complications.
In less than 1% of cases, the bit
of bowel can get stuck outside the abdomen. This can cause pain and vomiting,
and could damage your child's bowel. In these cases, immediate surgery will be
recommended to prevent bowel damage.
An umbilical hernia repair is a
routine and simple procedure to push the bulge back into place and strengthen
the abdominal wall. General anaesthetic will be used so that your child
does not feel any pain during the operation, which should take about 30
minutes. The weak spot is usually
closed with stitches, but if the hernia is large, mesh may be used to
strengthen the area. After the operation, the bulge will disappear and the
belly button should look normal.
When recovering from an umbilical
hernia repair, your child should be able to go home the same day but may feel a
bit sore and uncomfortable. They will need to limit their activity for a few
days and take time off school. Young children may be a bit tearful and sleepy,
but this is normal.
Complications from an umbilical
hernia repair are rare but can include:
- the wound becoming infected and needing
antibiotics
- the hernia returning
- feeling sick, a headache or numbness in the
legs a few hours after the operation.
If the hernia was large, some
excess skin may remain after the operation, but this will usually settle as
your child grows up.
Schematic diagram showing an umbilical hernia containing small bowel. Such hernias can cause bowel obstruction, perforation or ischaemia.
Surgical Repair
How it is
performed
Umbilical hernia repair is a fairly quick and
simple operation, and your child will usually be able to go home on the same
day. You will be asked to bring your
child into the day surgery (outpatients) section of the hospital and
not to give them food for four to six hours before. They can have water for up
to two hours before surgery.
At the hospital, you will meet
the nurse, anaesthetist (specialist who will put your child to sleep) and
surgeon. Your child will be given a general anaesthetic while you are
there. As soon as they are asleep, you can leave.
The surgeon makes a small cut
(2–3cm) at the base of your child's belly button, and pushes the fatty lump or
loop of bowel back into the abdomen. Muscle layers are stitched over
the weak spot in the wall of the abdomen to strengthen it. In some cases,
a mesh may be used to strengthen the area if the hernia was particularly large.
The wound on the surface of the
skin is closed with dissolvable stitches or special glue. Sometimes, a pressure
dressing is applied, which stays on for four to five days. The operation takes 20–30
minutes, but your child will be away from the ward for around one hour. You
will be taken to the recovery room as soon as your child wakes up, so you can
be with them on their way back to the ward.
Recovering
from surgery
Your child will not feel any pain while their
hernia is being repaired, but may feel sore and uncomfortable for a few days
afterwards. Local anaesthetic (which
numbs the area) will be injected before the end of the operation to reduce the
pain, and painkillers will also be given after the operation.
After the operation, your child
may be tearful and sleepy, and demand extra attention as a result of the
general anaesthetic. This is normal and will pass. Most children can go home a few
hours after surgery. They must have something to eat and drink first, and go to
the toilet. Your child may need to stay in hospital overnight for monitoring
if:
- they have other medical problems
- they vomit regularly after the operation and
cannot keep down any food or drink.
Your child may have bruising and
tenderness around the wound. This is normal and will settle within around seven
days. You can give them painkillers such as paracetamol and ibuprofen
(children under 16 must not be given aspirin). Try to keep the wound dry for
five to seven days. Your child can have a shower but they should avoid swimming
and bathing.
Loose clothing may help reduce
any discomfort your child has, but they should be able to wear trousers or a
skirt as normal. Most children naturally limit
their own activity for a few days until they feel comfortable and well.
You can keep your child off
school for five to seven days. This will give them time to recover from the
anaesthetic and from the operation. If your child is older, ask for
them to be excused from sports and games for at least two weeks after they
return to school.
Source: NHS Choices.
Source: NHS Choices.
