An umbilical hernia is a visible protrusion of the abdominal wall (skin and peritoneum) due to a defect or weakness of the tissues of the abdominal wall, or rather, the umbilical ring. In case of severe hernia, the internal organs, a part of the omentum and loops of the small intestine, fall into the pathological protrusion (hernial sac), which can result in pinching of these organs and tissue necrosis.
The umbilical hernia in a newborn is detected quite often – this pathology is diagnosed in every fifth child born on time, and in every third baby born prematurely.
In children of the first days of life, the minimum defect or weakness of the umbilical ring is found in almost every case, but this feature does not necessarily become a direct path to the hernia – with the development of the baby, muscular and connective tissue becomes stronger, and the ring becomes anatomically shaped.
True hernia is mainly detected in the first month of a small person’s life, but can be diagnosed later, for example, when the baby has already learned to walk.
Causes of umbilical hernia in children
In a child in the first minutes after birth, the umbilical cord is cut off, while the muscles surrounding the navel are contracting. The tied up part of the umbilical cord disappears 4-5 days after delivery, and the navel itself is the place where the umbilical cord was bandaged. Under the skin formation – the navel – is the muscle umbilical ring, which consists of the lower and upper parts.
In the lower part passes the urinary duct and umbilical artery. The tissues of the lower part of the umbilical ring are well reduced and form a dense scar tissue, not subject to defects. In the upper part of the ring, the umbilical vein passes, the walls do not have a muscular membrane and are thin, therefore they do not contract well later.
The tendency to the formation of a hernia in the navel in children laid by nature itself
In some cases, a hernia in children is caused by abnormalities in the development of the umbilical ring, which occurred during the period of intrauterine development.
Another factor in the occurrence of a hernia in the navel is the weakness of the peritoneal fascia and the cleft of the umbilical vein. Normally, the arteries and veins lose their function immediately after birth, the umbilical cord ligating causes anatomical collapse of the vessels and their fusion. Non-overgrowth of the umbilical vein can be caused by anatomical features, as well as occur due to poorly tied umbilical cord, for example, at home birth.
An important factor leading to the occurrence of this pathology in children is the often repeated increase in intra-abdominal pressure. There are many reasons for this – frequent crying and crying of a child, increased gas formation, constipation.
The leading cause of hernia in the navel is a hereditary predisposition, expressed in the natural weakness of the muscle tissue of the anterior abdominal wall. Often these kids initially have a reduced muscle tone. If the parents of the baby in childhood suffered an umbilical hernia, the probability of the development of this pathology in the child itself is 70%.
Symptoms of umbilical hernia
The umbilical hernia can manifest itself immediately after the fall of the umbilical cord. Many parents pay attention to this feature – the baby’s navel sticks one or two centimeters farther than the belly line, and immediately go to the doctors. In many cases, this symptom is false and only indicates the anatomical features of the navel. But the fact that the pediatrician should seem is a definite recommendation.
The initial manifestation of hernial protrusion often occurs with a strong crying and crying of the child, during a coughing fit, with constipation. A number of diseases, such as hypotrophy, hypotension, rickets in an infant (signs), create a favorable basis for the formation of a hernia at the navel, because they reduce the tone of the muscular system.
The external manifestation of an umbilical hernia is a protrusion of a rounded or oval shape the size of a cherry stone in the ring area, which is easily retracted back into the abdominal cavity. Due to the weakness of the muscle tissue of the anterior abdominal wall, the hernial protrusion may be accompanied by divergence of the rectus abdominis muscles.
The contents of a hernial protrusion or sac are usually intestinal loops. With a wide umbilical ring, as well as a significant amount of hernia, intestinal peristalsis can be seen externally – contraction of the intestine and the promotion of food masses along it.
Such a picture can greatly frighten parents, but the child at such moments does not feel pain or any discomfort. The size of the hernial protrusion is directly dependent on the size of the umbilical ring – the formation of a special shape surrounding the navel.
With a small ring size, a hernia only occasionally appears during a strong crying or anxiety of the child. In the presence of a large-sized ring, there is a constant swelling of the umbilical region, which tends to increase visually during crying and tension.
Hernia can increase significantly in size over a couple of months. Diagnosis of small hernias is carried out with the help of palpation – the doctor presses the baby’s navel so that the finger falls slightly into the abdominal cavity. This method allows you to reliably determine the exact size of the umbilical ring and detect the edges of the hernia gate.
Hernia rarely causes pain or discomfort to the child – it can spontaneously appear and subside, or be set off with the help of a light pressure on the hernial sac. If the defect is minor, but it has hard edges – the child can be restless, cry for a long time, thereby aggravating the pathological process.
Infringement of the contents of the umbilical hernia, especially in young children, is extremely rare. However, the hernia does not pass unnoticed – such children are more restless, meteosensitive, and also are more sensitive to any changes in their environment. Hernia itself does not cause pain, but due to increased gas formation provokes intestinal colic. Untreated umbilical hernia is also a cosmetic defect, traumatic psyche of the child.
Umbilical hernia treatment
Proper development of the child, restoration of intestinal function, physical activity, implementation of the doctor’s recommendations to strengthen the abdominal wall of the child often lead to self-healing of the hernia, and this probability is high for hernias up to one and a half centimeters in diameter.
In most cases, the identified umbilical hernia in newborns is chosen expectant treatment tactics. Spontaneous closure of small hernias (about 1.5 cm) occurs by 3-5 years. If this does not happen, surgical treatment may be prescribed. Most operations are performed at the age of 6 years; earlier surgical care is possible with the development of complications such as pinching of the hernia and the rapid progression of the pathological process.
Hernias larger than 1.5 cm in diameter rarely grow independently. In this case, it is possible to perform the operation earlier at the age of 3-4 years. Conservative therapy of umbilical hernia at the same time is the prevention of the development of this pathology and will not harm any child:
- Laying baby on belly
Every day, 10-15 minutes before the next feeding, it is recommended to lay out the baby on the stomach, on a flat and fairly hard surface – a table covered with a diaper, a changing table. This procedure can be carried out literally from the second week of life, 2-3 times a day. During the period when the baby is in position on the tummy, it reflexes the muscles reflexively, which helps to strengthen the tissues of the umbilical ring. In addition, the muscles of the back and neck are strengthened, intestinal peristalsis and the process of natural discharge of gases are activated. While laying out should be next to the baby and not leave him alone.
Massage for umbilical hernia in a newborn can begin after scarring of the umbilical wound. The main rule is not to overdo it, to avoid oppressive and intensive movements. Initially, it is enough to make three or four gentle stroking movements with a palm along the front of the baby’s tummy. Movement should be extremely soft, equal in intensity. For older children, movements are added that train the rectus abdominis muscles: the straight and index finger are placed 1-2 cm from the central part of the navel and make ten strokes with small and point movements. Then do the same, placing the fingers above and below the navel. This massage is done 2-3 times daily before feeding, gently, without causing discomfort to the child.
- Imposing a defect on the adhesive bandage
A special adhesive bandage is applied by a medical professional for a ten-day period. A special technique of dressing provides fixation of the rectus abdominis muscles over the umbilical ring. In the absence of the effect of the primary application of the patch, the procedure is repeated two more times. There is a method of applying a patch for an umbilical hernia in a child without the formation of a fold, with a mandatory replacement of the patch in 2-3 days. This method is softer, the parents themselves can change the plaster. This technique is permissible only in the absence of skin reactions and inflammatory elements.
- General massage and highly specialized therapeutic exercise
This conservative treatment is carried out by massage therapists and exercise therapy doctors. Treatment can be done already from one month of age. General massage strengthens the child’s muscular corset, while special exercises train the abdominal muscles and strengthen the umbilical ring. With the growth of the child introduced new exercises. Repeating treatment techniques on their own should not, because you can harm your child. Only an expert individually selects the duration of events, their load and the necessary multiplicity.
Surgical treatment of hernia is carried out in the presence of indications – large hernia, the lack of therapeutic effect from a comprehensive conservative treatment during the first five years of life, the danger of pinching and pinching. Indications for the operation to remove the umbilical hernia in children:
- The child has complications of a hernia, such as introducing an infection or tearing tissue
- The child is 5 years old, and the hernia is not prolonged
- Hernia growth progression after 6 months
- The child is 2 years old, and the size of the hernia is more than 1.5 cm
- The doctor is concerned about the appearance of the hernia
Parents are always afraid of surgery. However, this surgical operation is quite simple, it is performed quickly within 15-20 minutes and, as a rule, without complications. During surgery, the defect of the umbilical ring is sutured. However, any surgeon, making decisions about the need for surgical treatment, has a good reason for this intervention. Untreated hernias with age transform into a large hernial formation, prone to stinging and regular relapses. Therefore, the question of the treatment of hernia, including operative, should be closed before the time of the start of school.