Umbilical hernia? Don’t worry, it’s curable
We had just been introduced to each other and were now having tea. ‘Ah, so you are a doctor! I have a concern that has been disturbing my mind.’ I sat up and listened. This is a common line and quite frankly, as a doctor, I enjoy it, even in a social setting.
It reminds me of my role in society. ‘My angel has this thing,’ she pointed at her child’s belly button, ‘I also have it but I don’t like it. It stopped me from putting on the fashionable ‘tumbo’ cuts when I was growing up. Is there something that can be done about it?’
‘Ah, that is called an umbilical hernia. Don’t worry about it. If it is not getting bigger or painful, let it be. Most of them disappear by three years of age,’ I explained. And that was enough to draw a smile on her face.
So, what is a hernia? This happens when an internal organ or its covering protrudes through the wall of the cavity that contains it. Body cavities include the thorax that contains the lungs, heart and other organs. And the abdomen that contains the stomach, liver and small and large intestines, among other organs.
An abdominal hernia will, therefore, be the protrusion of organs found in the abdomen, most commonly, the small intestines through the abdominal wall. It may occur at several areas of weakness of the abdominal wall; at the belly button, around the belly button, at the groin region and in men it may extend to the scrotum. If it occurs at the belly button, it is called an umbilical hernia.
Children are born with the hernia, but it may also be found in adults who develop it later in life. The tendency to a have a congenital umbilical hernia runs within families and it is common in African children, with equal occurrence in both boys and girls. The belly button/nevus/umbilicus is the region where the umbilical cord joins the baby to the mother. While developing in the womb, a foetus’ organs are first formed out of the abdomen and then migrate into the cavity.
The point of entrance is at the umbilicus. Although in many people it seals well by the time of delivery, in some it leaves an area of weakness through which internal organs may protrude. Thus, one sees the characteristic bulge.
Generally, umbilical hernias are not repaired. They disappear by the time the child is three years. However, it is good to let it be assessed by a doctor. If it is too big, or if it has a very small neck (the ring on the wall through which the contents bulge out), or if it is increasing in size or becoming painful, it should be rectified through surgery.
Sometimes, the protrusion is too large and the neck too small. This will squeeze the contents of the hernia and cut off the blood supply. The hernia swells, is painful and may change colour. Immediate surgery is required in such a case.
The surgery involves opening the wall and stitching the area of weakness, or, a more advanced and successful method, putting a mesh over the area of weakness. Better still, a laparoscopic method may be used (this is minimally invasive surgery). This entails use of instruments outside the skin to indirectly observe the problematic area.
Unless in case of an emergency, most doctors prefer to postpone the surgery until the child is three years old. Traditionally, mothers used to put a coin over the hernia and tape it. This has proved to be of no benefit and may in fact harm the child if any contents of the hernia are stuck between the coin and skin.
Did you know that some communities found an umbilical hernia beautiful? They would decorate it with beads and paint around it. That coupled with a gap (mwanya in Kiswahili) between the incisor teeth, was the hallmark of a beauty queen….So, don’t be shy about your hernia.
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